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Sleep medicine > Insomnia > Flashcards

Insomnia Flashcards

1
Q

What are 2 requirements for a diagnosis of insomnia?

A
  • Adequate opportunity and circumstances for sleep
  • Daytime impairment
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2
Q

Can a patient have a psychiatric disorder and insomnia at the same time?

A

Yes. Treating depression successfully will not necessarily improve the insomnia

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3
Q

What is the prevalence for chronic insomnia? Transient insomnia?

A

Chronic insomnia = 10%

Transient insomnia = 30%

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4
Q

What are the 4 components of CBT?

A
  1. Sleep restriction
  2. Stimulus control therapy
  3. Relaxation therapy
  4. Sleep hygiene
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5
Q

What is the minimum amount of time in bed for sleep restriction therapy?

A

5 hours

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6
Q

In sleep restriction therapy, what sleep efficiency should the patient obtain before lengthening the time in bed? How much time should be added?

A

At least 85% sleep efficiency

Increase TIB by 15 to 30 min

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7
Q

What is cognitive restructuring?

A

Changing faulty beliefs and attitudes that patient’s with insomnia have about sleep

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8
Q

What is an essential feature of idiopathic insomnia?

A

Onset of the insomnia in childhood or infancy

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9
Q

What is the MOA of suvorexant (abelsomra)? Is it addictive?

A

Orexin antagonist. It has the potential for addiction.

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10
Q

What do beta blockers, NSAIDS and corticosteroids have in common?

A

They can all cause insomnia

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11
Q

Which can cause insomnia: Alpha 1 or alpha 2 blockers?

A

Alpha 1 blockers (like prazosin) can cause insomnia

Alpha 2 blockers like yohimbine are not used much In humans

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12
Q

Which are associated with somnolence and fatigue: alpha 1 or alpha 2 agonists?

A

Alpha 2 agonists (like clonidine) are associated with somnolence and fatigue

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13
Q

What are the major neurotransmitters that regulate sleep?

A
  • GABA
  • Galanin
  • Melatonin
  • Adenosine
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14
Q

What receptors do benzodiazepines bind to?

A

They nonselectively bind to GABA A receptors

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15
Q

What receptors to non benzodiazepine BzRAs bind to?

A

Alpha 1 subunit on GABA A receptors

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16
Q

What pharmacologic effects are lost with non benzodiazepine BzRAs?

A

Anxiolysis and muscle relaxant effects

It still has antiseizure and amnesia effects

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17
Q

What does the MSLT show in patients with insomnia?

A

Usually normal. Several studies show longer mean MSLT, indicating hyperalertness

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18
Q

What effect do barbiturates have on REM sleep?

A

They are potent REM inhibitors

19
Q

What is the main effect of benzodiazepines on sleep architecture?

A

They inhibit N3 sleep and to a lesser degree, REM sleep

20
Q

What antidepressants are the most potent inhibitors of REM sleep?

A

MAOIs

  • selegiline
  • rasagiline
21
Q

Zolpidem (Ambien) peak plasma level?

1/2 life?

A
  1. 5 hours
  2. 5 hours
22
Q

Antipsychotics typically increase N3 sleep except for?

A

quetiapine

23
Q

Mirtazepine helps with sleep because it blocks what receptors?

A
  • Adrenergic (alpha 1, alpha 2)
  • Sertoninergic (5HT2 and 5HT3)
  • Histaminergic (H1)
24
Q

Why is buspirone not sedating?

A

It is a partial serotonergic (5HT1A) agonist. It is an anxiolytic

25
Q

What effects does caffeine have on sleep architecture?

A

Prolongs latency to sleep onset and decreases N3 sleep

26
Q

What is the 1/2 life of caffeine?

A

3 to 5 hours

27
Q

What effects does diphenhydramine have on sleep?

A
  • Shortens sleep onset
  • Does NOT increase TST
  • Does NOT reduce nightime awakenings
28
Q

When is chloral hydrate used and what effects does it have on sleep architecture

A
  • Pediatric sleep aid
  • Acts on barbiturate receptor sites at GABA A receptors
  • 5 to 10 hr 1/2 life
  • Shortens LTSO and improves sleep continuity
  • No significant effect on N3 or REM
29
Q

Doxepin is FDA approved to help with what areas of sleep?

A

Onset and maintenance insomnia, mostly maintenance

30
Q

How long does it take for doxepin to achieve peak plasma level and what area of sleep does it help the most?

A

Peak plama in 1.5 to 4 hours after ingestion (15 hr 1/2 life)

It helps most with the last 1/3 of sleep

31
Q

What MOA likely explains beta blockers affect on sleep?

A

They decrease melatonin release

32
Q

What H2 receptor antagonist can decrease the clearance of benzo receptor agonists the most?

A

Cimetidine

33
Q

Name 3 effects that NSAIDs have that impairs sleep

A
  • Decreases melatonin release
  • Decrease the synthesis of protaglandin D2

Prostaglandin (PG) D2 and adenosine are potent humoral sleep-inducing factors that accumulate in the brain during prolonged wakefulness. PGD2 is produced in the brain by lipocalin-type PGD synthase, which is localized mainly in the leptomeninges, choroid plexus and oligodendrocytes, and circulates in the cerebrospinal fluid as a sleep hormone.

  • Impair the normal drop in body temperature
34
Q

What is the prevalence of insomnia in persons older than 65 years?

A

35 to 50%

35
Q

How many times per week should a patient have difficulty sleeping to meet a diagnosis of chronic insomnia?

A

At least 3 times per week

36
Q

What is paradoxical insomnia?

A

Also called sleep state misperception. Pt reports severe insomnia without daytime symptoms or correlating PSG findings

37
Q

What is adjustment insomnia?

A

Insomnia associated with an identifiable stressor lasting only a few days to several weeks but less than 3 months

38
Q

What is the most common cause of nocturnal awakenings during pregnancy?

A

Nocturia

39
Q

In sleep restriction therapy, what does the sleep efficiency need to be to allow an additional 15 minutes in bed for the next 7 days?

A

At least 85%

40
Q

What will the EEG show during acute sleep deprivation?

A
  • Decreased alpha activity with eye closure (if awake > 115 hours alpha can disappear entirely)
    • In chronic sleep deprivation alpha activity might not change at all
  • Increased theta and delta activity
41
Q

What are the diagnostic criteria for irregular sleep-wake rhythm disorder?

A
  • At least 3 irregular sleep-wake cycles (1 to 4 hrs sleep) over 24 hours
  • 2 week sleep diary/actigraphy
42
Q

What disorders commonly have irregular sleep-wake rhythm disorder?

A
  • Dementia
  • Developmental disorders
  • Head injury
  • Schizophrenia
43
Q

What 2 OTC meds are FDA approved for treating insomnia?

A
  • Diphenhydramine
  • Doxylamine (Unisom)

Sleep medicine (21 decks)

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