Sleep- Insomnia

Question 1

Most commonly reported sleep disorder

Answer 1

Insomnia

Question 2

Insomnia definition

Answer 2

Difficulty falling asleep, maintaining sleep, or nonrestorative sleep

Question 3

Transient insomnia defintion

Answer 3

Insomnia that lasts a few days

Question 4

Short-term insomnia defintion

Answer 4

Insomnia lasting <3 months

Question 5

Chronic insomnia definition

Answer 5

Insomnia that occurs at least 3 nights/week for ≥3 months

Question 6

Chronic insomnia comorbidities

Answer 6

psychiatric or medical conditions

Question 7

Causes of transient insomnia

Answer 7

Stress, jet lag or shift work, schedule changes, medical issues, psychiatric issues, pregnancy, drug-related

Question 8

Drugs that can cause or worsen insomnia

Answer 8

Alcohol, nicotine, caffeine, anticholinergics, SSRIs/SNRIs, alpha and beta-blockers, ACEis/ARBs, cholinesterase inhibitors, bronchodilators, CNS stimulants, corticosteroids, decongestants, diuretics, H2RAs, statin, opioids

Question 9

Causes of short-term insomnia

Answer 9

Untreated or underrated transient insomnia, acquired exacerbating behavior

Question 10

Goals for treating transient insomnia

Answer 10

Correct underlying sleep disorder and avoid ADEs

Question 11

Suggested treatment for transient insomnia

Answer 11

Bedtime doses of BZDRAs x2-3 weeks

Question 12

Factors to consider for transient insomnia treatment

Answer 12

Desirability for daytime anxiolytic effect

Need for next day early morning cognitive sharpness

DDIs

D/C of problematic meds

PK profile of BZDRA and patient’s specific insomnia complaints

Question 13

Goal of short-term insomnia treatment

Answer 13

Result in the patient sleeping normally with no medications

Question 14

Nonpharm options for short-term insomnia treatment

Answer 14

Correcting underlying sleep complaint, institution of good sleep hygiene, sleep diary

Question 15

Sleep hygiene techniques

Answer 15

Maintain regular sleep schedule

Establish calm bedroom setting

Don’t spend time in bed if awake

Limit intake of nicotine, caffeine, alcohol

Exercise regularly, but not close to bedtime

Light snack or warm milk/drink before bedtime

Avoid watching the clock

Question 16

Pharm treatment options for short-term insomnia

Answer 16

Adequate bedtime doses of BZDRAs x2-3 weeks, which may be followed by:

Reduction of bedtime doses and continuation for 2-3 weeks

Reduction to every other night for 2-3 weeks

Provision of small PRN supply

Question 17

Preferred therapy for long-term insomnia

Answer 17

CBT

Question 18

What to do if rapid improvement of long-term insomnia is necessary

Answer 18

CBT with medications