Flashcards in Behavioral Science - Insomnia - Thomas L. Schwartz Deck (20)
What is dyssomnia? What conditions are classified as dyssomnias?
sleep disorder characterized by problems in timing, quality, or amount of sleep
insomnia, sleep apnea, narcolepsy
What is parasomnia? What conditions are classified as parasomnias?
sleep disorder characterized by abnormalities in physiology or behavior associated with sleep
Bruxism (involuntary or habitual grinding of the teeth during sleep), nightmare disorder, sleep terror disorder, sleepwalking disorder
DSM-V criteria for insomnia
Complaint of dissatisfaction with sleep quantity or quality, associated with at least one of these symptoms:
Difficulty initiating sleep
Difficulty maintaining sleep
Early-morning awakening with inability to return to sleep
Sleep disturbance causes distress or impairment
Disturbance occurs at least 3 nights per week and is present for at least 3 months
Disturbance is not attributable to the physiologic effects of a substance or a coexisting medical or mental disorder
What is the most common cause of insomnia?
Who gets more insomnia men or women?
Women - 50% more than men
What are possible endogenous causes of DSM-V criteria met insomnia disorder?
excess excitatory neurotransmitters at night time,
decificency of inhibitory neurotransmitters at night time
What inhibitory neurotransmitters may become dysregulated in insomnia? Excitatory?
NE - LC
SE - Raphe
DA - VTA
Histamine - Tubulomammilary body
What medical conditions can cause insomnia?
Pulmonary disease (chronic bronchitis, obstructive sleep apnea)
Endocrine disorders - hyperthyroidism, diabetes mellitus
Others: restless leg syndrome, CHF, nocturia secondary to diuresis
What psychiatric conditions can cause insomnia?
Major depressive disorder
Generalized anxiety disorder/PTSD
What are the sleep symptoms associated with depression?
Short REM sleep latency, repeated nighttime awakenings, waking too early in the morning
What are the sleep symptoms associated with bipolar disorder?
Manic and hypomanic patients have problems falling asleep and maintaining sleep
What are the sleep symptoms associated with anxiety diorder/PTSD?
Trouble falling asleep/nightmare
What is the conditioned stimulus-response relationship between insomnia and anxiety?
General anxiety can lead to insomnia, which can progress in to anxiety about the insomnia itself - e.g. whether you will be able to fall asleep
Getting into bed (stimulus) leads to anxiety (state of increased wakefullness/vigilance) about falling asleep and inability to sleep (response)
What are some effects associations of insomnia?
Decreased quality of life
Complaints of impaired daytime performance and more accidents, absenteeism and presenteeism
Self-medication and risk of substance abuse occurs
Association between insomnia and psychiatric disorders
- predictor for development of major depression or alcohol dependence
1st step to management of insomnia
diagnosis, informed consent and education about causes of disorder and therapy
important to rule out other medical conditions that might be causing the insomnia. E.g. obstructive sleep apnea, chronic pain, diuretic use causing nocturia, hyperthyroidism, depression, anxiety
2nd step to management of insomnia
Sleep hygiene/Stimulus control
3rd step in management of insomnia
Sleep restriction therapy
cognitive therapy ( e.g. work with therapist about sleep anxiety and sleep expectations)
behavioral therapy ( e.g. sleep logs, relaxation,self hypnosis)
What is sleep restriction therapy?
limit total time in bed to increase the drive to sleep (delayed sleep schedule can shift circadian clock resulting in sleeping in longer in morning)
4th step in management of insomnia
pharmacotherapy - stepwise approach
OTC>non-habit forming Rx>mild habit forming Rx>habit forming Rx
Melatonin/antihistamines>Rx antihistamines (doxepin)/Rx melatonin receptor agonists (ramelteon/tasimelteon)>BZRAs(zolpidem, zaleplon, ezopiclone)/Orexin recptor antagonists (suvorexant)>Benzos (temazepam, triazelam, flurazepam)/off label drugs (trazadone, quietidone)