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Block 8 Week 1 Colt > Sleep Disorders - Gentry > Flashcards

Sleep Disorders - Gentry Flashcards

1
Q

what percent of primary care pts experience insomnia?

A

50%

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2
Q

What percent of pts with insomnia seek treatment?

A

5%

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3
Q

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

A

one third

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4
Q

what percent of US adults are impacted by chronic insomnia?

A

12%

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5
Q

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

A

1 in 10

1 in 5 olds

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6
Q

What groups of pts have an increased prevalence of insomnia?

A
  1. women
  2. older adults –ESPECIALLY with depression
  3. chronic mental or psychiatirc problems
    a. depression, PTSD, SUD
    b. sleep disorders (apnea)
    c. chronic pain
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7
Q

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

A

intellectual
social
vocational

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8
Q

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

A

true

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9
Q

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

A

true

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10
Q

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

A

3 fold

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11
Q

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

A

true

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12
Q

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

A 
Pain conditions
Gastrointestinal distress
Hypertension
Heart disease
May be risk factor for diabetes
Depression
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13
Q

What percent of those with MDD complain of sleep problems?

A

90%

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14
Q

What major risk is associated with MDD and bad sleep?

A

increased suicide risk

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15
Q

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

A

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

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16
Q

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

A

MDD

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17
Q

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

A

2-6 times

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18
Q

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

A

true

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19
Q

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

A

true

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20
Q

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

A

GABA

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21
Q

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

A

fewer side effects

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22
Q

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

A

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

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23
Q

What drugs are approved for falling asleep/sleep onset?

A

Ambein
Ambien CR
Lunesta
Sonata

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24
Q

What drugs are used for sleep maintanence?

A

Ambien CR

Lunesta

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25
Q

What drug can only be used for sleep onset?

A

Sonata

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26
Q

What are the pros to using benzos for sleep?

A

enhance sleep and reduce anxiety

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27
Q

What are the cons to using benzos for sleep?

A

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

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28
Q

What are the pros of using antidepressants for sleep?

A

used for both insomnia and depression

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29
Q

what are the cons of using antidepressants for sleep?

A

lots of side effects

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30
Q

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

A

Doxepin and Amitriptyline

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31
Q

What second generation antidepressants can you use for sleep?

A

Trazadone and Mirtazapine

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32
Q

What drug is a melatonin receptor agonist?

A

Ramelteon

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33
Q

Ramelteon is a selective agonist for what two melatonin receptors?

A

MT1 and MT2

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34
Q

which antihistamines can be used for sleep?

A

benadryl and Hydroxine

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35
Q

Which antispychotics can be used for sleep?

A

Seroquel, thorazine, risperdal, Zyprexa, Geodon

36
Q

Which drugs are FDA approved for insomnia specifically?

A 
Ambien
Sonata
Lunesta
Rozerem
Temazepam
low dose doxepin
37
Q

What drugs are FDA approved for sleep onset insomnia?

A

Ambien
Sonata
Rozerem

38
Q

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

A

Ambien CR

Lunesta

39
Q

T/F: Rozerem works by depressing the CNS

A

false; altering the sleep-wake cycle

40
Q

What is the recommneded firstline treatment for insomnia?

A

CBT

41
Q

What are the goals of CBT for insomnia?

A

1, Improve sleep quality

  1. Decrease daytime impairment
  2. Decrease insomnia symptoms
  3. Form a positive & clear association between bed & sleeping
  4. Decrease psychological distress related to sleep deprivation
42
Q

T/F: CBT is equivalent to improving sleep hygeine

A

false

43
Q

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

A

false

44
Q

T/F: CBT sessions have sustained effects for insomnia

A

true

45
Q

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

A

4-6 sessions

46
Q

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

A

Predisposing factors
Precipitating factors
Perpetuating factors

47
Q

What are the predisposing factors to insomnia?

A

biologic traits
psychological traits
social factors

48
Q

What are the precipitating factors of insomnia?

A

medical illness
psychiatric illness
stressful life events

49
Q

What are the perpetuating factors of insomnia?

A

excessive time in bed
napping
conditioning

50
Q

Which P is the most prevalent in new onset insomnia

A

Precipitating factors
medical illness
psychiatric illness
stressful life events

51
Q

Which P is the most prevlaent in short term insomnia?

A

Precipitating factors
medical illness
psychiatric illness
stressful life events

52
Q

Which P is most common in chronic insomnia?

A

Perpetuating factors
excessive time in bed
napping
conditioning

53
Q

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

A

true

54
Q

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

A

stimulus control

55
Q

Explain sleep restriction therapy?

A
  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

56
Q

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

A

Hyperattention to threats to sleep, aka clock watching

  1. Pre-sleep anticipatory anxiety (poor daytime function, negative mood, “ill-being” attributed to sleep)
  2. Avoidance behaviors and rigid sleep rules to prevent poor sleep or following poor sleep
57
Q

What are three ways to reduce hyperarousal?

A
  1. Relaxation techniques
  2. Creating buffer time before sleep
  3. Cognitive therapy
58
Q

What are the sleep drive factors that lead to insomnia?

A

Excessive TIB
Napping
Sleeping in

59
Q

What are the predisposing factors that lead to insomnia?

A

Temperament
past trauma
delayed phase

60
Q

What are the maintaining factors that lead to insomnia?

A

circadian clock
sleep drive
hyperarousal
beliefs and cognitions

61
Q

What are the hyperarousal factors that lead to insomnia?

A 
intrusive thoughts
beleifs re: sleep
sleep effor
muscle tension
conditioned arousal
62
Q

What are the circadian factors that lead to insomnia?

A

TIB misaligned with clock
Irregular sleep-wake schedules
Napping

63
Q

What are the contraindications for CBTI?

A
  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
64
Q

T/F: CBTI has equal efficacy to meds

A

true

65
Q

T/F: CBTI has longer lasting effects than meds

A

true

66
Q

T/F: medication is cheaper than CBTI

A

false

67
Q

How long may CBTI benefits last after treatment?

A

2 years

68
Q

Is relaxation training the same as CBTI?

A

nope

69
Q

Generally, do patients prefer CBTI or meds?

A

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

70
Q

With what type of insomnia are meds the most effective?

A

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

71
Q

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

A

true

72
Q

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

A

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

73
Q

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

A

true

74
Q

t/F: treating insomnia can cause depression remission

A

true

75
Q

T/F: insomnia and depression are linked

A

true

76
Q

What type of meditation is an effective analog to CBTI?

A

MBSR or MBTI

77
Q

Does MBSR or MBTI have higher rates of insomnia remission?

A

MBTI

78
Q

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

A

ACT (acceptance and commitment therapy)

79
Q

What is used to decrease the frequency of nightmares?

A

image rehearsal therapy (IRT)

80
Q

What is used for claustrophobic reactions to CPAP?

A

exposure therapy

81
Q

What is used to encourage CPAP use?

A

motivational enhancement

82
Q

T/F: CBT may improve CPAP adherence

A

true, insomnia and OSA happen together oftentimes

83
Q

T/F: CBT with CPAP had the greatest results

A

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

84
Q

what is the biggest barrier to CBTI?

A

lack of trained sleep therapists

85
Q

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

A

false; should be treated as its own entitiy

86
Q

When do you treat insomnia as a symptom?

A

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

Block 8 Week 1 Colt (10 decks)

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