Sleep Disoders

Question 1

key NTs for sleep

Answer 1

GABA, melatonin

Question 2

NTs for wakefulness

Answer 2

NE, histamine, ACh

Question 3

NTs for cycle regulation

Answer 3

serotonin, orexin, hypocretin

Question 4

younger adults are more likely to have sleep issues like _________ while older are more likely to _______

Answer 4

younger = difficulty falling asleep
older = awakenings night/ early morning

Question 4

younger adults are more likely to have sleep issues like _________ while older are more likely to _______

Answer 4

younger = difficulty falling asleep
older = awakenings night/ early morning

Question 5

normal sleep latency is

Answer 5

<30min

Question 6

normal sleep quantity is

Answer 6

7-9hrs

Question 7

what are dyssomnias

Answer 7

problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy

Question 8

what are parasomnias

Answer 8

disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)

Question 9

disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)

Answer 9

parasomnias

Question 10

problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy

Answer 10

dyssomnia

Question 11

what are circadian rhythm disorders

Answer 11

a loss of synchronization between internal biological clock and external environment
delayed/ advanced sleep phase syndrome where your internal clock makes you sleep earlier or later- jet leg

Question 12

a loss of synchronization between internal biological clock and external environment
delayed/ advanced sleep phase syndrome where your internal clock makes you sleep earlier or later- jet leg

Answer 12

circadian rhythm disorders

Question 13

insomnia is a complained of dissatisfaction with sleep quantity/ quality, associated with =>1 of

Answer 13

Difficulty initiating sleep
Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
Early morning awakening with inability to return to sleep

must be clinically significant distress + impair functioning

Question 14

insomnia occurs at least ___/wk for at least ___

Answer 14

3x/wl for 3 mths

Question 15

most common causes of insomnia include

Answer 15

not enough bours, not refreshing/ restorative, poor QoL

Question 16

what is defined as acute insomnia

Answer 16

Acute (<3mths): stress, environment, jetleg

Question 17

what is defined as secondary insomnia

Answer 17

insomnia from another cause- ex drugs

Question 18

what is secondary insomnia

Answer 18

attributed to some other cause

Question 19

how are insomnia assessments done?

Answer 19

sleep diary- record things like time to bed, total duration of sleep, awakenings, etc
rule out other causes: meds, psych conditions, sleep disorders

Question 20

what is the only movement disorder in sleep

Answer 20

periodic limb movement disorder

Question 21

what is the 3P model of insomnia

Answer 21

predisposing factors
precipitating factors
perpetuating factors

Question 22

what are predisposing factors to insomnia

Answer 22

factors increasing risk of developing insomnia (Ex- anxious predisposition, circular thinking, generalized hyperarousal)

Question 23

what are precipitating factors to insomnia

Answer 23

(cause of initial onset): emotional distress, onset of medical or psychiatric disorder

Question 24

what are perpetuating factors for insomnia

Answer 24

learned negative sleep behaviors and cognitive distortions

Question 25

The longer acute insomnia goes unmanaged, the ___ chance of it becoming chronic from the learned negative relationship

Answer 25

↑

Question 26

what is polysomnography

Answer 26

sleep studies

Question 27

sleep studies are indicated for

Answer 27

diagnosis of sleep disorders eval of sleep related systems treatment of sleep related breathing disorders

Question 28

describe a level 1 sleep study

Answer 28

done in lab with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc

Question 29

describe a level 2 sleep study

Answer 29

done at home with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc

Question 30

describe a level 3 sleep study

Answer 30

done at home to get info about sleep apnea, not as comprehensive as lvl 1 and 2

Question 31

describe a level 4 sleep study

Answer 31

done at home, only measures O2 levels in sleep for sleep apnea diagnosis

Question 32

5 components of CBT-I

Answer 32

stimulus control sleep hygeine sleep restriction relaxation techniques cognitive therapy

Question 33

acute insomnia should be treated if

Answer 33

substantial negative impact on daytime performance

Question 34

when to follow up if meds are given for acute insomnia

Answer 34

q2-4wks

Question 35

when should you consider LT tx for insomnia

Answer 35

if sig troubled by inadequate sleep Concerned about deleterious impact of inadequate sleep on pt’s health, safety, wellbeing CBT and/or nonpharm options have already been tried Comorbidities have been ruled out or treated maximally

Question 36

treatments of chronic insomnia include

Answer 36

nonpharm-CBTI and pharm F1-2wks

Question 37

T or F: Do not suggest OTC sleep aids or OTC meds with drowsiness as a SE

Answer 37

T

Question 38

1st line meds for insomnia include

Answer 38

BZs and Z drugs (zopiclone and zolpidem

Question 39

BZs ↓ sleep latency by ____min, ↓ nocturnal awakenings, ↑ total sleep time by ____min

Answer 39

10-19 30-50

Question 40

BZs decrease what kind of sleep?

