Insomnia Flashcards
what can cause insomnia?
o Drugs – cocaine, ampethimines, nonselective beta blockers
o Life events
o The environment – temperature, noise, light
o Illnesses – physical or mental health related
o Some people there isn’t an identifiable cause
what is insomnia a risk factor for?
depression
anxiety
obesity
hypertension
what is the sleeping cycle?
where you have the vivid dreams
Non - rem is the deeper sleep stages with SWS (Slow wave sleep) this is the deepest
As we get older the time spent in non REM 3 and 4 decreases = more easily woken up
what is transient insomina?
sleep well usually. Jet lag, shift work, noise/light disturbance
Short term – may last for a few weeks, bereavement, physical illness
what is chronic insomnia?
Chronic insomnia can be defined as an 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
what might patients report with if they have insomnia?
- Difficulty in falling asleep
- Frequent waking during the night
- Early morning waking
- Daytime sleepiness
- General loss of well-being due to bad night’s sleep
what are the two classes of drugs used for insomnia?
hypnotics
BZDs or Z drugs
what do you need to do before Rxing a hypnotic drug?
- consider treating any underlying causes (depression, anxiety, grievance, lifestyle change)
- consider sleep hygiene approaches and CBTi (chronic) unless urgent treatment required (then do both!)
how should you use hypnotics?
- 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
what are the sleep hygiene approaches?
- Determine whether expectations of sleep are realistic
- Increase daily exercise (not in the evenings/within 4 hours of bedtime)
- Stop daytime naps
- The bedroom should be at the right noise and light levels, at the right temperature
- Reduce consumption of certain substances in the evenings (e.g. food and fluids, alcohol, chocolate, smoking, avoid caffeine after midday)
- Use the bed only for sleeping/sex, avoid TV/computers/devices in the bedroom
- Use relaxation techniques (e.g. Audio tools, breathing, counting methods)
- Develop a routine for rising and going to bed
- If you cannot sleep after 30 minutes, get up and do something else, then return to bed
- Keep pets that disturb sleep out of the bedroom
what effect might alcohol have on sleep?
this is important as it reduces the amount of time spent in NON REM 1 and 2 and then a longer time in REM 3 and 4. This disrupts the natural pattern of sleep and you will become more tired throughout the day.
what would you use if you had trouble falling asleep?
short acting
what are the issues with short acting agents?
increased risk of tolerance/dependence and late night rebound insomnia
what are examples of short acting agents?
Temazepam (Benzodiazepine), Zolpidem (Z drug) (works within 15 mins, but only lasts a couple of hours)
what would you use if you found yourself waking up in the middle of the night / not a long enough sleep?
long acting agent
