ic15 sleep disorder Flashcards
dsm5 criteria for insomnia DISORDER?
≥1 of following complaints
- difficult with sleep initiation
- sleep maintenance
- early morning awakening
associated w social occupation… functional impairment
at least 3 nights per week for at least 3 months
happens even w ample opportunity to sleep
not due to another condition or drug
classification for ACUTE insomnia SYMPTOMS?
1 night - few weeks
TRANSIENT (no need for phx therapy, should be self-limiting)
<1 week
SHORT TERM
< 4 weeks
likely caused by acute stressors
classification for CHRONIC insomnia SYMPTOMS?
sleep difficulties for ≥3 nights/week for ≥1 month
(>4 weeks)
likely secondary to underlying psych or medical problems…
investigate and manage causes
discourage long term use of hynotics
what is first line treatment for insomnia? (explain)
sleep hygiene
- avoid caffeine/nicotine/alcohol especially later in the day
- avoid heavy meals within 2 hours of bedtime
- avoid drinking fluids after dinner to prevent night time urination
- avoid environments that will make you active after 5pm
- establish routine
- avoid taking daytime naps (if needed, before 3pm and less than 1h)
- pursue regular physical activities.
phx management of insomina?
use fast acting anxiolytics/sedative/hypnotics as adjunct, short term relief to distressful insomnia/anxiety.
PRN, lowest dose, for 1-2 weeks.
help patient relax and sleep
side effects of benzodiazepines
sedation, drowsiness, amnesia
muscle-related: muscle weakness, ataxia,
less common:
- slurred speech, vertigo, headache, confusion, paradoxical excitement
toxicity: respiratory depression
which BZP to use for insomnia (and how)
diazepam and lorazepam
lorazepam preferred due to shorter t1/2.
limit to 2 weeks PRN at lowest dose.
moa of z hypnotics
binds to the bzp binding sites with gamma and alpha1 subunits
side effects of z hypnotics
zolpiclone: taste disturbance
less common: N/V, dizziness, sedation, dry mouth, headache
rare: amnesia, confusion, hallucination, nightmare, sleep walking
may develop tolerance similar to benzodiazepines.
choice of z hypnotics
zolpidem t1/2 1.5-4h
- useful for initiating sleep
zolpiclone t1/2 6h
- useful for maintaining sleep
choice of antihistamines for sleep disorder
promethazine
hydroxyzine
SE of antihistamines used for sleep disorder
sedation
anticholinergic (dry mouth, constipation)
moa of lemborexant
ox1 and ox2 orexin receptor antagonist
SE of lemborexant
somnolence
nightmare
uncommon: sleep paralysis, hypnagogic (with sleeping)/hypnopompic hallucinations (with waking up), cataplexy-like sx
lemborexant contraindications
narcolepsy
severe hepatic impairment
mod-strong cyp3a inhibitors/inducers
