Sleep Disorders

Question 1

What is sleep-onset insomnia?

Answer 1

difficulty initiating sleep

Question 2

What is sleep-maintence insomnia?

Answer 2

early-morning awakenings with inability to return to sleep

Question 3

What are the classifications of insomnia?

Answer 3

-transient: less than a week, self-limiting
-short term: 1-3 weeks
-long term (chronic): > 3 weeks

Question 4

What are the common contributing factors for insomnia?

Answer 4

-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)

Question 5

What is the MOA of benzodiazepines?

Answer 5

binding to GABA complex in neuron membranes, potentiates GABA resulting in a sedative hypnotic effect

Question 6

What is the indication for benzodiazepines?

Answer 6

sleep onset insomnia and sleep maintenance insomnia
except: triazolam is only indicated for sleep onset

Question 7

Which benzodiazepine(s) are long acting?

Answer 7

flurazepam (t1/2= >100h)and quazepam (t1/2= 39-73h)

Question 8

Which benzodiazepine(s) are intermediate acting?

Answer 8

temazepam (t1/2= 3.5-18h) and estazolam (t1/2= 10-24h)

Question 9

Which benzodiazepine(s) are short-acting?

Answer 9

triazolam (t1/2= 1.5-5.5h)

Question 10

What are the adverse effects of benzodiazepines?

Answer 10

-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

Question 11

What is the MOA of benzodiazepine receptor agonist?

Answer 11

only has activity at BZD-1 receptor which produces its sedative and hypnotic effects

Question 12

What is the duration of action of benzodiazepine receptor agonists?

Answer 12

all are short acting!

Question 13

What is the treatment timeline for zolpidem?

Answer 13

approved for short term use, not to exceed 4 weeks to avoid tolerance and drowsiness

Question 14

Which drugs can be used for insomnia following middle of the night awakenings?

Answer 14

zolpidem sublingual or zaleplon

Question 15

Describe: Eszopiclone

Answer 15

nonbenzodiazepine approved for sleep onset insomnia and sleep maintenance insomnia

Question 16

What is the MOA of melatonin receptor agonist?

Answer 16

selective agonist of MT1 and MT2 receptors

Question 17

What is the indication of Ramelteon (melatonin receptor agonist)?

Answer 17

sleep onset insomnia

Question 18

What is the MOA of orexin antagonist?

Answer 18

blocks the neuropeptides orexin A/B to receptor OX1R/OX2R

Question 19

What is the indication for orexin antagonists?

Answer 19

sleep onset insomnia and sleep maintenance

Question 20

What antidepressant is approved for sleep maintenance insomnia?

Answer 20

low dose doxepin

Question 21

What drug is often used for insomnia in the elderly?

Answer 21

mirtazapine