Insomnia/Sleep Disorder Flashcards
(50 cards)
What are the 3 types of insomnia?
Transient, Acute, Chronic
Transient insomnia
symptoms that last a few days to weeks
Acute insomnia (short-term insomnia)
Symptoms persist several nights upto 3 weeks (<3 months)
Chronic insomnia
Lasts for months to years (>3 months)
How long should a diary of insomnia be maintained, to record total sleep time?
1 week
When should a patient be referred to a Dr?
If OTCs are ineffective after 3 nights and are required > 7 days
In MILD chronic or primary insomnia, what are the typical symptoms?
difficulty falling asleep, frequent nocturnal awakenings, and/or early AM awakenings for 7 days per week
how to treat mild insomnia?
sleep hygiene, CBT, otc drugs
how to treat mod-severe insomnia?
if no response after otc for 7 days, continue sleep hygiene + add BZD x 2 weeks
Non-pharms for insomnia
sleep hygiene
relaxation exercises
sleep restrictions, stimulus control
aerobic exercise during the day
sleep hygiene examples
-regular sleep schedule
-avoid daytime napping or horizontal rest extensively
-daily exercise 2-3 hrs before bed
-avoid heavy meals before bedtime
-avoid caffeine and alcohol before bed
-minimize noise, light, heat, and drinking too much fluids
-avoid smoking after 7pm
What are the goals of therapy for insomnia?
-improve daytime functionality
-reduce impairment (fatigue, dysphoria)
-promote restorative sleep
First line treatment for insomnia
CBT
How to treat primary insomnia?
CBT (non-pharm) + hypnotic (1-2 weeks then reassess). if it persists, follow up Q 3-6 months. If effective after 1 month, can taper/stop hypnotic
How often should a patient be assessed if they are on long-term stable dose of hypnotics?
Assess patient q 3-4 months
OTC options for insomnia
- Diphenhydramine (not recommended!)
- L tryptophan > 1 g
- Valerian
- Melatonin
Rx drug options
- short acting BZDs
- barbiturates (but not used due to AEs and narrow tx index)
- TCAs
- Chloral hydrate
Since alcohol can promote sleep, why is it not used as therapy?
It causes sedation, but the sleep has low REM and increased arousals. Not a normal sleep.
If a patient had insomnia for 2 days, never took meds before, what would you recommend?
OTC
Which scenarios indicate the use of OTCs?
- short term insomnia (2-3 days)
- recurrent short-term insomnia (3days-3wks, or chronic > 3 wks)
- jetlag
When is the best time to refer a pt to a physician after trying OTCs?
OTC for 3 days ineffective, or consecutively having to take for 7 days
Which has a faster onset - diphenhydramine or dimenhydrinate?
dimenhydrinate
which otc drug loses efficacy quickly and is not recommended in elderly?
diphenhydramine
what is the recommended duration to use diphenydramine for insomnia?
no longer than 7 consecutive days, and no more than 4 times per week
