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PHAR 253 Module 3 > Insomnia > Flashcards

Insomnia Flashcards

1
Q

What is sleep latency? (SL)

A

The time it takes to fall asleep following bed time

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2
Q

What is wake after sleep onset? (WASO)

A

Sum of wake times from sleep onset to final awakening

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3
Q

What is Time in Bed? (TIB)

A

Time from bedtime to getting out of bed

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4
Q

How do you calculate total sleep time? (TST)

A

TST = TIB - SL - WASO

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5
Q

How do you calculate sleep efficiency percent? (SE)

A

SE = TST / TIB x 100

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6
Q

What are the 2 basic types of sleep? what stages are in each?

A

Rapid eye movemend (REM) sleep –> only stage 4
Non-REM sleep –> stages 1-3 75% of sleep

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7
Q

What is stage 1 of sleep?

A

Lightest sleep, easiest to be woken from

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8
Q

What is stage 2 of sleep?

A

A deeoer sleep state than stage 1 and most of sleep occurs in this phase

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9
Q

What is Stage 3 of sleep?

A

Deepest stage of sleep, hardest to be woken from

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10
Q

What is stage 4 of sleep?

A

REM sleep, dreaming occurs in this phase

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11
Q

What are the wake-promoting NT’s? (7)

A

Glutamate
Acetylcholine
Dopamine
Norepinephrine
Serotonin
Histamine
Orexin/hypocretin

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12
Q

What are the non-REM NT’s? (4)

A

GABA
Galanin
Adenosine
Melatonin

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13
Q

What are the REM NT’s? (4) Which is for muscle atonia?

A

Acetylcholine
Glutamate
GABA
Glycine (Muscle atonia)

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14
Q

What is the definition of Insomnia?

A

Difficulty falling or staying asleep

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15
Q

Roughly Explain the DSM-5.

A
  1. Complaint of quality or quantity of sleep
  2. Report one of:
    -difficulty intiating sleep
    - difficulty maintaining sleep
    - early morning awkaening and inability to fall back asleep
    - non-restorative sleep
  3. Sleep complaint results in distress/impairment in daytime function w/ one of following:
    - fatigue/low energy
    - cognitive impairment
    - mood disturbances
    - impaired social function
  4. sleep difficulty occurs atleast 3 nights per week
  5. sleep difficulty present for atleast last 3 months
  6. difficulty occurs despite adequate oppurtunity for sleep.
    Duration –> acute, sub-chronic, or persistant
  7. Comorbid disorders?
    - Psychiatirc, Medial, Other
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16
Q

WHat is the duration for acute, sub-chronic, and persistant insomnia?

A

< 1 month
1-3 months
> 3 months

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17
Q

What is primary insomnia?

A

Insomnia in the absence of a causative factor

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18
Q

What is secondary Insomnia?

A

Insomnia caused by an underlying medical condition or medication adverse effect

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19
Q

What % are dissatisfied with their sleep?

A

25%

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20
Q

What % report symptoms of insomnia associated with daytime cosequences?

A

10-15%

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21
Q

What % meet criteria for an insomnia disorder?

A

6-10%

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22
Q

Is Isomnia more prevalent in men or women?

A

Twice as prevlaent in women

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23
Q

What % of seniors have sleep problems?

A

Up to 50%

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24
Q

How much more likely are pts with insomnia to have anxiety or depression?

A

5x more likely

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25
Q

How much more likely are pts with insomnia to have congestive heart failure?

A

2x more likely

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26
Q

What are risk factors for insomnia?

A

Stress
Increased age
Female
Co-morid condition
- HF
- COPD
- Nocturia
- Depression/anxiety
- Dementia
Shift work
Lower economic status

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27
Q

What are the 5 most common medications liekly to distrub sleep?

A

Levodopa
Prednisone
Venafaxine
Fluvoaxamine
Rotigotine

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28
Q

What are the primary goals of therapy?

A

Improve:
- Sleep quality and or time
- Insomnia related impairments such as energy, attention, or memory difficulties

29
Q

What are some other (non-primary) goals of therapy?

A

decrease frequency of awakenings
TST of 6 hrs or SE of 80-85%
SL of 30 minutes
WASO of 30 minutes
Reduced sleep-related psychological distress
Formation of positive and clear associated between bed and sleeping

30
Q

What are the 10 sleep hygiene components?

A
  1. Do not spend to much time in bed
  2. Maintain a consistent sleep/wake time
  3. Get out of bed if unable to fall asleep
  4. Exercise regularly
  5. Keep bedroom comfortable
  6. Don’t take problems to bed
  7. Avoid caffeine, tobacco, and alcohol after lunch
  8. limit liquids in the evening and don’t go to bed hungry
  9. keep bedroom dark and quiet
  10. Avoid late night screen time
31
Q

What are 4 relaxation techniques?

