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Flashcards in Sleep Disorders Deck (44):
1

Stages of Sleep

Falling asleep
Light sleep
Deep sleep

2

How long is the NREM-REM cycle?

70-120 minutes and we do it 4-6x a night

3

What neurotransmitters promote sleep?

GABA
Melatonin
Adenosine

4

Dyssomnias

1˚ sleep disorders
1˚ insomnia
Breathing related sleep disorder
Unspecified

5

Parasomnias

Strange behavior while asleep

6

1˚ Insomnia Dx Criteria

Difficulty with the following for ≥1 month:
Sleep onset
Sleep maintenance
Waking too early
Poor sleep quality

7

Risk Factors for Insomnia

Women
Age - quality decreases

8

What is the difference between acute and chronic 1˚ insomnia

4 weeks is the turning point
Before then, give PRN sleep aids and improve sleep hygiene

9

When is pharm therapy reserved for insomnia?

After adequate trials of non-pharm measures

10

Major Sedative/Hypnotic Counseling Pts

Empty stomach
No pregnancy
Careful in depression, lung, liver or heart dys
Try for 2-4 weeks and re-eval
Taper/CBT when d/cing

11

BZDs MOA

GABA Agonists

12

Is there tolerance with BZDs?

Potential
Most are effective for up to 2-4 weeks
Intermittent dosing reduces likelihood of tolerance

13

BZDs in Elderly

Not recommended
If used - give 1/2 to 1/3 normal adult dose of SHORT ACTING BZDs

14

Shortest and Longest Onset BZD

Shortest: triazolam and estazolam
Longest: flurazepam

15

Shortest and Longest Acting BZD

Shortest: triazolam
Longest: Flurazepam (active metabolite)

16

BZD Withdrawal

Rebound sx w/in hours to days
Can cause delirium
Especially high dose

17

BZDRAs

BZD Receptor Agonists
Bind BZD receptor on GABA

18

Advantages of BZDRAs

Stage 3 preserved
Sedative effects only
Less dependence/tolerance

19

Ambien Counseling Points

Diarrhea may resolve in 2 weeks
Use up to 35 days

20

Dosing Considerations with BZDRAs

Women, >65, and liver probs = lower dose

21

Intermezzo

IR SL zolpidem
PRN when wake up and still have at least 4 hours of sleep left

22

Zaleplon

Sonata
Max 30 days
Only for onset
High doses (while effective for increasing total sleep time) are not recommended

23

Temazepam Brand

Restoril

24

Triazolam Brand

Halcion

25

Flurazepam Brand

Dalmane

26

Eszopiclone

S-enantiomer
Lunesta

27

BZDRA Counseling Pts

Empty stomach right before bed

28

Shortest onset BZDRA

Sonata

29

Shortest and Longest Acting BZDRA

Shortest: Sonata
Longest: Lunesta

30

Melatonin Receptor Agonist

Ramelteon (Rozerem)

31

Melatonin

Secreted by pineal gland - less with age
Sleep/wake cycle
Agonism = sleep

32

Weird Lunesta Dosing

Onset: 1mg
Maintenance: 2mg

33

Rozerem

CI with fluvoxamine (1A2)
Empty stomach right before bed

34

TCA Approved for Sleep

Doxepin (Silenor)
Suicide potential
Anti-Ach AEs - H1 antagonist
w/in 30 min of bed empty stomach

35

Off-Label Use for Insomnia

Trazodone
Mirtazapine
SSRIs
TCAs
SGAs

36

Sleep bruxism

Teeth grinding

37

OTC options

Benadryl
Valerian
Melatonin
Kava
5-HT

38

Central Sleep Apnea

No airflow due to no ventilation
Male, DM, CHF, old age, stroke

39

Obstructive Sleep Apnea

No airflow, despite ventilation

40

Consequences of OSA

Heart complications and increased mortality

41

Screening tool for OSA

ISNORED
Insomnia
Snoring
Nighttime awakenings
Obesity
Restorative sleep?
Excessive sleepiness in day
Drugs affecting sleep

42

Drugs for OSA

Change drugs promoting weight gain/CNS depression
Nothing approved
Modafinil for daytime sleepiness if using CPAP

43

Restless Leg Syndrome

Risk - women, PD
1˚ and 2˚ - due to low Fe, pregnancy, kidney failure
Avoid stimulants or DA blockers

44

RLS Treatment

DA Agonists
Ropinirole
Pramipexole
Gabapentin ER - prodrug