Sleep disorders Flashcards
What is the first stage of sleep?
Transition phase between wakefulness and sleep
What is the second stage of sleep?
True sleep onset, 50% of total sleep is spent in stage 2
Can be easily aroused
What is the second and third stage of sleep?
Collectively = slow wave (delta) or deep sleep
restorative sleep stages that occur during deepest stages of sleep
What is a primary sleep disorder?
Causes sleeplessness or excessive daytime sleepiness
Categories:
- originating within the body
- those caused by external factors
- Those in which the timing of sleep phase is abnormal (circadian sleep-wake rhythm disorders)
What is a secondary sleep disorder?
Sleep disorder associated with medical, neurological, or psychiatric disorders wherein sleep is a major factor
What is a proposed sleep disorder?
A condition in which there is a need for further evaluation before each can be convincingly viewed as a disorder in its own right
Outline the 4 circadian rhythm sleep disorders (CRSDs)
Delayed sleep phase syndrome
- delayed bedtime and wake times (sleep late, wake up late)
Advanced sleep phase syndrome
- advanced bedtime and wake times (sleep early, wake early)
Non-24-h sleep-wake cycle
- free running rhythm
Jet lag
- severity of sx depends on number of time zones travelled
What is insomnia?
Characterised by complaints of disturbed sleep even though there has been adequate opportunity to sleep
Sx = difficulty falling asleep, difficulty maintaining sleep, early wakenings
What is chronic insomnia?
Difficulty initiating or maintaining sleep for at least three nights per week with associated daytime impairment for a duration of at least three months
What is the management approach for sleep disorders?
1) modify poor sleep practices, optimise management of comorbidities and/or change the use of problematic substances or medicines
2) Behavioural and cognitive therapies for insomnia
3) Drug therapy
What are some non-drug therapies for sleep disorders?
Cognitive therapy - techniques identify and change distorted thoughts
Stimulus control - suitable for people who have difficulty falling asleep
Sleep restriction - for those with difficulty staying asleep
Relaxation training - for those who cannot wind down
What is the general rule for pharmacotherapy in sleep disorders?
Use lowest effective dose for the shortest possible time
Preferably intermittently 2-5 nights per week for less than 2 weeks
What are the classes of drugs used for sleep disorders?
Benzodiazepines
Non Benzodiazepines (Z drugs)
Antihistamines
Chloral hydrate
Melatonin
What sleep medications should be avoided in the elderly?
Esp >60 y/o - Benzos - inc sedation, unsteadiness, memory loss
Use of long acting Benzos should be avoided (diazepam, flunitrazepam, nitrazepam) - inc sedation and accumulation
What is the general rule for weaning off of long-term benzos?
Dose reduction of 10-20% over 8-12 weeks or longer
What are the first line agents for sleep?
Temazepam
Zolpidem MR
Zolpidem immediate release
Zopiclone
What are the second and third line agents for sleep?
Melatonin MR
Melatonin IR
suvorexant
Outline the steps for the STOP guide for ceasing long-term hypnotics
S - Share views and agree on stopping plan
T - taper dosage gradually on an individual basis
O - ongoing review and use of non-drug therapies
P - provide support and reassurance
If someone has used hypnotics for >4-6 months it is appropriate to continue hypnotics for insomnia if….?
They are sleeping well and no ADRs
They are aware that they may be unintentionally dependent
Attempts to stop tx are refused of unsuccessful
When is melatonin most useful for insomnia?
Prolonged release - short term use (up to 13 weeks)
Primary insomnia characterised by poor quality sleep in >55 years of age
Does not cause impaired daytime alertness, dependence, w/drawal or rebound insomnia
During what phase of the sleep cycle does suvorexant work best to maintain?
Effective in maintaining sleep rather than initiating
What are some precautions and ADRs for suvorexant use?
Cyp interactions
Be cautious with its use in COPD and sleep apnea
ADRs:
- headache, somnolence
- Dizziness, paralysis, hallucinations in sleep, sleep walking, suicidal ideations
Why are sedating antihistamines not the best for treating sleep disorders?
Diphenydramine, doxylamine, promethazine
Develop tolerance quick
Cause daytime sedation, delirium, cognitive impairment, anticholinergic effects
