Week6- sleep disorder Flashcards
what is insomnia?
struggles to fall asleep and wakes up not feeling refreshed
what are the 4 main stages of insomnia?
stage 1-drifting off
stage 2- 50% of total sleep
stage 3/4- the most important parts
e.g. memory, learning, forgetting, and growth
how many sleep cycles does someone go through a night and how long o they last?
4-6 sleep cycles and average at about 90mins each
what are the 3 main types of insomnia?
Transient - lasts less than a week, often
caused by depression, anxiety and stress
Intermittent - poor sleep for a few days
happening over several weeks
Chronic or primary insomnia - lasts for
longer than a month
what are the causes of insomnia?
Mood disorders- e.g. depression and many more
Substance misuse
Drug-induced- e.g. SSRIs should be taken in the morning not at night
ADHD (Attention Deficit Hyperactivity Disorder) can be the cause of long-term insomnia
Stress
Sleep hygiene deficiencies
Breathing problems- e.g. (asthma, sleep apnoea)
Medical problems -e.g. cardiac (angina, heart failure), Alzheimer’s disease
Age
History of light sleeping or sleep initiation
what is the risk of untreated insomnia? mentally
can leads to substance misuse leading to:
Substance misuse (by trying to self-medicate)
Coping less well with stress
Depression and anxiety (five times as likely)
Having car crashes (due to fatigue)
Having accidents at work (>7% of all serious accidents at work)
what is the risk of untreated insomnia? physical
Heart disease (twice as likely to get congestive heart failure) High blood pressure Infections (immune system compromised) Type 2 diabetes (up to five times as likely with <6hrs sleep a night) Intestinal problems Pain Premature death Obesity and weight gain
what is some sleep hygiene techniques that someone can take onboard?
Do not stay in bed for prolonged periods if not asleep
Avoid daytime naps or long periods of inactivity
A warm bath or gentle exercise before bedtime may help sleep, but avoid strenuous exercise or mental activity
Make sure that the bed and bedroom are comfortable and avoid extremes of
noise, temperature and humidity
Establish a regular bedtime routine
Make sure your bed is associated with sleep
Avoid smoking late at night - nicotine is a stimulant and can keep you awake Diet — carbohydrate (e.g. pasta etc.) helps sleep, but not eating a big meal within about two hours of going to bed.
Avoid back-lit screens (e.g. phone, iPad, TV, computer) for 2 hours before bed
Avoid caffeine or alcohol within 2 hours of going to bed
what can a patient do in if they have sleep problems?
-have a sleep diary and fill it in every day
-to find out what influences of sleep disorder
-what to include: Sleep/wake times
Caffeine/Alcohol/ Medication/
Deterioration in MH condition
How you felt the next day
what are some of the general principles of pharmacological management for sleep disorders?
Prescribe the lowest effective dose (especially in elderly and people with
hepatic/renal disease/respiratory failure)
Advise patients on interaction with alcohol and other sedating drugs
Advise patients on driving and skilled tasks
Limit duration of use - best to take intermittently or a “when required” basis
Consider the risk of tolerance and abuse if used beyond 4 weeks
Be aware of psychological dependence
When appropriate gradually withdraw
what are the 3 main types of hypnotics?
GABA enhancers- e.g “Z” Hypnotics and Benzodiazepines
Histamine Antagonists- e.g Promethazine
Melatonin Agonists e.g Melatonin
what is a type of GABA enhancer? dose? abuse possibility?
-zopiclone
-The abuse potential with Zs is remarkably lower than hypnotic Benzodiazepines
Widely used but a
metallic taste in the
mouth is distasteful to
many
Some (relatively
modest) abuse
potential
Usual dose 3.75-7.5mg
at night
One hour onset,
duration several hours
Zolpidem
•Less widely used but has advantages over
zopiclone
•Dose 5-10mg at Night (5mg is usually
adequate)
•Onset 15-30 minutes, duration 2hrs
•No metallic taste
•Some isolated reports of sleep-walking and
hangover effect
-shouldn’t drive within 8hrs of taking it
Useful for sleep induction due to rapid clearance
what are the different types of benzodiazepine?
Longer-acting:
Diazepam, Chlordiazepoxide, Temazepam
Shorter-acting:
Lorazepam, Oxazepam, Lormetazepam, Loprazolam
what are some main facts about benzodiazepines?
-help with imporving sleep latency and duration adverse drug reactions are common e.g. drowsiness
•They can disrupt the normal sleep architecture and
reduce REM sleep
•Use short acting BDZs to avoid hangover effect
•Can use intermittent dosing (alternate nights)
•Licensed for short term use only (2-4 weeks)
•With prolonged use, there may be psychological and
physiological dependence
•Users of benzodiazepines are at greater risk of road traffic accidents, especially if combined with alcohol
•Although relatively safe in overdose, BDZs (especially
Flunitrazepam and Nitrazepam) have been implicated
in drug poisoning suicides
what are some main facts about melatonin (circadin) for sleep disorder? whos is it licensed for and dose?
Modified Release product licensed for age over 55years, off licensed can be
effective in younger people
2 mg M/R once daily, 1-2 hours before
bedtime and after food. For up to thirteen weeks.
Very useful for insomnia from ADHD in
younger people
