Insomnia Flashcards
(41 cards)
Chronic Primary Insomnia
Insomnia that’s not secondary to something else, like drugs or a medical condition
What is the most common type of sleep disorder?
Chronic primary insomnia
What percentage of primary care patients complain of insomnia?
30%
Insomnia can…
transient, acute, or chronic
What are of the vast majority of professional treatments for insomnia?
hypnotics (sleeping pills)
What are the most important factors affecting chronic insomnia that OTC’s and hypnotics neglect?
Behavioral and psychological factors
What structure of the brain houses the “sleep-wake switch”?
The hypothalamus
What NT is associated with sleep?
GABA, the primary inhibitory NT
What NT is associated with wakefulness?
Histamine
What are the 5 stages of sleep?
Stage 1, Stage, 2, Stage 3, Stage 4, and REM
How many cycles does a person go through on average per night?
4-5 cycles, each lasting about 90 minutes
Stage 1
transition from wakefulness to sleep
occupies 5% of sleep in healthy adults
Stage 2
Occupies 50% of sleep
Which stage(s) does a person experience ‘slow-wave’ sleep?
Stage 3 & 4; also known as delta sleep and deep sleep
What disrupts slow-wave sleep?
Stress, alcohol
How does stress disrupt sleep?
Corticotropic-releasing hormone (CRH) & cortisol disrupt slow-wave sleep
What is commonly synthesized during deep sleep?
5-HT, DA, & NE
Hypnotics
Drugs used to treat insomnia
T or F: BZD’s are commonly prescribed for sleep.
T; however, they have problems and should NOT be considered 1st-line Rx.
What is a major concern for using BZD’s for insomnia?
They bind to GABA receptor in such a way as to change its shape, causing tolerance, dependence, withdrawal sx, and REBOUND INSOMNIA
Rebound insomnia
insomnia that occurs upon discontinuing a medication for insomnia that is worse than the original insomnia that the medication was meant to treat.
What is the problem with using antihistamines for treating insomnia?
They interfere with slow-wave sleep and can cause rebound insomnia when discontinued
What are the “z” drugs?
- zolpidem (Ambien, Ambien CR, Edluar, Zolpimist, Intermezzo)
- zalepion (Sonata)
- eszopliclone (Lunesta)
How do the z drugs work?
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.