Sleep disorders

Question 1

Insomnia symptoms

Answer 1

~ difficulty initiating sleep
~ difficulty maintaining sleep
~ early morning awaking
~ poor sleep quality

Question 2

3 types of isomnia

Answer 2

~ Transient
~ Short-term
~ Chronic

Question 3

Transient insomnia

Answer 3

~ causes = environmental (noise, shift, jet lag)
~ choose short-acting (So rapidly eliminated)
~ give only 1 or 2 doses

Question 4

Short-term insomnia

Answer 4

~ related to emotional problems/serious medical illness
~ lasts few weeks or recur
~ TAKE intermittently &omit some doses
~ give no more than 3/52

Question 5

Chronic insomnia

Answer 5

~ causes = psychiatric disorder (anxiety, depression), alcohol, drugs, pain, dyspnoea, pruritus

Question 6

Z-drugs class

Answer 6

CD4 part 1

Question 7

Z-drugs tx duration, & e.g.

Answer 7

are short acting hypnotics for
~ sleep-onset insomnia
~ elderly dosing
~ little hangover effect = can drive/job

SHORT-TERM USE (4 weeks max; 2 weeks if zaleplon) for severe insomnia that interferes with daily life

e.g.
~ Zopiclone (taste disturbances)
~ Zolpidem (GI, leave 8h before driving)
~ Zaleplon (shortest acting)

Question 8

Benzodiazepines sedatives class

Answer 8

CD4 part 1

Question 9

Benzodiazepines tx duration

Answer 9

SHORT-TERM use (2-4 weeks) for severe disabling insomnia or causing pt extreme stress

Question 10

Long-acting benzodiazepines profile & e.g.

Answer 10

~ sleep maintenance insomnia that causes daytime effect
~ anxiolytic effect during day (diazepam single dose at night)
~ hangover effect

~ Nitrazepam
~ Flurazepam
~ Diazepam (Dental procedures)

Question 11

AVOID Z-drugs / Benzodiazepine in ??

Answer 11

ELDERLY === ataxia + confusion = falls/ injury

Question 12

short-acting benzodiazepines profile & e.g.

Answer 12

~ Sleep-onset insomnia
~ elderly pt, hepatic impairment
~ little hangover effect = can drive/work

e.g.
~ Temazepam (CD3, dental procedures, preferred)
~ Lorazepam (Dental, insomnia with anxiety)
~ Oxazepam (insomnia with anxiety)

Question 13

OTHER HYPNOTICS

Answer 13

~ Clomethiazole (use: elderly, no hangover effect, licensed for acute alcohol withdrawal)
~ Chloral hydrate (use as hypnotic limited)
~ Antihistamines: promethazine, diphenhydramine
~ melatonin (pineal hormone in over 55 years)

Question 14

Z-drugs MOA

Answer 14

act on benzodiazepine site on GABA-A and bind to receptors

Question 15

Z-drugs side effects

Answer 15

~ paradoxical = increase in hostility, aggression, excitement, antisocial acts
~ daytime sleepiness = avoid alcohol, CNS depression enhanced
~ avoid long term use
— dependence & withdrawal = rebound insomnia, broken sleep, avoid abrupt withdrawal
— tolerance in 3-14 days of continuous use - take PRN !!

Question 16

Narcolepsy is

Answer 16

~ rare long term brain disorder that causes person to fall asleep at inappropriate times

Question 17

Narcolepsy symptoms

Answer 17

~ sleep attacks
~ excessive daytime sleepiness
~ cataplexy
~ sleep paralysis
~ excessive dreaming

Question 18

Narcolepsy tx

Answer 18

CNS stimulants
~ Modafinil (CD2)
~ Methylphenidate (CD2)
~ Dexamphetamine (CD2))
~ Sodium oxybate (CD2)
~ Pitolisant