Sleep Disorders - Gentry Flashcards by Colt Williams

what percent of primary care pts experience insomnia?

50%

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What percent of pts with insomnia seek treatment?

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What percent of US adults don’t get enough sleep?

one third

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what percent of US adults are impacted by chronic insomnia?

12%

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Persistent and severe sleep distrubane affects at least 1 in (blank) adults and 1 in (blank) elders

1 in 10

1 in 5 olds

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What groups of pts have an increased prevalence of insomnia?

women
older adults –ESPECIALLY with depression
chronic mental or psychiatirc problems
a. depression, PTSD, SUD
b. sleep disorders (apnea)
c. chronic pain

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peeps with chronic insomnia have greater rates of dysfunction in what three areas compared to those that sleep well?

intellectual
social
vocational

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T/F: chronic sleep disturbance is associated with lower scores and higher absenteeism

true

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T/F: poor sleep increases the risk for widespread pain

true

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by how much does your risk of general pain increase over 15 months of shitty sleep?

3 fold

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T/F: chronic insomnia is a risk factor or new onset and recurrent psych and med issues

true

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What conditions are people with insomnia most likely to suffer from?

Pain conditions
Gastrointestinal distress
Hypertension
Heart disease
May be risk factor for diabetes
Depression

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What percent of those with MDD complain of sleep problems?

90%

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What major risk is associated with MDD and bad sleep?

increased suicide risk

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t/F: MDD and sleep distrubance has no affect on rates of remission and treatment efficacy

false; slower and lower rates of remission and less stable response to treatment

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what makes up the largest group of insomnia sufferers at sleep clinics?

MDD

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pts with chronic insomnia are between (blank and blank) times more likely to have new onset or recurrent depression

2-6 times

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T/F: No CBT-D or pharmacotherapy difference on insomnia after MDD remission

true

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T/F: residual insomnia is the chief complaint even after remission from PTSD or MDD

true

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Non-benzo receptor agonists bind to specific subtypes of what type receptor?

GABA

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What are the pros of using a non-benzo receptor agonist?

fewer side effects

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What are the cons to using a non-benzo receptor agonist for sleep?

Drowsiness, dizziness, unsteadiness of gait, rebound insomnia and memory impairment have been reported.

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What drugs are approved for falling asleep/sleep onset?

Ambein
Ambien CR
Lunesta
Sonata

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What drugs are used for sleep maintanence?

Ambien CR

Lunesta

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What drug can only be used for sleep onset?

Sonata

What are the pros to using benzos for sleep?

enhance sleep and reduce anxiety

What are the cons to using benzos for sleep?

Daytime sedation, unsteady gait, higher tolerance, dependence, withdrawal

What are the pros of using antidepressants for sleep?

used for both insomnia and depression

what are the cons of using antidepressants for sleep?

lots of side effects

What are the tricyclic antidepresants that you can use for sleep?

Doxepin and Amitriptyline

What second generation antidepressants can you use for sleep?

Trazadone and Mirtazapine

What drug is a melatonin receptor agonist?

Ramelteon

Ramelteon is a selective agonist for what two melatonin receptors?

MT1 and MT2

which antihistamines can be used for sleep?

benadryl and Hydroxine

Which antispychotics can be used for sleep?

