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Flashcards in Insomnia Deck (47):
0

insomnia is associated with

psychiatric disorders- major depressive disorder
certain substances
medical/neurological disorders

1

perpetuating factors

mental arousal in bed (intrusive thoughts)
negative expectations
heightened somatic tension in bed
complaint more fixed over time
cognitions; cognitive distortions and catastrophization

2

cognitive distortions

things you believe about your sleep
"chemical imbalance" "i should stay in bed even if i cant sleep"

3

catastrophization

worrying about what a poor night of sleep will mean for the rest of the day

4

daytime consequences

only one required to make diagnosis

5

4 nature of complaints

difficulty falling asleep
mid cycle awakening sustained
mid cycle awakening brief/repetitive
early morning awakening

6

difficulty falling asleep

anxiety, depression, delayed sleep phase, conditional arousal

7

mid cycle awakening

conditioned arousal, depression, anxiety

8

MCA (brief/repetitive)

phyisological event/other-Obstructive sleep apnea or other underlying medical sisue

9

early motnign awakening

depression
advanced sleep phase
cnditioned arousal

10

sleep logs

if person has ocd or anxiety- bad

11

epworth sleepiness scale

rate the likelihood of dosing off in following circumstances..

12

polysomnography

not indicated for routine evaluation of insomnia

13

Chronic Insomnia Disorder

>3x/week, >3x/month

14

short-term insomnia disorder

symptoms present for <3 months

15

arousal and affective disturbance in insomnia

HPA axis: cortisol in insomnia patients higher during early sleep period- lacking cortisol drop

symp elevated HR and BP at sleep onset

16

medication beliefs

provide effect short-term relief for many with insomnia; improvements typically wane with discontinuation of medication

17

FDA approved hypnotics

benzos
BzRAs- benzo receptor agonists- Imidazopyridines, cycopyrrolones, pyrazolopyrmidines
melatonin agonists
histamine agonists

18

sedating anti-depressants

tricyclic antideprssants- amitriptyline
trazodone
mirtazpaine

19

most effective long term management

CBT

20

important in CBT

cogntiive distrotions, relaxation training, biofeedback, stimulus control, slepe rstriction (restrict time in bed to actual sleep time)

21

for average sleep efficiency greater than 85%

increase TIB by 15 minutes

22

for average sleep efficiency over one week less than 85%

decrease TIB by 15 mins

23

short term insomnia may be complicated by

conditioned arousal

24

treatment focused on short term insomnia

sleep hygiene! get out of bed
hypnotics as indicated

25

restless leg vs perioic limb mobement

bed partner telling story in periodic limb movement
clinical features of interrupted, light sleep and/or daytime sleepiness

26

etiology of periodic limb movement disorder

familial
neuropathy/radiculopathy/myelopathy
Fe deficiency
end-stage renal
RA
substances (caffeine, alch)

27

PLMS polysomnograph

repeptive episodes of muscle contraction

28

treatment PLMS

dopamine agents - ropnirole, carbidopa
benzos
opioids
anticonvulsants

29

parasomnias tessted for by

multiple sleep latency test
4-5 nap opportunites at 2 hr intervals

30

narcolepsy

disorder of sleep-wake regulation involving inappropriate manigestations of REM sleep

31

etiology narcolepsy

destruction of orexin neurons in hypothalamus-- maybe via HLA (inconclusive)

32

CSF-orexin

significantly reduced in patients with narcolepsy and cataplexy

33

cataplexy

inappropriate intrusion of REM atonia into waking

34

sleep-onset REM

sleep paralysis

35

in catalplexy, you typically maintain

consciousness

36

15% with full Nercoleptic tetrade

excessive sleepiness/sleep attacks
cataplexy
sleep paralysius
hypnagogic/hypnapompic- really clear hallucinations with intruder
disturbed nocturnal sleep

37

treatment narcolepsy

sleepiness- stimulations- amphetamine, metylphenidate, modonifil, gamahydroxybutryate, planned naps

cataplexy-rem suppressant (tricycle/ssri/snri), GHB

psychosocial support-education

38

idiopathic hypersomnia

excessive sleepiness daily for > 3 months (MSLT will show a mean latency <8 mins)
insufficient sleep ruled out
supportive features- long nocturnal sleep, sleep drunkeness, long unrefreshing naps, possible autnomic disturbance

39

parasomnias

abnormal events or behaviors whcih arise from sleep or sleep-wake transition

40

types of parasomnias

nREM
REM -rem behavior disorder, nightmares, sleep paralysis

41

nREM-disorder of arousal

sleep walking, night terrors, confusional arousals

42

patho of nREM

arise from stage 3/4 sleep

high amplitude delta waves
first third of the night (when we get most of our N3 sleep)
amnesia/partial recall

43

treatment nREM

gently guide back to bed
remove dangerous items
benzos
psychogical treatment
stop ambien if ambien started it!

44

REM behavior disorder

dream enactment associated with loss of muscle atonia in REM sleep
predom male
45-50% with neuropath but others are idiopathic

45

REM behavior associated neuropathy

synucleopathies
parkinsons
dementia with lewy bodies
multisystem atrophy

46

treatment of REM behavior disorder

neuro eval
pharm treatments-clonazepam
safety