A
  1. Breathing exercises
  2. Progressive muscle relaxation; closing eyes, focus on tensing and relaxing each muscle group for 3-6 seconds starting from head to toe while maintaining slow deep breaths
  3. Imagery; thinking and picturing something soothing, pleasant, relatively uninteresting
  4. Meditation
32
Q

What are the sleep restriction instructions?

A

Do not get into bed unless you fell tired
Reduce time in bed to your perceived total sleep time
Use sleep logs

33
Q

How do Bnezodiazepine recpetor agonists work for sleep therapy?

A

Bind to GABA receptors, inhibition of CNS, binding GABA receptors increase efficiency of GABA to decrease excitability of neurons

34
Q

What are the short-acting benzo’s and what is a feature to be aware of with them?

A

Alprazolam, Midazolam, Triazolam
Tend to cause more amnesia, withdrawal symptoms and potential dependancy

35
Q

What are the medium-acting benzo’s and what is a feature to be aware of with them?

A

Lorazepam, Oxazepam, Temazepam, Clonazepam
Lorazepam, Oxazepam, and temazepam have no acive metabolites

36
Q

What are the long-acting benzo’s and what is a feature to be aware of with them?

A

Bromazepam, Diazepam, Chlordiazepoxide
Tend to be drugs that have active metabolites which last a long time

37
Q

What are some of the risks with using benzo’s?

A

Falls, sedation, motor vehicle accidents

38
Q

What are some benefits of using benzo’s?

A

Increase sleep time by 25 minutes, decrease sleep latency by ~10 minutes, decrease number of awakenings

39
Q

What are some key counselling points w/ benzo’s?

A

Benefits of increased sleep time of 25 minutes, 1 less awkaening
Can cause some daytime drowsiness, fatigue, headache, nightmares, Nausea/upset stomach
Medication increases risk of traffic accident, work accident/falls and this risk is higher w/ alcohol use during medication use.

40
Q

Are antihistamines recommended for sleep aid?

A

NO

41
Q

What are some adverse effects of antihistamines?

A

dry mouth, constipation, blurred vision, orthostatic hypotension, increased apetite

42
Q

At what day do antihistamine tolerance with continual use?

A

3-4 days of continuous therapy

43
Q

What is the dosing for diphenhydramine for sleep?

A

50mg hs

44
Q

How does Doxepin work for insomnia?

A

high specificity and affinit for H1, low dose selective for H1.

45
Q

What is doxepin’s effect on sleep?

A

increase sleep quality, efficiency and time but does not seem to affect sleep latency

46
Q

What is the risk for dependance with doxepin?

A

very minimal risk

47
Q

Can you take doxepin with food?

A

Shouldn’t take within 3hrs of meal b/c delayed absorption

48
Q

What are AE’s of doxepin?

A

Dry mouth, sedation, hypertension, naseau

49
Q

What is dosing? Cost?

A

3-6 mg hs (3 for elderly)
Costs >$40/month

50
Q

How does Trazodone work for insomnia?

A

weak Serotonin reuptake inhibtor (5HT2 receptor antagonist & alpha 1 blocking)

51
Q

What is the dosing for trazodone?

A

50-100mg w/out depression diagnosis, up to 150mg w/ depression diagnosis

52
Q

What are some AE’s with trazodone?

A

daytime sleepiness, excesive sedation, headache, dizziness, hypotension, blurred vision.
Less risk of morning hangover b/c shorter half-life

53
Q

What is mirtazapine used concomitantly w/ insomnia?

A

depression, insomnia off label use

54
Q

AE’s of mirtazipine?

A

wt gain, drowsiness, dizziness, dry mouth

55
Q

Is sedation more prevalent with low or higher doses of mirtazipine?

A

lower doses

56
Q

What are the insomnia treatment w/ quitiapine attributed too?

A

Antagonism of H1 receptor

57
Q

WHat are AE’s of quetiapine?

A

wt gain/BMI/FBG, dizziness

58
Q

Dosing for quetiapine?

A

25mg, >150mg for mood/psychotic diagnosis

59
Q

What is a weird AE of zopiclone?

A

metalic taste

60
Q

Dosing for zopiclone?

A

3.75-7.5 mg

61
Q

Is there a risk for tolerance/dependance with zopiclone?

A

yes

62
Q

How does zopiclone impact sleep?

A

improve sleep latency, total sleep time, decreases wake after sleep

63
Q

Howdoes Lemborexant (ORA) work?

A

blocks binding of orexin A and B to receptor OX1R and OX2R (wake promotion)

64
Q

What are AE’s of Lemborexant?

A

Dorwsiness, fatigue, headache, abnormal dreams, sleep paralysis,
Rare: mood change, hallucinations, suicidal ideation

65
Q

Is there rebound insomnia w/ lemborexant d/c?

A

No

66
Q

What is dosing for Lemborexant?

A

5mg can be titrated to 10mg; 5mg for elderly b/c of CNS depression

67
Q

When do you take lemborexant?

A

right before bed, take 7hrs before planned awakening

68
Q
A

PHAR 253 Module 3 (3 decks)

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