Insomnia Lecture Flashcards Preview

OTC Test 2 > Insomnia Lecture > Flashcards

Flashcards in Insomnia Lecture Deck (43):
1

Types of insomnia

Difficulty falling asleep (sleep onset)
Difficulty maintaining sleep (sleep maintenance)
Early morning awakening (sleep offset)
Unrefreshing sleep (non-restorative sleep)

2

Insomnia facts?

33% experience insomnia
$14 billon on medical costs
$325.8 million nonprescription meds
Prevalence increases with age and with women
26% try natural products
5X more likely to present with anxiety and or depression
Can be due to another medical disorder

3

Classification of insomnia

Transient
Short-term
Chronic

4

Define transient

Self-limiting
<1 week
Travel, hospitalization or upcoming stress

5

Define short-term

1-3 weeks
More serious stressor (death, unemployment, divorce)

6

Define chronic

Almost every night for >3 weeks
Result of an underlying cause

7

Define insomnia disorder

- Predominant complaint of dissatisfaction with sleep quantity/quality associated with one or more: difficulty initiating sleep, maintaining, early-morning awakenings
- Sleep disturbances causes clinically significant distress or impairment in other parts of the life
- More than 3 nights per week
- At least 3 months
- Difficulty occurs even when sleep is an option
- No other explanation
- Not attributable to physiological effects of substance - No other coexisting mental disorder or conditions

8

Define situational/acute insomnia

Last a few days/weeks, associated with life events or rapid changes in sleep/environment
- Daytime napping
- Activity before sleep (eating and exercise)
- Jet lag
- Sift work
- Stress
- Poor sleep hygiene

9

Medications of insomnia?

Albuterol
Anti (depressants, psychotics, convulsants, parkinson's)
Alcohol
Nicotine
Decongestants
Theophylline
Steroids
Stimulants (caffeine, amphetamines)
Clonidine
Methyldopa
Beta blockers

10

What are complications of sleep disorders?

Worsening health (depression, headaches, heart disease)
Substance abuse
Daytime drowsiness
Decreased productivity
Car accidents

11

Signs and symptoms of insomnia?

Complaint of difficulty falling or staying asleep
Daytime fatigue
Poor concentration
Impaired memory
Irritability

12

Assessment of insomnia?

Consider: symptoms, onset, duration, severity, history, pre-sleep conditions, sleep schedule, daytime functioning, drug or substance abuse

13

What are supportive of insomnia?

Do you take longer than 30 minutes to fall asleep?
Wake up and stay awake for more than 30 minutes
Sleep less than 50% of the time you are in bed
Less than 6.5 hours
Falling asleep at work or at school?

14

What are exclusions for self treatment of insomnia?

Less than 12 or older than 65
Pregnant
Nocturnal awakenings or early morning awakening
Chronic insomnia
Sleep disturbances at night for several days
Secondary to a other medical disorders (sleep apnea, narcolepsy, restless leg syndrome)

15

What are goals of treatment?

Alleviate symptoms
Minimize adverse effects
Improve quality of life and function
Id and address cause of insomnia
Outcomes: decreased time to fall asleep, sleep quality, decrease daytime fatigue and drowsiness, normal sleep cycle

16

What is cognitive behavioral therapy?

Stimulus control
Sleep restriction
Relaxation
Cognitive therapy
Sleep hygience
Session for 4-6 weeks
Few of the above at a time

17

Preferred non-pharmacological therapies?

Try to ID the cause
Evidence shows CBT works and is safe
Improves sleep over time
Try before initiating pharmacotherapy

18

What does good sleep hygiene mean?

Stick to a schedule
Exercise regularly
Turn off worries
Make bedroom quiet, dark, safe and comfortable
Not too cold or hot
No large meals before bed
Not lots of food before bed
Do not read or watch tv in bed
-- Sleep and sexual activity only
If you can't sleep, get up after 10 minutes
Remove the clock
Avoid or limit daytime naps
Reduce alcohol, nicotine and caffeine use
Avoid using sedatives frequently

19

Antihistamines drug products?

