Sleep Disorders Flashcards
What is sleep-onset insomnia?
difficulty initiating sleep
What is sleep-maintence insomnia?
early-morning awakenings with inability to return to sleep
What are the classifications of insomnia?
-transient: less than a week, self-limiting
-short term: 1-3 weeks
-long term (chronic): > 3 weeks
What are the common contributing factors for insomnia?
-situational (interpersonal conflicts, work/financial stress, jet lag)
-medical (CV, respiratory, pain, endocrine disorders (DM, hyperthyroidism), GI, neurological disorders, pregnancy)
-psychiatric (mood disorders, anxiety, substance abuse)
-medications (seizure meds, diuretics, SSRIs, corticosteroids, stimulants, decongestants)
What is the MOA of benzodiazepines?
binding to GABA complex in neuron membranes, potentiates GABA resulting in a sedative hypnotic effect
What is the indication for benzodiazepines?
sleep onset insomnia and sleep maintenance insomnia
except: triazolam is only indicated for sleep onset
Which benzodiazepine(s) are long acting?
flurazepam (t1/2= >100h)and quazepam (t1/2= 39-73h)
Which benzodiazepine(s) are intermediate acting?
temazepam (t1/2= 3.5-18h) and estazolam (t1/2= 10-24h)
Which benzodiazepine(s) are short-acting?
triazolam (t1/2= 1.5-5.5h)
What are the adverse effects of benzodiazepines?
-CNS depressant
-complex sleep-related behaviors (like sleeping walking)
-anterograde amnesia
-increased risk of falls and hip fractures
-long term use can cause withdrawal with discontinuation or disturbed sleep
What is the MOA of benzodiazepine receptor agonist?
only has activity at BZD-1 receptor which produces its sedative and hypnotic effects
What is the duration of action of benzodiazepine receptor agonists?
all are short acting!
What is the treatment timeline for zolpidem?
approved for short term use, not to exceed 4 weeks to avoid tolerance and drowsiness
Which drugs can be used for insomnia following middle of the night awakenings?
zolpidem sublingual or zaleplon
Describe: Eszopiclone
nonbenzodiazepine approved for sleep onset insomnia and sleep maintenance insomnia
What is the MOA of melatonin receptor agonist?
selective agonist of MT1 and MT2 receptors
What is the indication of Ramelteon (melatonin receptor agonist)?
sleep onset insomnia
What is the MOA of orexin antagonist?
blocks the neuropeptides orexin A/B to receptor OX1R/OX2R
What is the indication for orexin antagonists?
sleep onset insomnia and sleep maintenance
What antidepressant is approved for sleep maintenance insomnia?
low dose doxepin
What drug is often used for insomnia in the elderly?
mirtazapine
