Sleep disorders

Question 1

Insomnia causes

Answer 1

• Pain at night – optimise analgesics with sedative side effects
• Nocturnal urinary frequency e.g. peripheral oedema, prostatism, polyuria
• Comorbidities – Orthopnoea, Oesophageal reflux, Parkinson’s Disease
• Depression / Anxiety – very common. Antidepressants preferred
• Alcohol dependence
• Drugs
• Corticosteroids, Omeprazole, Phenytoin, Amiodarone, Sulfasalazine, Atrovastatin,
  Ramipril
• Psychiatric Drugs – Paroxetine, Haloperidol, Chlorpromazine
• Nightmares – B-blockers, Levodopa

Question 2

Insomnia Mx

Answer 2

• Sleep Hygiene

Question 3

Sleep hygiene Mx

Answer 3

• Reduce or stop daytime ‘catnapping’
• Avoid caffeine, heavy meals, and alcohol in the evening (alcohol helps
  to fall asleep but reduces sleep quality)
• Use a bedroom routine
• Ensure the environment is dark, quiet, and comfortable
• Relaxation and cognitive behavioural techniques can be useful
• Try warm milky drinks
• Manage expectations – older people will rarely sleep as much or well
  as younger people

Question 4

Short-term <3/12 Insomnia med Mx

Answer 4

• Sleep hygiene
• Zolpidem / Zopiclone for 3-7 days

Question 5

Long-term >3/12 insomnia med Mx

Answer 5

• Sleep hygiene
• CBT
• Zolpidem / Zolpiclone for 3-7 days

Question 6

Other sleeping disorders

Answer 6

• Hypersomnolence
• Excessive daytime sleepiness despite normal sleep at night.
• Causes – Dementia, Stroke, System failure, OSA, Hypothyroidism, Narcolepsy and
  sedative drugs.
• Restless legs syndrome
• 10% of older adults affected
• Unpleasant sensation in the limbs which increases with drowsiness and is eradicated
  by movement.
• Also associated limb jerking during sleep with sleep disorders
• Sleep Apnoea
• Common in older patients
• Contributes to daytime sleepiness, accidents and heart failure