Diphenhydramine- Benadryl
Doxylamine- Unisome, Nyquil
-- often contain acetaminophen or ibuprofen

20

Antihistamines drug MOA?

Ethanolamine antihistamine
Block histamine 1 and muscarinic receptors
Newer are less lipophilic exert few CNS effects

21

Antihistamines drug adverse effects?

Sedation
Morning hangover effect
Dry mouth/throat
Constipation
Blurred vision
Urinary retention
Diminished cognitive function

22

Antihistamines drug reactions?

Anticholinergic meds
CYP450 2D6

23

Antihistamines drug precautions/contraindications?

Males of advanced age
Angle closure glaucoma
Dementia
Cardiovascular disease
Prolonged half-life with cirrhosis

24

Antihistamines drug conseling?

May develope tolerance
Use cation in tasks that require alertness
Do not drink alcohol
Paradoxical effects

25

How does alcohol affect insomnia?

Improves sleep in nonalcoholics
Tolerance develops quickly
Chronic drinkers have disturbed sleep cycles
Experience: fall asleep faster, more restless, wake up after 2-4 hrs, reduces total sleep time

26

Define complementary therapy?

May promote health and relaxation
58% of patients do not discuss use of complementary therapy with their PCP
Complementary therapies include: acupuncture, music therapy, light therapy, herbs and natural products

27

Valerian indications and MOA?

Most studied
Benzodiazepine-like effects
Increase GABA activity in CNS by inhibiting an enzyme that metabolizes GABA

28

Valerian clinical effects?

Reduce time to sleep onset
Take several nights to weeks to work

29

Valerian adverse effects?

Headache, excitability, paradoxical insomnia
Cause uterine contractions in pregnant women

30

Valerian precautions?

Few cases of hepatotoxicity
Interactions possible with CYP450 3A4

31

Melatonin MOA?

Increases endogenous production by pineal gland
May allow for rapid adjustment of circadian rhythm after changing time zones

32

Melatonin clinical effects?

Evidence for jet lag
Increase REM, decrease latency
Low risk of dependence or abuse

33

Melatonin adverse effects and precautions?

headache, tachycardia, irritability, "hangover"
Do not use in pregnancy or lactaion
No elderly
Drug interactions

34

Define german chamomile

Bedtime tea --> takes time to work
May affect GABA receptors
May be beneficial in patients with anxiety
May interact with CYP450 3A4
Avoid in patients with ragweed or similar allergies

35

Define passionflower

Once was an OTC sleep aid
Now a dietary supplement
May cause sedation by affecting benzodiazepine receptors
No evidence

36

Define KAVA

Efficacy: insufficient evidence
Safety: possibly unsafe due to severe hepatotoxicity
NOT APPROVED FOR INSOMNIA

37

Define L-tryptophan

Efficacy: insufficient evidence
Safety: possibly unsafe --> recalled
NOT APPROVED FOR INSOMNIA

38

Define 5-HTP

Efficacy: insufficient evidence
Possibly unsafe
NOT APPROVED FOR INSOMNIA

39

Define coenzyme Q-10

Efficacy: possibly effective
Safety: likely safe
Bottom line: helps with insomnia due to heart failure, discuss with physician first

40

Insomnia in elderly

Duration of sleep is shorter
# of nocturnal awakenings increases
Less time in stage 4 and REM sleep
Normal sleep latency
Diphenhydramine can cause increased cognitive impairment and falls

41

Insomnia in children

Asked about caffeine and alcohol intake
Nonpharmacologic therapy first line
Anthistamines not indicated to treat insomnia in less than 12 years old
Not recommended to induce sleep in infants
Use of melatonin is controversial

42

Insomnia in pregnancy?

Diphenhydramine Category B
Should be referred for evaluation
Herbals not recmmended

43

Insomnia in lactating women?

May limit lactation
Increase infant drowsiness
Herbals not recommnded