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Pharmacotherapeutics Theory 2 > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What are the 2 Types of Sleep Disorders?

A
  • Primary Sleep Disorders
  • Secondary Sleep Disorders
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2
Q

2 Types of Sleep Disorders: What are the 2 Types of Primary Sleep Disorders?

A
  • Dysomnias (initiating, maintaining, excessive)
    • Primary insomnia, primary hypersomnia, narcolepsy, breathing or circadian rhythm related
  • Parasomnias (abnormal physiology during sleep)
    • Nightmare, sleep terror, sleep walking disorders
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3
Q

2 Types of Sleep Disorders: What are the Types of Secondary Sleep Disorders?

A
  • Sleep disorders related to another mental disorder
  • Sleep disorders due to general medical condition
  • Substance induced sleep disorders
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4
Q

What is Insomnia?

A
  • Insomnia is an impairment of perceived sleep quality that’s often associated with daytime sequale that interferes with many aspects of daytime functioning such as fatigue, irritability, impaired concentration and malaise
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5
Q

If Insomnia is associated with another conditions, what’s it termed?

How is this treated?

A
  • Co-morbid insomnia
  • Treat comorbidities to treat insomnia
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6
Q

Medical conditions contributing to insomnia include?

A
  • CVD e.g. IHD, CCF
  • Respiratory e.g. OSA, COAD
  • Chronic pain
  • GI e.g. GORD
  • Neurological e.g. delirium, epilepsy
  • Pregnancy
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7
Q

Psychiatric conditions contributing to insomnia include?

A

Depression, mania, anxiety, substance abuse

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8
Q

Medications/Substances contributing to insomnia include?

A
  • Antidepressants e.g. SSRIs
  • Beta blockers
  • Bronchodilators e.g. B2 agonists
  • CNS stimulants e.g. Methylphenidate
  • Nicotine
  • Corticosteroids
  • Diuretics
  • Alcohol, caffeine and illicit drugs (e.g amphetamines)
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9
Q

Primary insomnia can be divided into 2 categories, what are they?

A
  • Acute (<30 days duration)
  • Chronic (>30 days duration)
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10
Q

Insomnia can also be divided into what?

A
  • Difficulty falling asleep
  • Difficult maintaining sleep
  • Waking too early
  • Poor quality of sleep
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11
Q

Risk factors for development of chronic insomnia include

A
  • Increasing age
  • Female
  • Psychiatric illness
  • Medical co-morbidities
  • Impaired social relationships
  • Lower socioeconomic status
  • Separation from a spouse or partner
  • Unemployment
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12
Q

What is the Assessment and Diagnosis of Insomnia?

  • Are there diagnostic tests?
  • What are quantitative indices for insomnia?
A
  • No definitive diagnostic tests
    • Quality generally more important than quantity
      • No objective measure of perceived quality
  • Quantitative indices for insomnia
    • Sleep-onset latency (>30 mins)
    • Sleep efficiency (<85% bed time asleep)
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13
Q

Hypnotic Practice Points

  • Can you use more than one at a time?
  • Is tolerance common?
  • Are some better than the other?
A
  • Little basis for using more than one at a time
  • Tolerance
    • rare with short term use (1-2 weeks)
    • Longer term use (>4 weeks) leads to tolerance and can make insomnia worse
  • All hypnotics have the same effect on sleep patterns
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14
Q

Length of Action of Hypnotics: Very Short acting

A
  • not useful for sleeping
  • Midazolam
  • Triazolam
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15
Q

Length of Action of Hypnotics: Short acting

A
  • Alprazolam
  • Oxazepam
  • Temazepam
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16
Q

Length of Action of Hypnotics: Medium acting

A
  • Bromazepam
  • Lorazepam
17
Q

Length of Action of Hypnotics: Long acting

A
  • Diazepam
  • Clobazam
  • Clonazepam
18
Q

What is important when selecting a hypnotic?

A
  • Match drug to the sleep disturbance reported
    • Match the onset and duration of effect with specific sleep disturbance
19
Q

Factors in selecting hypnotic: Difficulty falling asleep but can maintain sleep

A
  • Very short or short acting hypnotic with quick onset of effect (e.g. zolpidem, temazepam)
20
Q

Factors in selecting hypnotic: Able to fall asleep, but waking early

A
  • Short acting hypnotic – quick onset not necessary (temazepam, oxazepam, zolpidem SR)
21
Q

Factors in selecting hypnotic: Difficulty falling and maintaining sleep

A
  • Short acting benzodiazepine with quick onset (e.g. temazepam, zolpidem SR, zopiclone)
22
Q

What is Benzodiazepine Dependence?

A
  • Strong desire or sense of compulsion to take a substance, difficulty in controlling its use, tolerance and the presence of a withdrawal state
23
Q

What is advised in long-term users of Benzos?

A
  • A trial of benzodiazepine withdrawal is advised in long-term users
24
Q

Symptoms associated with abrupt withdrawal of benzos include (more common in the first few weeks)?

A
  • Difficulty sleeping and bizarre dreams
  • Fatigue
  • Dizziness
  • Palpitations/Shakiness/Myoclonic Jerks
  • Anxiety and irritability
25
Q

Withdrawal of Benzos - Short Trial

A

Cease immediately

26
Q

Withdrawal of Benzos - Longer Term Users

A
  • Gradual reduction, titrated to withdraw symptoms
27
Q

What is preferred in Benzo Withdrawal?

A
  • Longer half-life is preferred e.g. diazepam
    • Convert to equivalent dosage
  • Short half-life = get big peaks and troughs → get therapeutic effects and withdrawal effects within single dosage cycle
  • With longer half-life, concentration reduces quite gradually. Not much difference between peak and troughs
28
Q

What is a reasonable withdrawal plan for benzos?

A
  • 4-6 weeks is a reasonable plan to start with, or reduction in TDD by about 15% every week
  • Time required varies between individuals
29
Q

What is Deprescribing?

A

The term used to describe the trial cessation of medicines

30
Q

Is deprescribing easy to do?

A
  • Difficult to do in patient who’s been on medication for a long period of time
    • Involves stopping drug, monitoring and support that goes around what’s needed to successfully withdraw a medicine
31
Q

Deprescribing is easiest to achieve when?

A
  • Deprescribing is easiest to achieve when the process starts during prescribing
    • Set limits around treatment duration
    • Shared decision making (physician and patient responsibilities)
    • Initiate non-drug therapies

Pharmacotherapeutics Theory 2 (17 decks)

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