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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
What are the pros for antidepressants?
can be used for insomnia and depression
26
What are the cons for antidepressants?
still reported side effects
27
What are some other kinds of drugs you can use for insomnia?
Melatonin receptor agonists : ramelteon (rozerem) - antihistamine - antipsychotics
28
What is the first line treatment recommended by NIH and academy of sleep for insomnia?
CBTI
29
What do you need to combine CBTI with?
sleep hygiene
30
How many session of CBTI do you need to treat insomnia?
4-6 sessions
31
What are Spielman's 3 P model?
Predisposing factors Precipitating factors perpetuating factors
32
What are the three predisposing factors of insomnia?
biologic traits psychological traits social factors
33
What are the three precipitating factors?
medical illness psychiatric illness stressful life events
34
What are the three perpetuating factors?
excessive time in bed napping conditioning
35
What are the two processes that controls sleep?
- homeostatic sleep drives, sleep load (sleep drive) | - circadian oscillations, alerting signal (biologica clock)
36
What is this: Works through the extinction of a conditioned arousal- repeated experiences of anxiety, frustration and tension when unable to sleep.
stimulus control
37
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
38
What causes cognitive arousal in people with sleep problems?
hyper-attention to "threats'" to sleep - pre-sleep anticiaptory anxiety, arousal producing cognitions - avoidance behaviors
39
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)
40
What are all the factors involved in insomnia?
- sleep drive - circadian clock - predisposing factors - precipitating factors - maintaining factors - hyperarousal
41
WHat are the components of hyperarousal?
- intrusive thoughts - beliefs re: sleep - sleep effort - muscle tension - conditioned arousal
42
What are the maintaining factors of insomnia?
- circadian clock - sleep drive - hyperarousal - beliefs and cognition
43
What are the predisposing factors of insomnia?
- temperament - past trauma - delayed phase
44
What are the sleep drive factors?
- excess TIB - napping - sleeping in
45
What are the factors of the circadian clock
- TIB misaligned with clock - Irregular sleep-wake schedules - napping
46
What are contradictions for sleep?
- active psychotic symptoms - current alcohol/drug dependence - excessive daytime sleepiness - bipolar disorder
47
Which is better, CBTI or hypnotics?
Best when combined acutely but use CBTI alone for long term
48
Treating insomnia helps (blank)
depression
49
Insomnia and depression are linked T or F
T
50
Meditation based interventions (MBSR or MBTI) are shown to be effective treatment options and could provide alternative to CBTI
T
51
Combo therapy including both CBTI and Slee apnea treatment results in greater improvements in (Blank) than either treatment alone
insomnia
52
What do you use to decrease frequency of nightmares?
imagery rehearsal therapy (IRT)
53
What therapy should you give for claustrophobic reactions to CPAP?
exposure therapy | also motivational enhancement therapy

Block 8 Week 1 (13 decks)

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