Sleep Disorders and Pharm Flashcards
What neurotransmitters are thought to play a role in the sleep-wake cycle
Serotonin: arousal promoting
NE: arousal promoting
GABA: sleep promotig
Histamine:arousal promoting
Orexin: regulates arousal, wakefulness, and appetite
Ach
Dopamine
SLeep is divided into two categories, what are they? Describe each.
- REM (increase in eye movement, heart rate, breathing, HR, BP, & temp)
- Non-REM (4 stages)
* REM + Non-REM = 90minute cycles
Description:
Non-REM: stages 1 &2 cyclic waxing and waning of TV and RR, have periodic breathing (periods of apnea), stage 3&4 breathing becomes more regular.
REM: resp become irregular and may include short periods of apnea.
What are the types of Sleep Disorders?
- Insomnia
- Hypersomnolence
- narcolepsy
- breathing-related sleep disorders
- circadian rhythm sleep wake disorders
- Non-REM sleep arousal disorders
- REM sleep Behavior disorder
- Movement Disorder
Insomnia:
- what is this?
- most common in who?
- risk factors
What: difficulty initiating, maintaining sleep, or waking up early in the AM without the ability to return to sleep.
- most common in women
- Risk factors: Stress, caffeine, physical discomfort, daytime napping, early bedtimes, alcohol abuse, heavy smoking, depression, & manic disorders
Etiologies of Insomnia
Medical Conditions: cardiac, neurological, pulmonary, GI (acid reflux), substances (stimulants, caffeine, alcohol, corticosteroids, bronchodilators
Psychiatric Conditions: depression, Anxiety, PTSD, Panic disorder, psychotrophic meds
Environmental problems:
-bereavement, shift work, jet lag, changes in altitude
Sx of insomnia
- difficulty falling asleep and staying asleep
- daytime sleepiness
- irritability
- fatigue/malaise
- increased errors or accidents
- poor social or educational dysfunction
Dx and Tx of Insomnia
Dx:
- sleep hx; # of awakenings, duration of awakening, duration of the problem
- sleep log: bedtime, duration until sleep onset, final awakening time
Tx:
-Before therapy most patients are asked to maintain sleep log for 2-4wks, perform good sleep hygiene, avoid caffeine, nicotine, alcohol 6-8hrs before bedtime
-Meds: *short term use is preferred to restore normal sleep pattern, hypnotic drugs are used for 2wks or less
Insomnia Medications:
- for each what is the half life, preg category, and MOA
- trouble getting to sleep
- trouble maintaining sleep
- other
- orexin receptor antagonists
Trouble getting to sleep:
-Ambien 1st line: half life 1.5-2.4hrs, Preg B, MOA: GABA
-Zaleplon(Sonata): alternative
Trouble Maintaining SLeep:
-Lunesta: Half life 5-7hrs, Preg C, MOA: GABA
Other:
- Benzodiazepines (Triazolam, lorazepam, estazolam); MOA: GABA
- be careful in those with breathing difficulties (COPD)
-Melatonin Agonists (Ramelteon); half life: 1.5-5hrs
Orexin receptor antagonists: Belsomra, MOA: inhibits orexin, Preg C
Hypersomnolence Disorder
- what is this?
- commonly affects who?
- sx
What: recurrent epidsodes of excessive daytime sleepiness or prolonged nighttime sleep that is not caused by medications, medical conditions, not getting enough sleep, or insomnia.
- Most commonly affects adolescents and young adults
- Sx: anxiety, increased irritation, decreased energy
Hypersomnolence Disorder:
-diagnostic criteria
-excessive sleepiness for at least 1 mo (acute) or at least 3 mo (persistent) as evidence by either prolonged sleep episodes or daytime sleep episodes that occur at least 2 times per week.
Hypersomnolence disorder:
-Tx
-non-pharm: takes naps whenever possible, maintain regular sleep schedule, avoid alcohol and meds that cause drowsiness
Pharm:
1st line: Provigil, Preg C
2nd line: Dextroamphetamine; stimulates CNS, Preg C, BBW: high potential for abuse
Narcolepsy
- what is this?
- most common in what age?
- causes
What: daytime sleepiness
Most common in teens and early twenties
- Causes: loss of orexin(hypocretin)
- genetic
- brain lesion
Narcolepsy:
-sx and symptoms
- extreme drowsiness during the day with a strong urge to sleep, often followed by a short nap (sleep attack)
- naps last about 15minutes each, may happen after eating, while driving, talking to someone, etc. Wake up feeling refreshed
Tetrad of Sx:
-sleep paralysis (generalized flaccidity of muscles)
- cataplexy: sudden loss of muscle tone in muscles while awake that makes them slump to the floor unable to move; may be triggered by strong emotions. usually last less than 30seconds
- hypnagogic hallucinatinos: visual or auditory which may precede or occur during the sleep attack
- excessive daytime sleepiness
Narcolepsy:
- dx
- tx
Dx:
- hx of daytime sleepiness
- absence of underlying nocturnal sleep disorders
- epworth sleep scale
- polysonogram (EEG, eye movements, EMG, EKG)
- multiple sleep latency test (series of naps 2hrs apart and measure the REM cycle for each nap)
Tx:
- good sleep hygiene
- take 1-3 planned 15-20min naps/day
- Meds:
- -1st line: Provigil, Preg C
- -2nd line: Dextroamphetamine; Preg C, BBW: abuse potential
Sleep related Breathing Disorders:
-what are the 3 types?
- obstructive sleep apnea hypopnea
- central sleep apnea
- obesity hypoventilation syndrome