Insomnia

Question 1

How how is short term insomnia defined

Answer 1

Symptoms account a few times a week for less than 3 months

Triggered by stressful events like work

Question 2

How how is chronic insomnia defined

Answer 2

Symptoms occur more that 3 times per week for over 3 months

Triggered by conditions
• mental health
• epilepsy
• migraines

Question 3

What does The Asending reticular activation system regulate/promote (ARAS)

Answer 3

• arousal
• wakefulness
• sleep-wake cycle

There’s is a continuous stimulation of the cortical neurons - in insomnia

So increased activity of neuron s

Question 4

Out of those there which one is increased in insomnia

Answer 4

Hyper - arousal

Question 5

The ARAS is turned on by the following endogenous neurons

Answer 5

• serotonin
• dopamine
• norepinephrine
• acetylcholine
• histamine
• orexin

Question 6

The ARAS is turned off by the following endogenous neurons

Answer 6

• GABA
• Melatonin
• adenison
• galanin

Question 7

Primary causes of insomnia

Answer 7

Non identifiable

Question 8

Second causes of insomnia

Answer 8

• anxiety, depression
• physical health conditions- CVD, thyroid
• chronic pain
• sleep disorders- restless leg syndrome, sleep apnea

Question 9

Can insomnia be diagnosed if there are sleeping difficulties with no daytime impairment

Answer 9

NO

daytime impairment: irritability, depressed mood

Question 10

Management of short term insomnia

Answer 10

1st
• sleep hygiene

2nd:
• 3-7 days of Z-drug

3rd: if insomnia is not likely to resolve
• CBTi + Z-drug or PR melatonin

Question 11

Generally what is the maximum days z drugs should be prescribed

Answer 11

Max 2 weeks

(Or 4 check bnf)

Question 12

What age range should melatonin be given to

Answer 12

> 55

Question 13

First line management for chronic Insomnia

Answer 13

CBTi

Z drugs only if symptoms are exacerbating (use for less than 1 week)

Or melatonin 13 weeks max

Question 14

Can jet lag be managed

Answer 14

Yes

Melatonin

Treatment length 5 days

Question 15

Do patients with long term insomnia benefit from hypnotics

Answer 15

Not usually because there is an underlying cause

Question 16

Which x drugs have a short duration of action

Answer 16

Zoplicone

Zopidem tartrate

Question 17

If patient are finding it difficult to sleep what should be given SA or LA

Answer 17

Short acting

Question 18

If patient are finding it difficult to maintain sleep what should be given SA or LA

Answer 18

Long acting

Question 19

If the underlying cause of insomnia was depression what would you give

Answer 19

Mirtazapine - a sedating antihidepressant

Question 20

Which drug is used in the elderly and has less of a hangover effect

Answer 20

Chlormethiazole

Question 21

Moa of BZDs

Answer 21

GABA-A agonist

Increase chloride ion influx - hyperpolarazidation

Question 22

Moa of Z drugs

Answer 22

GABA-A against BUT for selective for a1 subunit

(Binds to the BZD site)

Question 23

Melatonin moa

Answer 23

M1/M2 agonist

Question 24

Which drug regulation circadian rhythm

Answer 24

Melatonin

Question 25

Chlormethiazole

Answer 25

GABA A agonist

Question 26

Z drugs common ADRs

Answer 26

Dry mouth Taste bitter

Question 27

When should doses of Z drugs be taken

Answer 27

Before bed

Question 28

When should doses of melatonin be taken

Answer 28

1- 2 hours before bed

Question 29

Can z drugs and melatonin be given in pregnancy

Answer 29

No avoid

Question 30

Which other drug class can be used (may in pregnancy) apart from the ones mentioned before

Answer 30

Antihistamines • promethazine • chlorphenamine

Question 31

Which gland is responsibility for the production and release of melatonin

Answer 31

Pineal gland

Question 32

Sleep hygiene points

Answer 32

• comfortable sleeping environment • only use bedroom for sleep and intimacy • avoid napping during the day • Limit alcohol, caffeine or nicotine consumption • avoid exercise before bed

Question 33

Which z drugs have a short duration of action

Answer 33

Zoplicone Zolpidem tartrate

Question 34

What is the maximum duration of melatonin

Answer 34

13 weeks

Question 35

If CBTi tried or unsuitable which drug can be given in chronic CBT which drug can be given

Answer 35

Dardorexant

Question 36

In which causes should DVLA be informed

Answer 36

If excessive sleepiness is going to have an effect on driving

Question 37

True or false - chronic insomnia is befitted by hypnotics

Answer 37

False - only for 4 weeks max

Question 38

True or false - BZDs and Z-drugs can be given to elderly

Answer 38

False - avoid in elderly

Question 39

Which patients will benefit from clomethizole as it does not cause the hang over effect

Answer 39

Elderly

Question 40

What is the short term treatment of jet lag

Answer 40

Melatonin

Question 41

What time of day should z drugs be given

Answer 41

At night

Question 42

Can doses of z drugs be halved for older people

Answer 42

Yes - starting dose

Question 43

Which z drug causes gi upset

Answer 43

Zolpidem

Question 44

Does melatonin have a high risk of independency

Answer 44

No

Question 45

Which drug can be bought OTC for insomnia

Answer 45

Promethozine - Antihistamine

Question 46

Z drug interactions

Answer 46

Alcohol and options - sedation - respiratory depression CYP inhibitors and inducers Phenytoin - decrease seem conc of zopiclone