Sleep disorders Flashcards
What is chronic insominia?
insomnia for 3 months
In insomnia what are the three ways that you can have sleep disturbances?
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
In insomnia, sleep disturbances cause clinicaly significant (blank) in social, occupational or other important areas of functioning
distress or impairment
In insomnia, sleep difficulty occurs at least (blank) nights per week and presents for at least (blank) months
3
3
In insomnia, sleep difficulty occurs despite adequate (Blank) to sleep
opportunity
The insomnia is not better explained by and does not occur exclusively during the course of another (blank)
sleep-wake disorder
Insomnia is not attributatable to physiologic effects of a (blank)
substance
UP to (blank) primary care patients experience insomnia, with only 1/3rd actually mentioning the problem and only 5% seeking treatment
50%
Who is most likely to have insomnia?
older female patients with chronic medical or psych problems
What are some common problems associated with insomnia?
depression, PTSD, substance use, sleep disorders, chronic pain, medical disorders
T or F
poor sleep increases risk for development of widespread pain
T
Insomnia can be linked to illness. Patients with insomnia are more likely to suffer from….?
- pain
- GI distress
- HTN
- Heart disease
- diabetes
- depression
What is depression disturbed sleep associated with?
- increased symptom severity
- slower and lower rates of remission
- higher treatment dropout rates
- less stable response to treatment
- increase suicide risk
What are the nonbenzodiazepines for insomnia?
- zolpidem (ambien)
- Zolpidem ER (ambien CR)
- Zaleplon (sonata)
- Eszopiclone (lunesta)
What are the pros of nonbenzodiazepines?
bind to GABA receptors the modulate sleep and have limited SEs
What are the cons of nonbenzodiazepines?
drowsiness, dizziness, unsteadiness of gait rebound insomnia and memory impairment
Which nonbenzodiazepines are approved for falling asleep or sleep onset?
Ambien
Which nonbenzodiazepines are approved for both sleep onset and sleep maintenance?
lunesta and ambien CR
Which nonbenzodiazepines are approved fro sleep onset only?
sonata
What are the benzos used for insomnia?
- alprazolam (Xanax)
- Lorazepam (Ativan)
- Clonazepam (klonopin)
- Temazepam (restoril)
- Diazpepam (valium)
What are the pros of benzos?
ehance sleep, decreased anxiety
What are the cons of benzos?
- daytime sedation
- unsteadiness of gait (increase fall risk in elderly)
- higher risk of tolerance, dependence, withdrawal and risk of abuse
What are the tricyclic antidepressents used in insomnia?
- doxepin (sinequan)
- amitriptyline (elavil)
What are second generation antidepressants for insomnia?
- trazadone (desyrel)
- Mirtazapine (remeron)
What are the pros for antidepressants?
can be used for insomnia and depression
What are the cons for antidepressants?
still reported side effects
What are some other kinds of drugs you can use for insomnia?
Melatonin receptor agonists : ramelteon (rozerem)
- antihistamine
- antipsychotics
What is the first line treatment recommended by NIH and academy of sleep for insomnia?
CBTI
What do you need to combine CBTI with?
sleep hygiene
How many session of CBTI do you need to treat insomnia?
4-6 sessions
What are Spielman’s 3 P model?
Predisposing factors
Precipitating factors
perpetuating factors
What are the three predisposing factors of insomnia?
biologic traits
psychological traits
social factors
What are the three precipitating factors?
medical illness
psychiatric illness
stressful life events
What are the three perpetuating factors?
excessive time in bed
napping
conditioning
What are the two processes that controls sleep?
- homeostatic sleep drives, sleep load (sleep drive)
- circadian oscillations, alerting signal (biologica clock)
What is this:
Works through the extinction of a conditioned arousal- repeated experiences of anxiety, frustration and tension when unable to sleep.
stimulus control
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.
Sleep restriction therapy
What causes cognitive arousal in people with sleep problems?
hyper-attention to “threats’” to sleep
- pre-sleep anticiaptory anxiety, arousal producing cognitions
- avoidance behaviors
How can you reduce hyperarousal?
- 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)
What are all the factors involved in insomnia?
- sleep drive
- circadian clock
- predisposing factors
- precipitating factors
- maintaining factors
- hyperarousal
WHat are the components of hyperarousal?
- intrusive thoughts
- beliefs re: sleep
- sleep effort
- muscle tension
- conditioned arousal
What are the maintaining factors of insomnia?
- circadian clock
- sleep drive
- hyperarousal
- beliefs and cognition
What are the predisposing factors of insomnia?
- temperament
- past trauma
- delayed phase
What are the sleep drive factors?
- excess TIB
- napping
- sleeping in
What are the factors of the circadian clock
- TIB misaligned with clock
- Irregular sleep-wake schedules
- napping
What are contradictions for sleep?
- active psychotic symptoms
- current alcohol/drug dependence
- excessive daytime sleepiness
- bipolar disorder
Which is better, CBTI or hypnotics?
Best when combined acutely but use CBTI alone for long term
Treating insomnia helps (blank)
depression
Insomnia and depression are linked T or F
T
Meditation based interventions (MBSR or MBTI) are shown to be effective treatment options and could provide alternative to CBTI
T
Combo therapy including both CBTI and Slee apnea treatment results in greater improvements in (Blank) than either treatment alone
insomnia
What do you use to decrease frequency of nightmares?
imagery rehearsal therapy (IRT)
What therapy should you give for claustrophobic reactions to CPAP?
exposure therapy
also motivational enhancement therapy
