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Flashcards in Sleep disorders Deck (29):
1

sleep disorder symptoms

difficulty initiating sleep, difficulty maintaining sleep, early awakenings, nonrestorative sleep with ample opportunity for sleep

2

Sleep disorder

insomnia sx w/ sig waking sx or impairment (daytime drowsiness, drowsy driving)

3

Excessive sleepiness

chronic excessive sleepiness affects 5% of general population, impact of drowsy driving (100,000 MVA/year)

4

Risk factors of sleep disorders

female, oler, divorced, stressors at work, perception of health, medica and psychiatric disorders, medications, drug abuse

5

Stages of sleep

REM (20-25%), Non REM (75-80%), 1 cycle typically last 1.5-2 hours, stage 1 relaxed wakefulness, initiates sleep, stage 2- lighter sleep, provides rest for brain and muscles, Stage 3- provides rest, feeling of rejuvenation, stage 4-immune system enhanced, growth hormone released

6

Norepi, histamine, ACh

Promote wakefulness

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Serotonin

neurons in the brainstem inhibit motor activity and lessen sensory input, promoting emergence of slow wave sleep

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Opiates and GABA

promote sleep, GABA is more active during NREM

9

Hypocretin

found in hypothalamus, loss of hypocretin neurons linked to narcolepsy

10

Non-pharm approaches

use bedroom only for sex and sleep, relaxation therapy, stimulus control, use alcohol/nicotine w/ caution, sleep restriction, exercise, avoid eating close to bed time

11

Pharm treatment

BZD, triazolam (Halcion), Temazepam (Restoril), estazolam (Prosam), recommended for short term use only; nonBZD- Zolpidem (ambien), Zaleplon (Sonata), Eszopicolone (Lunesta), Ramelteon (Rozerem), Desyrel, benedryl

12

Triazolam (Halcion)

shortest acting BZD

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Temazepam (Restoril)

intermediate acting, slow onset, 15-30 mg PO once daily

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Estazolam (Prosom)

intermediate acting, fast onset

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Zolpidem (Ambien) dose

5-10 mg PO once daily at bedtime

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Eszopiclone (Lunesta) dose

1-3 mg PO once daily at bedtime

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MOA of non BZD

binds to a1 subtype of the BZD receptor

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Non BZDs pearls

very quick onset (30 mins), short-acting little to no hangover effect, eszopiclone is the only one approved for long term use causes metallic taste, sedation, all are C-IV controlled

19

Ramelteon (Rozerem) MOA

melatonin agonist, not controlled substance, goal to restor circadian rhythm, use for jet lag

20

Trazodone (Desyrel)

not FDA approved for sleep but only used for sleep, DOC for insomnia in elderly, no addiction potential, no ACh ADRs

21

Diphenhydramine (Benadryl)

OTC, lots of ACh ADRs, tolerance develops

22

Supplements for sleep

Valerian, chamomile, melatonin

23

Sequence of agents employed

Temazepam, zolpidem/zaleplon, trazodone, if early morning awakening, use temazepam, if daytime anxiety use long acting BZD

24

Sleep attacks

REM sleep at anytime during the waking state, last 10-30 mins

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Cataplexia

loss of muscle tone in face/limbs, often induced by emotions or laughter

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Hypnogogic hallucinations

perceptual disturbances that occur during sleep attack

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Sleep paralysis

inability to breath deeply, move limbs or speak, often occurring upon falling asleep

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Narcolepsy treatment

Dextroamphetamine (Adderall), Methylphenidate, modafanil (Provigil), Armdafinil (Nuvigil)

29

MOA of Modafanil (Provigil)

inc wakefulness via a adrenergic and GABA modulating mechanisms, no effect on cataplexy, efficacy similar to stimulants