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Block 8 Week 1 > Sleep disorders > Flashcards

Sleep disorders Flashcards

1
Q

What is chronic insominia?

A

insomnia for 3 months

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2
Q

In insomnia what are the three ways that you can have sleep disturbances?

A

Difficulty initiating sleep

  - Difficulty maintaining sleep (i.e., frequent awakening with problems returning to sleep)
  - Early morning awakening with the inability to return to sleep
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3
Q

In insomnia, sleep disturbances cause clinicaly significant (blank) in social, occupational or other important areas of functioning

A

distress or impairment

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4
Q

In insomnia, sleep difficulty occurs at least (blank) nights per week and presents for at least (blank) months

A

3

3

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5
Q

In insomnia, sleep difficulty occurs despite adequate (Blank) to sleep

A

opportunity

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6
Q

The insomnia is not better explained by and does not occur exclusively during the course of another (blank)

A

sleep-wake disorder

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7
Q

Insomnia is not attributatable to physiologic effects of a (blank)

A

substance

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8
Q

UP to (blank) primary care patients experience insomnia, with only 1/3rd actually mentioning the problem and only 5% seeking treatment

A

50%

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9
Q

Who is most likely to have insomnia?

A

older female patients with chronic medical or psych problems

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10
Q

What are some common problems associated with insomnia?

A

depression, PTSD, substance use, sleep disorders, chronic pain, medical disorders

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11
Q

T or F

poor sleep increases risk for development of widespread pain

A

T

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12
Q

Insomnia can be linked to illness. Patients with insomnia are more likely to suffer from….?

A
  • pain
  • GI distress
  • HTN
  • Heart disease
  • diabetes
  • depression
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13
Q

What is depression disturbed sleep associated with?

A
  • increased symptom severity
  • slower and lower rates of remission
  • higher treatment dropout rates
  • less stable response to treatment
  • increase suicide risk
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14
Q

What are the nonbenzodiazepines for insomnia?

A
  • zolpidem (ambien)
  • Zolpidem ER (ambien CR)
  • Zaleplon (sonata)
  • Eszopiclone (lunesta)
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15
Q

What are the pros of nonbenzodiazepines?

A

bind to GABA receptors the modulate sleep and have limited SEs

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16
Q

What are the cons of nonbenzodiazepines?

A

drowsiness, dizziness, unsteadiness of gait rebound insomnia and memory impairment

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17
Q

Which nonbenzodiazepines are approved for falling asleep or sleep onset?

A

Ambien

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18
Q

Which nonbenzodiazepines are approved for both sleep onset and sleep maintenance?

A

lunesta and ambien CR

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19
Q

Which nonbenzodiazepines are approved fro sleep onset only?

A

sonata

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20
Q

What are the benzos used for insomnia?

A
  • alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (klonopin)
  • Temazepam (restoril)
  • Diazpepam (valium)
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21
Q

What are the pros of benzos?

A

ehance sleep, decreased anxiety

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22
Q

What are the cons of benzos?

A
  • daytime sedation
  • unsteadiness of gait (increase fall risk in elderly)
  • higher risk of tolerance, dependence, withdrawal and risk of abuse
23
Q

What are the tricyclic antidepressents used in insomnia?

A
  • doxepin (sinequan)

- amitriptyline (elavil)

24
Q

What are second generation antidepressants for insomnia?

A
  • trazadone (desyrel)

- Mirtazapine (remeron)

25
Q

What are the pros for antidepressants?

A

can be used for insomnia and depression

26
Q

What are the cons for antidepressants?

A

still reported side effects

27
Q

What are some other kinds of drugs you can use for insomnia?

A

Melatonin receptor agonists : ramelteon (rozerem)

  • antihistamine
  • antipsychotics
28
Q

What is the first line treatment recommended by NIH and academy of sleep for insomnia?

A

CBTI

29
Q

What do you need to combine CBTI with?

A

sleep hygiene

30
Q

How many session of CBTI do you need to treat insomnia?

A

4-6 sessions

31
Q

What are Spielman’s 3 P model?

A

Predisposing factors
Precipitating factors
perpetuating factors

32
Q

What are the three predisposing factors of insomnia?

A

biologic traits
psychological traits
social factors

33
Q

What are the three precipitating factors?

A

medical illness
psychiatric illness
stressful life events

34
Q

What are the three perpetuating factors?

A

excessive time in bed
napping
conditioning

35
Q

What are the two processes that controls sleep?

A
  • homeostatic sleep drives, sleep load (sleep drive)

- circadian oscillations, alerting signal (biologica clock)

36
Q

What is this:
Works through the extinction of a conditioned arousal- repeated experiences of anxiety, frustration and tension when unable to sleep.

A

stimulus control

37
Q

What is this:
First, reduce time in bed (TIB) to the patients current sleep time.
When unwanted wakefulness has decreased and sleep quality improves, begin expanding TIB.

A

Sleep restriction therapy

38
Q

What causes cognitive arousal in people with sleep problems?

A

hyper-attention to “threats’” to sleep

  • pre-sleep anticiaptory anxiety, arousal producing cognitions
  • avoidance behaviors
39
Q

How can you reduce hyperarousal?

A
  • relaxation techniques to quiet the mind
  • creating “buffer time before sleep
  • cognitive therapy (understand how thoughts can intefere with sleep, educate patients on facts and myths about underlying sleep beliefs)
40
Q

What are all the factors involved in insomnia?

A
  • sleep drive
  • circadian clock
  • predisposing factors
  • precipitating factors
  • maintaining factors
  • hyperarousal
41
Q

WHat are the components of hyperarousal?

A
  • intrusive thoughts
  • beliefs re: sleep
  • sleep effort
  • muscle tension
  • conditioned arousal
42
Q

What are the maintaining factors of insomnia?

A
  • circadian clock
  • sleep drive
  • hyperarousal
  • beliefs and cognition
43
Q

What are the predisposing factors of insomnia?

A
  • temperament
  • past trauma
  • delayed phase
44
Q

What are the sleep drive factors?

A
  • excess TIB
  • napping
  • sleeping in
45
Q

What are the factors of the circadian clock

A
  • TIB misaligned with clock
  • Irregular sleep-wake schedules
  • napping
46
Q

What are contradictions for sleep?

A
  • active psychotic symptoms
  • current alcohol/drug dependence
  • excessive daytime sleepiness
  • bipolar disorder
47
Q

Which is better, CBTI or hypnotics?

A

Best when combined acutely but use CBTI alone for long term

48
Q

Treating insomnia helps (blank)

A

depression

49
Q

Insomnia and depression are linked T or F

A

T

50
Q

Meditation based interventions (MBSR or MBTI) are shown to be effective treatment options and could provide alternative to CBTI

A

T

51
Q

Combo therapy including both CBTI and Slee apnea treatment results in greater improvements in (Blank) than either treatment alone

A

insomnia

52
Q

What do you use to decrease frequency of nightmares?

A

imagery rehearsal therapy (IRT)

53
Q

What therapy should you give for claustrophobic reactions to CPAP?

A

exposure therapy

also motivational enhancement therapy

Block 8 Week 1 (13 decks)

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