Anxiety & Sleep Disorders Flashcards
The brain contains ___________ neurons and ____________ connections.
100 billion
1000 trillion
What are psychiatric disorders?
Central nervous diseases characterized by disturbances in emotion, cognition, motivation and socialization
Why are anxiety and sleep disorders high in co-occurance?
- In pts with anxiety there is an excess of “stimulating” neural flow relative to “calming” neural flow
- considerable overlap of symptoms, pathophysiology and treatment approaches
What is the diagnostic criteria of GAD (generalized anxiety disorder)?
- excessive anxiety and worry occurring more days than not for 6 months
- pt finds it difficult to control the worry
- associated with 3 or more of these Sx:
- restlessness, feeling keyed up, on edge
- easily fatigued
- difficulty concentration, mind going blank
- irritability
- muscle tension
- sleep disturbance
What is dimenhydinate?
What is it used for?
- Gravol…used for motion sickness
- antihistamine, anticholinergic
- CNS depressant
- causes drowsiness and sedation
- used as an off-label sleep aid
What is stage 3 and 4 of sleep called?
- delta sleep
- muscle atonia and restoration
What is non-REM sleep enabled by?
- primary serotonergic tracts in medulla and dorsal Raphe nucleus
What is REM sleep controlled by?
Turned on by cholinergic tracts
Turned off by noradrenergic areas
What neurotransmitters induce wakefulness?
- dopamine
- NE
- Ach
- Histamine
- Substance P
- Corticotropin releasing factor –> cortisol
What is insomnia?
What can it be caused by?
- difficultly falling asleep, difficulty maintaining sleep or non-restorative sleep
- can be caused by situational, medical, psychiatric or pharmacological factors
- can be transient, short-term or chronic
What is sleep hygiene?
- make regular times to go to bed and wake up
- sleep only as much necessary to feel rested
- go to bed when sleepy, avoid long periods of wakefulness in bed
- if you don’t fall asleep within 20-30 mins, get out of bed and do something relaxing
- avoid day naps
- schedule worry time in the day
- exercise routinely, not close to bedtime
- minimize sensory stimulation during bedtime
- reduce use of caffiene, nicotine and alcohol
- avoid large quantities of liquids at night
- do something relaxing and enjoyable before bedtime
What are the treatment targets for insomnia?
- address the reversible causes and utilize sleep hygiene
- enhance GABA, serotonin
- inhibit histamine, Ach, NE, DP, Substance P, cortisol
- GABA agonists (benzos), non-benzo GABA agonists, antihistamines, antidepressants, melatonin agonists
What are the medical causes of anxiety?
- CV
- neuro
- endo
- resp
What are the psychiatric causes of anxiety?
- depression
- bipolar
- schizophrenia
- Alzheimer’s
- substance abuse
What drugs can cause anxiety?
- antidepressants
- bronchodilators
- steroids
- herbals
- thyroid
- stimulants
- withdrawal from sedatives
