Sleep & Sleep disorders

Question 1

Drugs that may cause insomnia

Answer 1

tricyclics
narcotics
diphenhydramine can be stimulating

Question 2

Goals in tx insomnia

Answer 2

1) resolve the underlying problem
2) improve the quality of life
3) prevent progression of transient insomnia to chronic insomnia

behavioral techniques
sleep hygiene
relaxation technique
stimulus control
cognitive therapy
combined therapy

Question 3

Drug for tx of insomnia

Answer 3

Fluoxetine (prozac) - an SSRI used for antidepressants, causes apetite loss and nightmares bc its an activating med.

dont take at night!

Question 4

Sedating Antidepressants

Answer 4

compare the risk:benefit

CONTRAINDICATED: benign prostate hypertrophy (BPH) or cardiovascular disease
CAUTION IN ELDERLY - Amitryptyline (TCA) prevents older patients from peeing

Question 5

Antihistamines

Answer 5

Hydroxyzine - first generation histamine, causes DEEP SLEEP
Diphenhydramine

may worsen or cause insomnia so they are not good for sleeping disorders

side effects: psychotic, dry mouth

Question 6

Pt with unusual and severe leg sensations
creepy, crawling, searing pain
helped by walking, rubbing, and heat

Answer 6

Restless Leg Syndrome

Question 7

Tx for restless leg syndrome

Answer 7

anti-parkinson medications (SE: increases chances of compulsive behaviours)
Benzodiazepines: chlonafen, rifazepen, lorazepan
opiates - not as often
TCA antidepressants - neurotin or gabapentin

Question 8

Most common disorder of daytime comnolence

Answer 8

sleep apnea

Question 9

Pt sleepy, headaches, insomnia, memory trouble, irritable, slow reaction time, hypertension and nocturia
Pt snore and gasp and are woken up because they are not breathing

Answer 9

sleep apnea

Question 10

Tx for sleep apnea

Answer 10

lose weight
CPAP
tennis balls
surgery - UPPP
avoid sleeping pills and alcohol

Question 11

Issue on chromosome 6

Answer 11

narcolepsy

Question 12

Narcolepsy

Answer 12

first sx show up in second decade
deficiency of hypocretin 2 aka orexin-B - secreted by lateral hypothalamus
Tetrad:
1) excessive daytime sleepiness
2) cataplexy - sudden loss of muscle tone
3) sleep paralysis
4) hynagogic hallucinations

sx in a third of pts improve with age

Question 13

DDx narcolepsy

Answer 13

epilepsy due to sudden collapses

disorder of excessive somnolence (DOES)

Question 14

Tx narcolepsy

Answer 14

eduction
naps
exercise
meds:
caffiene
pemoline - removed off market due to liver damage
methylphenidate
TCA - SE decreases REM sleep
modafinil
sodium oxybate - date rape drugs, good for the cataplexy part

Question 15

Pt suffers from sleep depression, drinks, is taking MAO inhibitors and TCA

Answer 15

Pt will experiance REM suppression and Rebounds

get crazy dreams when you end up sleeping, so you’re hyper-dreaming

Question 16

category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams

most often seen in KIDS

Answer 16

parasomnias

Question 17

Somnambulism

Answer 17

sleep walking
occurs during stage III or IV
difficult to arouse
confusional state
susceptible to injury

Question 18

Night Terrors (Pavor Nocturnus)

Answer 18

age 2-12
screaming, crying, or intense fear
Stage III AND IV sleep
3-5 minutes
don't recall dream

Question 19

tx parasomnias

Answer 19

psychological therapy
guard against injury
benzodiazepines - SE is an advantage bc it inhibits stage III and IV sleep
avoid precipitating causes like loud noises, medications, full bladder, sleep deprivation

Question 20

Tx for nocturnal enuresis

Answer 20

impipramine for 5 months - short terms

DDAVP (desmopressin)