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Insomnia Flashcards

(43 cards)

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1
Q

What are 2 requirements for a diagnosis of insomnia?

A
  • Adequate opportunity and circumstances for sleep
  • Daytime impairment
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2
Q

Can a patient have a psychiatric disorder and insomnia at the same time?

A

Yes. Treating depression successfully will not necessarily improve the insomnia

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3
Q

What is the prevalence for chronic insomnia? Transient insomnia?

A

Chronic insomnia = 10%

Transient insomnia = 30%

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4
Q

What are the 4 components of CBT?

A
  1. Sleep restriction
  2. Stimulus control therapy
  3. Relaxation therapy
  4. Sleep hygiene
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5
Q

What is the minimum amount of time in bed for sleep restriction therapy?

A

5 hours

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6
Q

In sleep restriction therapy, what sleep efficiency should the patient obtain before lengthening the time in bed? How much time should be added?

A

At least 85% sleep efficiency

Increase TIB by 15 to 30 min

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7
Q

What is cognitive restructuring?

A

Changing faulty beliefs and attitudes that patient’s with insomnia have about sleep

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8
Q

What is an essential feature of idiopathic insomnia?

A

Onset of the insomnia in childhood or infancy

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9
Q

What is the MOA of suvorexant (abelsomra)? Is it addictive?

A

Orexin antagonist. It has the potential for addiction.

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10
Q

What do beta blockers, NSAIDS and corticosteroids have in common?

A

They can all cause insomnia

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11
Q

Which can cause insomnia: Alpha 1 or alpha 2 blockers?

A

Alpha 1 blockers (like prazosin) can cause insomnia

Alpha 2 blockers like yohimbine are not used much In humans

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12
Q

Which are associated with somnolence and fatigue: alpha 1 or alpha 2 agonists?

A

Alpha 2 agonists (like clonidine) are associated with somnolence and fatigue

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13
Q

What are the major neurotransmitters that regulate sleep?

A
  • GABA
  • Galanin
  • Melatonin
  • Adenosine
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14
Q

What receptors do benzodiazepines bind to?

A

They nonselectively bind to GABA A receptors

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15
Q

What receptors to non benzodiazepine BzRAs bind to?

A

Alpha 1 subunit on GABA A receptors

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16
Q

What pharmacologic effects are lost with non benzodiazepine BzRAs?

A

Anxiolysis and muscle relaxant effects

It still has antiseizure and amnesia effects

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17
Q

What does the MSLT show in patients with insomnia?

A

Usually normal. Several studies show longer mean MSLT, indicating hyperalertness

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18
Q

What effect do barbiturates have on REM sleep?

Study These Flashcards
A

They are potent REM inhibitors

19
Q

What is the main effect of benzodiazepines on sleep architecture?

Study These Flashcards
A

They inhibit N3 sleep and to a lesser degree, REM sleep

20
Q

What antidepressants are the most potent inhibitors of REM sleep?

Study These Flashcards
A

MAOIs

  • selegiline
  • rasagiline
21
Q

Zolpidem (Ambien) peak plasma level?

1/2 life?

Study These Flashcards
A
  1. 5 hours
  2. 5 hours
22
Q

Antipsychotics typically increase N3 sleep except for?

23
Q

Mirtazepine helps with sleep because it blocks what receptors?

Study These Flashcards
A
  • Adrenergic (alpha 1, alpha 2)
  • Sertoninergic (5HT2 and 5HT3)
  • Histaminergic (H1)
24
Q

Why is buspirone not sedating?

Study These Flashcards
A

It is a partial serotonergic (5HT1A) agonist. It is an anxiolytic

25
What effects does caffeine have on sleep architecture?
Prolongs latency to sleep onset and decreases N3 sleep
26
What is the 1/2 life of caffeine?
3 to 5 hours
27
What effects does diphenhydramine have on sleep?
* Shortens sleep onset * Does NOT increase TST * Does NOT reduce nightime awakenings
28
When is chloral hydrate used and what effects does it have on sleep architecture
* Pediatric sleep aid * Acts on barbiturate receptor sites at GABA A receptors * 5 to 10 hr 1/2 life * Shortens LTSO and improves sleep continuity * No significant effect on N3 or REM
29
Doxepin is FDA approved to help with what areas of sleep?
Onset and maintenance insomnia, mostly maintenance
30
How long does it take for doxepin to achieve peak plasma level and what area of sleep does it help the most?
Peak plama in 1.5 to 4 hours after ingestion (15 hr 1/2 life) It helps most with the last 1/3 of sleep
31
What MOA likely explains beta blockers affect on sleep?
They decrease melatonin release
32
What H2 receptor antagonist can decrease the clearance of benzo receptor agonists the most?
Cimetidine
33
Name 3 effects that NSAIDs have that impairs sleep
* Decreases melatonin release * Decrease the synthesis of protaglandin D2 Prostaglandin (PG) D2 and adenosine are potent humoral sleep-inducing factors that accumulate in the brain during prolonged wakefulness. PGD2 is produced in the brain by lipocalin-type PGD synthase, which is localized mainly in the leptomeninges, choroid plexus and oligodendrocytes, and circulates in the cerebrospinal fluid as a sleep hormone. * Impair the normal drop in body temperature
34
What is the prevalence of insomnia in persons older than 65 years?
35 to 50%
35
How many times per week should a patient have difficulty sleeping to meet a diagnosis of chronic insomnia?
At least 3 times per week
36
What is paradoxical insomnia?
Also called sleep state misperception. Pt reports severe insomnia without daytime symptoms or correlating PSG findings
37
What is adjustment insomnia?
Insomnia associated with an identifiable stressor lasting only a few days to several weeks but less than 3 months
38
What is the most common cause of nocturnal awakenings during pregnancy?
Nocturia
39
In sleep restriction therapy, what does the sleep efficiency need to be to allow an additional 15 minutes in bed for the next 7 days?
At least 85%
40
What will the EEG show during acute sleep deprivation?
* Decreased alpha activity with eye closure (if awake \> 115 hours alpha can disappear entirely) * In chronic sleep deprivation alpha activity might not change at all * Increased theta and delta activity
41
What are the diagnostic criteria for irregular sleep-wake rhythm disorder?
* At least 3 irregular sleep-wake cycles (1 to 4 hrs sleep) over 24 hours * 2 week sleep diary/actigraphy
42
What disorders commonly have irregular sleep-wake rhythm disorder?
* Dementia * Developmental disorders * Head injury * Schizophrenia
43
What 2 OTC meds are FDA approved for treating insomnia?
* Diphenhydramine * Doxylamine (Unisom)

Sleep medicine (21 decks)

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