Seroquel, thorazine, risperdal, Zyprexa, Geodon

Which drugs are FDA approved for insomnia specifically?

``` Ambien Sonata Lunesta Rozerem Temazepam low dose doxepin ```

What drugs are FDA approved for sleep onset insomnia?

Ambien Sonata Rozerem

what drugs are FDA approved for sleep onset and sleep maintanence?

Ambien CR | Lunesta

T/F: Rozerem works by depressing the CNS

false; altering the sleep-wake cycle

What is the recommneded firstline treatment for insomnia?

CBT

What are the goals of CBT for insomnia?

1, Improve sleep quality 2. Decrease daytime impairment 3. Decrease insomnia symptoms 4. Form a positive & clear association between bed & sleeping 5. Decrease psychological distress related to sleep deprivation

T/F: CBT is equivalent to improving sleep hygeine

false

T/F: improving sleep hygeine by itself is an effective treatment of insomnia

false

T/F: CBT sessions have sustained effects for insomnia

true

How many sessions are necessary to see improvement when doing CBTI?

4-6 sessions

What are the three P's of Spielman's 3 P model?

Predisposing factors Precipitating factors Perpetuating factors

What are the predisposing factors to insomnia?

biologic traits psychological traits social factors

What are the precipitating factors of insomnia?

medical illness psychiatric illness stressful life events

What are the perpetuating factors of insomnia?

excessive time in bed napping conditioning

Which P is the most prevalent in new onset insomnia

Precipitating factors medical illness psychiatric illness stressful life events

Which P is the most prevlaent in short term insomnia?

Precipitating factors medical illness psychiatric illness stressful life events

Which P is most common in chronic insomnia?

Perpetuating factors excessive time in bed napping conditioning

T/F: wake propensity is the greatest right before bed

true

(blank) Works through the extinction of a conditioned arousal- repeated experiences of anxiety, frustration and tension when unable to sleep.

stimulus control

Explain sleep restriction therapy?

1. reduce time in bed to pt's current sleep time | 2. when unwanted wakefulness has decreased and sleep quality improves, increase time in bed

What are some factors that lead to cognitive arousal at bedtime?

Hyperattention to threats to sleep, aka clock watching 2. Pre-sleep anticipatory anxiety (poor daytime function, negative mood, "ill-being" attributed to sleep) 3. Avoidance behaviors and rigid sleep rules to prevent poor sleep or following poor sleep

What are three ways to reduce hyperarousal?

1. Relaxation techniques 2. Creating buffer time before sleep 3. Cognitive therapy

What are the sleep drive factors that lead to insomnia?

Excessive TIB Napping Sleeping in

What are the predisposing factors that lead to insomnia?

Temperament past trauma delayed phase

What are the maintaining factors that lead to insomnia?

circadian clock sleep drive hyperarousal beliefs and cognitions

What are the hyperarousal factors that lead to insomnia?

``` intrusive thoughts beleifs re: sleep sleep effor muscle tension conditioned arousal ```

What are the circadian factors that lead to insomnia?

TIB misaligned with clock Irregular sleep-wake schedules Napping

What are the contraindications for CBTI?

1. active psychotic symptoms 2. current alcohol/drug depenence (30 days sober nec.) 3. Excessive daytime sleepiness when safety is an issue 4. bipolar disorder

T/F: CBTI has equal efficacy to meds

true

T/F: CBTI has longer lasting effects than meds

true

T/F: medication is cheaper than CBTI

false

How long may CBTI benefits last after treatment?

2 years

Is relaxation training the same as CBTI?

nope

Generally, do patients prefer CBTI or meds?

CBTI, because it increases daytime functioning and has longer effects and no side effects

With what type of insomnia are meds the most effective?

brief forms of insomnia due to jet lag, bereavement, or unfortunate life stress

T/F: meds are not as effective in treating chronic insomnia

true

what factors play into the reduced efficacy of meds in treating chronic insomnia?

tolerance and reduced efficacy psychological and physiological dependence unable to address behavioral factors

T/F: CBTI is effective in pts with complicating conditions like PTSD, chronic pain/fibromyalgia, cancer

true

t/F: treating insomnia can cause depression remission

true

T/F: insomnia and depression are linked

true

What type of meditation is an effective analog to CBTI?

MBSR or MBTI

Does MBSR or MBTI have higher rates of insomnia remission?

MBTI

Besides MBSR and MBTI, what other alternative treatments exist for insomnia?

ACT (acceptance and commitment therapy)

What is used to decrease the frequency of nightmares?

image rehearsal therapy (IRT)

What is used for claustrophobic reactions to CPAP?

exposure therapy

What is used to encourage CPAP use?

motivational enhancement

T/F: CBT may improve CPAP adherence

true, insomnia and OSA happen together oftentimes

T/F: CBT with CPAP had the greatest results

true, duh because clearly CBT is the best fucking thing since sliced bread

what is the biggest barrier to CBTI?

lack of trained sleep therapists

T/F: insomnia should be treated as a symptom of other disorders

false; should be treated as its own entitiy

When do you treat insomnia as a symptom?

when it occurs in the context of a medical or psychiatric illness