Insomnia Flashcards
How is the duration of insomnia classified as?
transient - few days
short-term - up to 3 weeks
chronic - greater than 3 weeks
What is insomnia?
disturbed sleep -waking in the middle of the night
trouble getting to sleep
waking up too early or feeling tired throughout the day despite sleeping early
what questions would you ask a pt with insomnia?
- pattern of sleep - emotional disturbance
- daily routine - shift patterns, more workload
- underlying medical conditions - GORD, pregnancy, asthma
- recent travel - time zones
- daytime sleeping - naps throughout the day
what medicines can induce insomnia?
- Stimulants: caffeine - more than 4 cups can cause insomnia, theophylline MAOIs
- antiepileptics
- alcohol
- BB
- SSRIs
- diuretics - must take in the morning
- griseofulvin
When to refer a pt with insomnia?
- Duration longer than 3 weeks - chronic insomnia
- children under 12
- suspected adverse events from medication like fluoxetine, MAOI’s
- suspected depression
- prostatic hypertrophy and closed angle glaucoma are C/I to antihistamine therapy
what are key steps to good sleep hygiene?
maintain a regular routine food snacks and alcoholic/caffeine should be avoided avoid stimulants and alcohol no naps associate bed with sleep recommend ways to prevent snoring lavendar oil light exercise in the evening warm bath
What tx options are available for pts with insomnia?
first generation antihistamines (diphenhydramine, promethazine)
melatonin - reduces jet lag, taken at night
What are the age restrictions of first generation antihistamines? side effects? Interaction?
> 16 years
dry mouth, sedation
glaucoma, prostrate enlargement
when should diphenhydramine and promethazine be taken?
DPH: 20 mins before bed
Promethazine: one hour before bed
what are branded names of antihistamines used for insomnia?
Nytol
Nightcalm