Answer 40

REM and delta sleep = less restorative sleep

Question 41

caution with BZs in older adults because

Answer 41

they have lower phase 1 metabolism = choose drugs that only undergo phase 2 met

Question 42

what sleep drugs only undergo phase 2 metabolism

Answer 42

lorazepam, oxazepam, tempazepam

Question 43

Zopiclone and zolpidem MOA

Answer 43

Binds to a1 subunit of GABA receptor (selective binding = ↓ anxiolytic eff comp BZs)

Question 44

alpha 3 binding plays a role in

Answer 44

sleep regulation

Question 45

T or F: Z like drugs have lses hangover eff and faster sleep induction comp BZs

Answer 45

T- more selective binding

Question 46

T or F: Z lke drugs affect sleep architecture

Answer 46

F does not

Question 47

zopiclone onset and half life

Answer 47

onset <1hr, t1/2 5hrs

Question 48

zolpidem onset and half life

Answer 48

onset 20min, t1/2 2.6h

Question 49

which is better for night time awakenings to go back to bed 1. zopiclone 2. zolpidem

Answer 49

zolpidem

Question 50

2nd line pharm for insomnia

Answer 50

melatonin L tryptophan valerian

Question 51

melatonin has some evidence of

Answer 51

↑ eff in older pts but ↑ risk of AEs like daytime sleepiness in >4mg, shift workers, jet lag, delayed sleep phase

Question 52

if using melatonin to shift the circ rhythm, how should you take it?

Answer 52

take lower dose 4-5hrs before bed

Question 53

if using melatonin as a hypnotic, how should you take it

Answer 53

take 30-90min before bed

Question 54

which of the following has no physical tolerance and dependence 1. zopiclone 2. melatonin 3. lorazepam 4. zopidem

Answer 54

2

Question 55

zopiclone AE

Answer 55

metallic taste complex sleep related behaviours tolerance and dependence

Question 56

zopidem benefits

Answer 56

less chance of morning hangover eff due to short half life rapid onset of action

Question 57

zolpidem AEs

Answer 57

Complex sleep related behaviours can be induced Risk of physical tol and dep

Question 58

at least ____ should be allowed for sleep if taking zopiclone and zolpidem

Answer 58

8hrs

Question 59

doxepin is indicated for

Answer 59

sleep maintennace

Question 60

temazepam is a

Answer 60

BZ, nonspec GABAa agonsit

Question 61

dozepin is a

Answer 61

TCAA, H1 antagonist

Question 62

trazodone and mirtazapine are

Answer 62

phenylpiperazine, 5HT2/H1 antagonist

Question 63

trazodone and mirtazapine SEs

Answer 63

Risk of OH Rare risk of priapism and cardiac conduction issues

Question 64

trazodone and mirtazapine use should be limited to pts with

Answer 64

depression

Question 65

T or F: mirtazapine preserves sleep structure

Answer 65

T

Question 66

what are orexins

Answer 66

hypocretins that are neuropeptides which stimulate wake promoting system in cycle

Question 67

dependence to sleep drugs form after _______ of regularuse

Answer 67

2wks-1mth

Question 68

what drugs have less tolerance and and withdrawal due to receptor selectivity

Answer 68

Z drugs

Question 69

which sleep drugs have minimal dependence

Answer 69

eszopiclone, ramelteon, and temazepam (6mths nightly use)

Question 70

which has higher misuse potential 1. BZs 2 .nonBZs

Answer 70

BZs

Question 71

how can you reduce risk of dependence and misuse with sleep aids

Answer 71

use intermitent dosing dispense smallest effective dose + shortest period of time Taper dose → intermediattent use → trial d/c q3-6mths