Insomnia

Question 1

Chronic Primary Insomnia

Answer 1

Insomnia that’s not secondary to something else, like drugs or a medical condition

Question 2

What is the most common type of sleep disorder?

Answer 2

Chronic primary insomnia

Question 3

What percentage of primary care patients complain of insomnia?

Answer 3

30%

Question 4

Insomnia can…

Answer 4

transient, acute, or chronic

Question 5

What are of the vast majority of professional treatments for insomnia?

Answer 5

hypnotics (sleeping pills)

Question 6

What are the most important factors affecting chronic insomnia that OTC’s and hypnotics neglect?

Answer 6

Behavioral and psychological factors

Question 7

What structure of the brain houses the “sleep-wake switch”?

Answer 7

The hypothalamus

Question 8

What NT is associated with sleep?

Answer 8

GABA, the primary inhibitory NT

Question 9

What NT is associated with wakefulness?

Answer 9

Histamine

Question 10

What are the 5 stages of sleep?

Answer 10

Stage 1, Stage, 2, Stage 3, Stage 4, and REM

Question 11

How many cycles does a person go through on average per night?

Answer 11

4-5 cycles, each lasting about 90 minutes

Question 12

Stage 1

Answer 12

transition from wakefulness to sleep

occupies 5% of sleep in healthy adults

Question 13

Stage 2

Answer 13

Occupies 50% of sleep

Question 14

Which stage(s) does a person experience ‘slow-wave’ sleep?

Answer 14

Stage 3 & 4; also known as delta sleep and deep sleep

Question 15

What disrupts slow-wave sleep?

Answer 15

Stress, alcohol

Question 16

How does stress disrupt sleep?

Answer 16

Corticotropic-releasing hormone (CRH) & cortisol disrupt slow-wave sleep

Question 17

What is commonly synthesized during deep sleep?

Answer 17

5-HT, DA, & NE

Question 18

Hypnotics

Answer 18

Drugs used to treat insomnia

Question 19

T or F: BZD’s are commonly prescribed for sleep.

Answer 19

T; however, they have problems and should NOT be considered 1st-line Rx.

Question 20

What is a major concern for using BZD’s for insomnia?

Answer 20

They bind to GABA receptor in such a way as to change its shape, causing tolerance, dependence, withdrawal sx, and REBOUND INSOMNIA

Question 21

Rebound insomnia

Answer 21

insomnia that occurs upon discontinuing a medication for insomnia that is worse than the original insomnia that the medication was meant to treat.

Question 22

What is the problem with using antihistamines for treating insomnia?

Answer 22

They interfere with slow-wave sleep and can cause rebound insomnia when discontinued

Question 23

What are the “z” drugs?

Answer 23

• zolpidem (Ambien, Ambien CR, Edluar, Zolpimist, Intermezzo)
• zalepion (Sonata)
• eszopliclone (Lunesta)

Question 24

How do the z drugs work?

Answer 24

They enhance action of GABA receptor but bind in such a way as to not interfere w/deep-stage sleep or cause tolerance, dependence, withdrawal sxs, or rebound insomnia.

Question 25

What are some common SE’s of z drugs?

Answer 25

• headache, drowsiness, dizziness, lethargy, ‘drugged feeling’
• complex sleep-related behaviors (e.g. sleep walking, sleep driving)

Question 26

When using z drugs, you should take caution with:

Answer 26

alcohol and other CNS depressants

Question 27

Which z drugs are often used for middle insomnia?

Answer 27

zaleplon (Sonata)

zolpidem (Intermezzo)

Question 28

What z drug is indicated for initial insomnia?

Answer 28

zaleplon (Sonata)

Question 29

ramelteon

Answer 29

Rozerem

Question 30

What is the MOA of Rozerem?

Answer 30

It functions as an agonist at melatonin receptors and is thought to resent normal circadian rhythms in pts w/shift-work disorder or jet lag; best for initial insomnia

Question 31

What are the SE’s of Rozerem (ramelteon)?

Answer 31

dizziness, headache

Question 32

What are the benefits of using Rozerem or melatonin supplements for insomnia?

Answer 32

No tolerance, dependence, withdrawal sxs, rebound insomnia, or interference w/sleep stages.

Question 33

What are some of the SE’s of melatonin supplements?

Answer 33

dizziness, headache, transient depression

Question 34

What are melatonin supplements best used for?

Answer 34

initial insomnia

Question 35

What are some antidepressants used primarily for insomnia?

Answer 35

trazodone & mirtazapine (Remeron)

Question 36

Phase-delay

Answer 36

you normal phase of when you wake up and when you go to sleep is delayed (like they go to sleep late and have trouble waking up in the morning)

Question 37

Phase-advance

Answer 37

used for patients like in the elderly population who tend to sleep and wake up earlier.

Question 38

What is the MOA of trazodone & Remeron for insomnia?

Answer 38

Antagonize H1 receptor when used at low doses

Question 39

T or F: Hypnotics are more efficacious than CBT.

Answer 39

F; efficacy research shows that CBT is more effective, both in the short and long term, than hypnotics

Question 40

CBT for insomnia targets

Answer 40

• Cognitive and psychological factors
• Behaviors that perpetuate insomnia
• Arousal reduction
• Sleep hygiene education

Question 41

What are the most common psychotropic treatments for insomnia?

Answer 41

BZD's
OTC Antihistamines
ramelteon (Rozerem)
synthetic melatonin
trazadone & mirtazapine (Remeron)