Insomnia Flashcards
Facts about sleep
Sleep is vital
Part of circadian rhythm – many functions including growth, rest & recovery.
Pattern varies throughout life
Adults need 4 to 9 hours sleep
Deprivation leads to –ve effect on mood, motivation, alertness, memory & physical function.
Lab rats die after 14 days of no sleep!!
Normal adult sleep pattern in one night
Level of sleep is not the same Goes via several stages of sleep REM- Shallowest stage of sleep, they are most aware and the brain is functional waking in between cycle They do not spend more time at REM sleep
Define Insomnia
A condition of unsatisfactory quantity and/or quality of
sleep which persists for a considerable period of time,
including difficulty falling asleep, difficulty in staying
asleep, or early final wakening.
Insomnia is a common
symptom of many mental and physical conditions. True or false?
True
How Insomnia is described
Can be indicated if an individual reports two or more of the following: Take more than 30 mins to go to sleep Difficulty maintaining sleep Disturbed sleep - >3 x per week Daytime functioning impaired Short but healthy sleep vs. insomnia
State the two types of Insomnia
- Primary Insomnia
2. Secondary Insomnia
What type of insomnia comes from an unknown origin or arises from sleep environment?
Primary Insomnia
Define secondary Insomnia
Insomnia that arises due to an underlying psychological or physical condition
List and briefly explain the classification of insomnia due to duration of symptoms
- Transient Insomnia- Lasts 2-3 days
- Short-term- Lasts longer than three days, but
<3 weeks - Long-term (chronic) -Lasts longer than three
weeks
A high level of cortisol production during the day and at night time could result in lack of sleep. True/false.
True
What is the common reason for the excessive production of cortisol
One common reason for the excessive production of cortisol is tumor in the pituitary gland
Production of high levels of steroids hormones leads to what type of insomnia?
Secondary Insomnia
Most of the P medicines are licensed for short term and transient insomnia. True/false
True
Epidemiology of Insomnia
About 10-38% of all people have sleep problems in any given year
In a UK study, 30-48% of people reported insomnia symptoms and 8-18% sleep dissatisfaction, only 6% met the criteria for a diagnosis of insomnia
Prevalence seems to be greater in women, older people, and those who are socioeconomically disadvantaged
Insomnia typically develops at times of increased life stress
Primary Insomnia mainly caused by;
- A poor sleep environment e.g. light, noise, heat
- Behaviour that makes sleep difficult e.g.
Physical / intellectual arousal - Varying sleep routine – mismatch between
attempts to sleep and circadian rhythm e.g. Jet-
lag and shift
State the ‘5 P’s’ approach to causes of secondary Insomnia
1.Physical- CV disease; COPD/asthma; pain
2.Physiological- Late heavy meals, high in fat or
protein or both
3.Psychological- Stress; tension; grief;
ASPS/DSPS
4. Psychiatric- Mood and/or anxiety disorders
5. Pharmacological- Alcohol; medicines; illicit
recreational drugs
What is ASPS?
Advanced Sleep Phase Syndrome- The patient becomes really tired much earlier in the day than you would expect, they feel like its late at sort of tea time. Their 24 hour is shorter in ASPS
Whats DSPS?
Delayed Sleep Phase Syndrome- 24hour longer in
DSPS
This is where the patient does not keep to 24-hour pace circadian rhythm
Effect of Alcohol on the sleep cycle
Alcohol prevents deep sleep (REM) REM cycle from happening, it does not provide a refreshing sleep although it helps people to sleepalcohol-fuelled sleep is marked less refreshing than the non-alcohol fuelled sleep
List POMs which can cause insomnia
Anticonvulsants (Phenytoin, Lamotrigine) Beta-blockers (Atenolol, Propranolol) SSRIs (Fluoxetine, Sertraline) Antiparkinson drugs (Levodopa) Decongestants (Pseudoephedrine) Corticosteroids (Prednisolone, Dexamethasone) Levothyroxine
List Information needed for diagnosis of Insomnia
Detailed questioning required
Sleep diary
Patient records sleep diary over 2 weeks
Includes:
quantity of sleep, awakenings during night,
quality of sleep,
activity during the day, caffeine, nicotine
this helps to establish a pattern
List the relevant information needed for the diagnosis of Insomnia
pattern of sleep
daily routine
underlying medical condition
Recent travel
When to refer a patient suffering from Insomnia
Children under 12 Longer than 3 weeks No known cause Previous undiagnosed medical conditions Symptoms of anxiety/depression Other sleep disorders Sleep apnoea Narcolepsy Hypersomnia
List the available treatment options for Insomnia
Sleep hygiene OTC Medication: Diphenhydramine Promethazine Herbal products POM Medication
