Insomnia Lecture Flashcards
Types of insomnia
Difficulty falling asleep (sleep onset)
Difficulty maintaining sleep (sleep maintenance)
Early morning awakening (sleep offset)
Unrefreshing sleep (non-restorative sleep)
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
Classification of insomnia
Transient
Short-term
Chronic
Define transient
Self-limiting
<1 week
Travel, hospitalization or upcoming stress
Define short-term
1-3 weeks
More serious stressor (death, unemployment, divorce)
Define chronic
Almost every night for >3 weeks
Result of an underlying cause
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 <drug abuse, alcohol, etc)
- No other coexisting mental disorder or conditions
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
Medications of insomnia?
Albuterol Anti (depressants, psychotics, convulsants, parkinson's) Alcohol Nicotine Decongestants Theophylline Steroids Stimulants (caffeine, amphetamines) Clonidine Methyldopa Beta blockers
What are complications of sleep disorders?
Worsening health (depression, headaches, heart disease) Substance abuse Daytime drowsiness Decreased productivity Car accidents
Signs and symptoms of insomnia?
Complaint of difficulty falling or staying asleep Daytime fatigue Poor concentration Impaired memory Irritability
Assessment of insomnia?
Consider: symptoms, onset, duration, severity, history, pre-sleep conditions, sleep schedule, daytime functioning, drug or substance abuse
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?
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)
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
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
Preferred non-pharmacological therapies?
Try to ID the cause
Evidence shows CBT works and is safe
Improves sleep over time
Try before initiating pharmacotherapy
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
Antihistamines drug products?
Diphenhydramine- Benadryl
Doxylamine- Unisome, Nyquil
– often contain acetaminophen or ibuprofen
Antihistamines drug MOA?
Ethanolamine antihistamine
Block histamine 1 and muscarinic receptors
Newer are less lipophilic exert few CNS effects
Antihistamines drug adverse effects?
Sedation Morning hangover effect Dry mouth/throat Constipation Blurred vision Urinary retention Diminished cognitive function
Antihistamines drug reactions?
Anticholinergic meds
CYP450 2D6
Antihistamines drug precautions/contraindications?
Males of advanced age Angle closure glaucoma Dementia Cardiovascular disease Prolonged half-life with cirrhosis
Antihistamines drug conseling?
May develope tolerance
Use cation in tasks that require alertness
Do not drink alcohol
Paradoxical effects
