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Patient Semester 2 > Insomnia > Flashcards

Flashcards in Insomnia Deck (18):

Secondary causes of insomnia

drugs, life events, environment, illness


Three types of insomnia?

Transient, acute, chronic


What is transient insomnia?

sleep well usually. Jet lag, shift work, noise/light disturbance


What is acute insomnia?

may last for a few weeks, bereavement, physical illness


What is chronic insomnia?

inability to achieve or maintain sleep satisfactorily on the majority of nights over a period of at least three months, despite adequate opportunity, with subsequent adverse consequences on daily functioning


Symptoms of insomnia?

- difficulty falling asleep
- frequent waking
- early morning wakening
- daytime sleepiness
- general loss of wellbeing due to sleep loss


Things to consider when treating insomnia?

- try to treat underlying cause first
- hypnotics only used in severe insomnia interfering with life
- consider sleep hygiene first unless urgent treatment required (then do both) - habits are v important


Principles of using hypnotics for insomnia?

For the shortest time period (usually 2 weeks, max 4 weeks, see SmPCs)
For one or two doses, or intermittently if possible
At the lowest effective dose

for short term/transient, a few doses may be enough.
- additive sedative effects from other drugs or alcohol
- prescribe agent w lowest acquisition cost as efficacy is the same


When to use short acting agent for insomnia?

difficulty falling asleep

higher risk of dependence and late night rebound insomnia


When to use lon-acting agent for insomnia?

early morning wakening

less likely to cause rebound insomnia, but risk of next day grogginess


Most widely prescribed hynotics?

can use short or long acting - counsel on use of machinery/driving etc
extreme caution in elderly


Most widely prescribed hynotics?

can use short or long acting - counsel on use of machinery/driving etc
extreme caution in elderly or previous addiction
reduce stage 3 and 4 non-REM sleep


What are the Z drugs?

Zolpidem (short), zopiclone (long)

shorten stage 1, increase stage 2, little effect on 3 nad 4
similar to BZDs for cautions
withdraw gradually in prolonged use


Other drugs available for insomnia?

Sedating antihistamines
OTC preps


Place of melatonin in insomnia treeatment?

Mimics natural melatonin: not addictive and well tolerated, does not cause tolerance
Usual dose 2mg daily, licensed as monotherapy for over 55’s, very short acting (often appears as MR prep) – promotes sleep initiation and uninterrupted sleep


Place of sedating antihistamines in insomnia therapy?

available OTC, high risk of hangover effect, tolerance can develop


PLace of clomethiazole in insomnia therapy?

Dependence/tolerance and respiratory depression in overdose limit use


OTC preps for insomnia therapy?

e.g. valerian-hops, passion flower

limited evidence behind