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PHA333 > Wk 31 - Sleep disorders 2 > Flashcards

Wk 31 - Sleep disorders 2 Flashcards

1
Q

What is insomnia?

A

Inability to fall asleep and/or by waking up during the night + difficulty going back to sleep

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2
Q

What is the major cause of insomnia in terms of medical conditions?

A
  • Cardiac
  • Neurologic
  • Endocrine
  • Pulmonary
  • Gastrointestinal
  • Hematologic conditions
  • Substances
  • Meds
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3
Q

What is the major cause of insomnia in terms of psychiatric conditions?

A
  • Depression
  • Post traumatic stress disorder
  • Psychotropic medication
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4
Q

What is the major cause of insomnia in terms of environmental conditions?

A
  • Stressful or life-threatening events
  • Shift work, jet lag or changes in altitude
  • Overly warm sleeping env
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5
Q

Give examples of behavioural changes that may be used to treat insomnia

A
  • Following specific nighttime routine
  • Improving sleep env
  • Red caffeine + alcohol intake
  • Red afternoon nap
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6
Q

How does alcohol affect REM sleep?

A

Alcohol inhibits REM sleep, restorative stages of sleep + tf doesn’t promote good restful sleep

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7
Q

Which class of drugs are used to combat insomnia?

A
  • Antihistaminergic
  • Benzodiazepines
  • Z drugs
  • Antidepressants
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8
Q

Which antihistamines are used to aid sleep?

A
  • Diphenhydramine

- Doxylamine

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9
Q

Which benzodiazepines are used to aid sleep?

A

Higher activity at a1 GABAA subunit receptor:

  • Temazepam
  • Flunitrazepam
  • Triazolam
  • Flurazepam
  • Midazolam
  • Nitrazepam
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10
Q

What can hypnotic BZD lead to?

A
  • Tolerance
  • Physical dependence
  • W/drawal upon discontinuation
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11
Q

Which Z-drugs are used to aid sleep?

A
  • Zolpidem
  • Zaleplon
  • Zopiclone
  • Eszopiclone
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12
Q

Which antidepressants are used to aid sleep?

A
  • Amitriptyline
  • Doxepin
  • Mirtazapine
  • Trazodone
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13
Q

What are the effects of antidepressants?

A

Can lead withdrawal effect which may induce rebound insomnia:

  • Amitriptyline + doxepin: have antihistaminergic, anti-cholinergic + anti-adrenergic properties
  • Mirtazapine: has antihistamine + anti-serotonergic activity, s/e: drowsiness + weight gain
  • Trazodone: s/e: orthostatic hypotension + sedation
  • Trimipramine: does not suppress REM sleep
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14
Q

Agomelatine

A
  • Melatonergic antidepressant
  • Doesn’t cause daytime drowsiness
  • Agonist at MT1 + 2
  • Antagonist at 5-HT2B + 5-HT2C receptor
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15
Q

What are the interactions of agomelatine?

A
  • Birth control pills inc melatonin
  • Caffeine dec melatonin
  • Fluvoxamine inc melatonin
  • Melatonin inc blood sugar tf dec effectiveness of diabetes med
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16
Q

Circadin

A
  • Contains melatonin

- Relieves insomnia for >55

17
Q

What is narcolepsy?

A

Chronic neurological disorder caused by brain’s inability to regulate sleep-wake cycle normally (pass from wakefulness to REM)

18
Q

What can narcolepsy lead to?

A

Hypersomnia -> excessive sleepiness during day -> sudden bouts of sleep that occur several times per day

19
Q

When is narcolepsy most evident?

A
  • Adolescence/young adulthood

- Affects men + women

20
Q

What is 3 symptoms that may not occur in people with narcolepsy?

A
  • Cataplexy
  • Sleep paralysis
  • Hypnagogic hallucinations
21
Q

What are some measures that can be used for someone suffering from narcolepsy?

A
  • Weight loss
  • Abstain from alcohol + nicotine
  • Sleep hygiene
  • Psychotherapeutic techniques
22
Q

What is the primary treatment to help people with narcolepsy to stay awake during the day?

A

CNS stimulant - except methylphenidate + amphetamine

23
Q

Give examples of psychostimulants used to help with narcolepsy

A
  • Pemoline: ADHD + narcolepsy, not used due to hepatotoxicity
  • Modafinil: non-amphetamine, used to treat sleepiness associated w/ narcolepsy, sleep work shift disorder + obstructive sleep apnea
24
Q

Give other examples of medication used for narcolepsy other than psychostimulants

A

Fluoxetine + Venlafaxine suppress REM

25
Q

What is used for treatment of cataplexy?

A
  • Sodium oxybate (xyrem)
  • Take 2 doses at bedtime + 4 hrs later
  • S/e: nausea, bedwetting + worsening sleep walk
  • W/ sleep meds, narcotic pain reliever + alcohol -> difficulty breathing, coma + death
26
Q

What is cataplexy a result of?

A

Absence of orexin NT in hypothalamus

27
Q

What plays a role in narcolepsy?

A

Hypocretins (orexins) prod by hypothalamus

28
Q

What is suvorexant?

A
  • Blocks orexin receptors
  • Indicated: insomnia difficulty w/ sleep onset + maintenance
  • Contraindicated for narcolepsy
  • Not for liver impairment
  • Causes fetal harm during pregnancy
29
Q

What is restless legs syndrome?

A
  • Irresistible urge to move legs
  • Symptoms exacerbated by rest/inactivity
  • Partially relieved by movement
30
Q

People with RLS have increased number of what?

A

K-complexes

31
Q

Which medications reduce RSL?

A
  • L-dopa but doesn’t red K-complex

- Clonazepam - inhibits REM + dec freq. K complexes -> improves sleep restoration

32
Q

Give examples of mild RSL treatments

A
  • Exercise
  • Leg massages
  • Eliminate alcohol + caffeine
33
Q

Which medications are used for RSL?

A
  • DA agonist = 1st line
  • Pramipexole + ropinirole
  • Pergolide (less effective + more s/e)
  • Zolpidem, zaleplon + clonazepam: muscle relaxants
34
Q

What are the types of sleep apnea + what are their differences?

A
  • Obstructive sleep apnea (obstruction of upper airway)

- Central sleep apnea (no effort made to breath)

35
Q

What is obstructive sleep apnea?

A
  • Cessation/dec in airflow in presence of breathing effort
  • Untreated: heart arrhythmias, HF, high BP + stroke
  • Goal: keep airway open
36
Q

What is central sleep apnea?

A
  • Effort to breathe diminished/absent for 10-30 secs

- Leads to problems w/ brainstem

37
Q

What are conditions that can cause central sleep apnea?

A
  • Stroke affecting brain stem
  • Encephalitis
  • PD
  • Arthritis in cervical spine/base of skull
  • Complications in cervical spine surgery
  • Radiation of cervical spine
  • Bulbar poliomyelitis
  • Obesity
  • Primary hypoventilation syndrome
  • Narcotic containing painkillers
38
Q

What is the treatment for central sleep apnea?

A
  • Addressing med problem
  • Red opioid med
  • CPAP
  • BPAP
  • ASV
  • Supplemental oxygen
  • Acetazolamide

PHA333 (35 decks)

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