Insomnia Flashcards
what are the neurotransmitter promoting sleep?
GABA
what are the neurotransmitter promote wakefulness
NE, DA, acetylcholine, histamine, orexin
which stage of the sleep is the restorative sleep?
delta, stage 3-4
what is insomnia?
inability to initiate/maintain sleep, associated with daytime problems (fatique, impaired concentration/memory)
insomnia disorder (DSM-5 criteria)
- at least 1 of the following:
- difficulty with sleep initiation
- difficulty with sleep maintenance
- early morning awakening - sleep compliant is associated with social, occupational, academic, educational, behavioral/functional distress/impairment
- at least 3 nights/week and for at least 3 months
- sleep difficulties happen even with ample opportunity to sleep
- sleep compliant not attributed to/explained by another sleep-wake disorder, adverse effect of medication/substance or co-existing psychiatric illness/medical condition
how can anxiety disorder be classfied?
acute (sleep difficulties for 1 nights - few weeks):
- transisent < 1wk
- short-term < 4wk
chronic >4wk
how is transient acute anxiety disorder manage?
sleep hygiene
usually self-limiting
how is short-term insomnia manage?
short term PRN course of hypnotic for 7-10d, up to 204w
sleep hygiene
how is chronic insomnia manage?
investigate for underlying psychiatric/medical condition –> treat them
sleep hygiene
discourage long-term use of hypnotics
principle of pharmacological therapy for insomnia?
Fast acting Anxiolytics/ Sedatives/ Hypnotics , are intended only as
adjuncts for short term relief of distressful Insomnia/ Anxiety,
- limited to PRN dosing, at lowest effective dose, & short course (1 2 weeks)
- continuous use is harmful if the primary physical/mental issue is not resolved.
what are the non-pharmacological therapy for insomnia?
- Avoid the use of caffeine containing products, nicotine and alcohol especially later in the day.
- Avoid heavy meals within 2 hours of bedtime.
- Avoid drinking fluids after dinner to prevent frequent night time urination.
- Avoid environments that will make you really active after 5pm (i.e. avoid noisy
- Establish a routine for getting ready to go to bed.
- Avoid taking daytime naps. If you have to take them, make sure you do so before 3.00 pm and that
the total napping time does not exceed one hour. - Pursue regular physical activities like walking or gardening but avoid vigorous exercise too close to bedtime.
what are the adjunctive treatment for insomnia?
hypnotics:
- benzodiazepones
- z-hypnotics (zolpidem, zopiclone)
- antihistamine
- melatonin receptor agonist
- lemborexant
MOA for benzodiazepine?
potentiates GABA
side effects for benzodiazepine?
sedation, drowsiness, muscle weakness, ataxia, amnesia
duration of treamtment for benzodiazepines?
short term, limit to 2 weeks PRN at lowest effective dose
