Insomnia Flashcards
(68 cards)
What is sleep latency?
time to fall asleep following bedtime
what is WASO?
wake after sleep onset
sum of wake times from sleep onset to final awakening
What is TIB?
time in bed
time from bedtime to getting out of bed
What is TST?
total sleep time
TIB - SL - WASA
how is sleep efficacy calculated?
TST/TIB x 100
what are the 4 stages of sleep?
- the lightest sleep stage and easiest to be woken from
- a deeper sleep state and most of our sleep occurs in this phase
- the deepest stage of sleep and it is the hardest to wake from
- REM sleep stage: where dreaming occurs
what are the 2 basic types of sleep?
REM sleep and non REM sleep
What percent of sleep is REM sleep?
25%
What neurotransmitters are wake promoting?
glutamate
ACh
dopamine
NE
serotonin
histamine
orexin/hypocretin
what neurotransmitters promote non REM sleep?
GABA
galanin
adenosine
melatonin
what neurotransmitters promote REM sleep?
ACh
glutamate
GABA
glycine
What is required for an insomnia diagnosis (DSM-5)
A. predominant complaint of dissatisfaction with sleep quantity or quality made by patient
B. report one or more of the following sx:
- difficulty initiating sleep
- difficulty maintaining sleep
- early morning awakening with inability to return to sleep
- non restorative sleep
- persistent resistance to going to bed
C. the sleep complaint is accompanied by great distress or impairment in the daytime by report of one of the following:
- fatigue or low energy
- daytime sleepiness
- cognitive impairment
- mood distubrances
- behaviour difficulties
- impaired occupational/academic functioning
- impaired interpersonal/social function
- negative effect on caregiver or family functioning
D. the sleep difficulty occurs at least 3 nights a week
E. the sleep difficulty is present for at least 3 months
F. the sleep difficulty occurs despite adequate opportunity for sleep
What is the duration of acute, sub chronic and persistent insomnia?
acute insomnia = <1 month
sub-chronic insomnia = 1-3 months
persistent insomnia = >3 months
what is the clinical definition of insomnia?
SL >30 mins
WASO >30 mins
SE <80%
TST <6.5 hours
occurring at least 3 nights per week
what is primary insomnia vs secondary insomnia?
primary insomnia: insomnia in the absence of a cumulative factor
secondary insomnia: insomnia caused by an underlying medical condition or medication adverse effect
what question could you ask to rule out sleep apnea?
“are you a heavy snorer? does your partner say that you sometimes stop breathing at night”
what question could you ask to rule out restless leg syndrome?
“when you try to relax in the evening or sleep at night, do you ever have unpleasant restless feelings in your legs that can be relieved by walking or movement?”
what question can you ask to rule out narcolepsy?
“do you sometimes fall asleep in the daytime completely without warning? do you have collapses or extreme muscle weakness triggered by emotion, for instance when you are laughing?”
what question can you ask to rule out circadian rhythm sleep disorder?
“do you tend to sleep well but just at the ‘wrong times’ and are these sleeping and waking times regular?”
what question can you ask to rule out parasomnias?
“do you have unusual or unpleasant experiences or behaviours associated with your sleep that trouble you or are dangerous?”
Differential diagnosis of insomnia
obstructive sleep apnea syndrome (OSAS)
restless leg syndrome (RLS)
narcolepsy
circadian rhythm sleep disorder (CRSD)
parasomnias
what does your score on the Athens insomnia scale mean?
0-5 = absence of insomnia
6-9 = mild insomnia
10-15 = moderate insomnia
16-24 = severe insomnia
What kind of questions does the Epworth sleepiness scale ask?
“how likely are you to fall asleep in the following situations?”
What score on the Epworth sleepiness scale is of concern?
10 or greater
