Insomnia Flashcards
(40 cards)
What symptoms are typical of daytime impairment in insomnia?
Fatigue, depressed mood, irritability, general malaise, and cognitive impairment.
What differentiates insomnia disorder from simple sleep disturbance?
Insomnia disorder includes daytime impairment; sleep disturbance without it does not qualify.
How is insomnia categorized based on duration?
Short-term: < 3 months; Chronic: ≥ 3 months, several days/week.
What commonly triggers short-term insomnia?
Stressful events or changes in sleep (e.g., illness, childbirth, financial difficulties, environmental disturbance).
What tool can help evaluate sleep patterns in insomnia?
A sleep diary (kept for 1–2 weeks).
What are some key recommendations for good sleep hygiene?
Avoid napping, caffeine, alcohol; use the bed only for sleep/intimacy; exercise early in the day; relax before bed.
What is the first-line treatment for both short- and long-term insomnia?
Cognitive Behavioural Therapy for Insomnia (CBTi).
When might hypnotic medications be considered in short-term insomnia?
When daytime impairment is severe and insomnia is likely to resolve soon.
Which hypnotics are preferred for short-term use?
Non-benzodiazepine hypnotics (Z-drugs).
What age group should avoid hypnotics, if possible?
Older adults (>65 years).
For how long should hypnotics be prescribed?
Short course (preferably <1 week; max 2 weeks).
What is the risk of long-term hypnotic use?
Tolerance, dependence, withdrawal, and rebound insomnia.
What are examples of Z-drugs?
Zolpidem and zopiclone.
What antihistamine is used OTC for insomnia, and what are its issues?
Promethazine hydrochloride—can cause next-day drowsiness and antimuscarinic effects.
When is melatonin recommended?
For adults >55 years with short-term insomnia or jet lag; max treatment: 13 weeks.
What are signs of benzodiazepine withdrawal?
Insomnia, anxiety, tremor, tinnitus, perceptual disturbances.
What is the approximate equivalent of diazepam 5 mg in other benzos?
Nitrazepam 5 mg, Clobazam 10 mg, Oxazepam 10 mg, Temazepam 10 mg, Lorazepam 0.5 mg, Chlordiazepoxide 12.5 mg.
What is the preferred hypnotic for anxious dental patients?
Temazepam.
What medications should be avoided in benzodiazepine withdrawal?
Beta-blockers, antidepressants, antipsychotics (unless absolutely necessary).
What are examples of short-acting benzodiazepines used as hypnotics?
Temazepam, Loprazolam, Lormetazepam
(Short duration, little to no hangover effect; higher withdrawal risk)
What are examples of long-acting benzodiazepines used as hypnotics?
Nitrazepam, Flurazepam
(Prolonged action, risk of next-day sedation; cumulative with repeated use)
What are the main indications for benzodiazepine use?
First-line for seizures/status epilepticus
First-line for alcohol withdrawal
Sedation during interventional procedures
Short-term treatment of severe anxiety
Short-term treatment of severe insomnia
What are the key dose-related adverse effects of benzodiazepines?
Drowsiness, sedation, coma, and airway obstruction (especially with overdose).
Which patient groups should avoid or receive lower doses of benzodiazepines?
The elderly
Patients with respiratory impairment or neuromuscular disease (e.g. myasthenia gravis)
Patients with liver failure (except lorazepam) - Because it is less reliant on hepatic metabolism.
