Insomnia Flashcards

1
Q

Define insomnia

A

Difficulty falling OR staying asleep

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2
Q

What’s primary insomnia?

A

insomnia w/o cause

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3
Q

what’s 2ndary insomnia?

A

insomnia caused by a condition/drug

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4
Q

NTs assoc w/ non-REM sleep

A

GABA and adenosine

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5
Q

NTs/substances assoc w/ wakefulness

A
  1. ACh
  2. NE
  3. DA
  4. substance P
  5. corticotropin releasing factor
  6. histamine
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6
Q

How do lower levels of DA affect sleep?

A

Lower DA levels PROMOTE sleep

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7
Q

How many hours of sleep are assoc w/ poor health outcomes?

A

≤ 6h

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8
Q

What is the MOST COMMON med that promotes insomnia? Why?

A

Levodopa > increases CNS DA levels > promotes wakefulness

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9
Q

5 most common meds likely to disrupt sleep

A

levodopa, prednisone, venlafaxine, fluvoxamine, rotigotine

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10
Q

How frequently must sleep difficulty occur for insomnia to be dx’ed?

A

at least 3 nights per week

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11
Q

How long must sleep difficulty be present for insomnia to be dx’ed?

A

at least 3 mths

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12
Q

Insomnia: sleep onset latency goal?

A

< 30mins

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13
Q

Insomnia: wake after sleep onset goal?

A

< 30 mins

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14
Q

Insomnia: total sleep time goal?

A

> 6h

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15
Q

T or F: Pharmacotx is NOT great for insomnia usually.

A

T

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16
Q

1st line tx for insomnia

A

CBT for insomnia (CBTi)

17
Q

T or F: CBTi improves sleep, but not total sleep time.

A

T

18
Q

Non-pharm tx’s for insomnia

A
  1. sleep hygiene
  2. sleep restriction
  3. stimulus ctrl
  4. cognitive tx
  5. relaxation tx
19
Q

T or F: Drugs are last line for insomnia tx

A

T

20
Q

Pharmacotx should not be used longer than ____ for insomnia tx.

A

1 month

21
Q

How much time can sedative hypnotics increase total sleep time by (according to studies)?

A

25 minutes (not sig)

22
Q

Classes of drugs for used for insomnia

A

Z-drugs
antidepressants
BZDs
OTCs

23
Q

Z-drugs used for insomnia? Which one is most common?

A

Zopiclone - more common

Zolpidem

24
Q

Which antidepressants are used for insomnia? Which one has evidence?

A

Doxepin
Trazodone
L-tryptophan

25
Q

Which BZDs are used for insomnia?

A

Temazepam

26
Q

BZDs should be avoided in…

A

elderly

27
Q

Which OTC products are used for insomnia?

A

melatonin

valerian root

28
Q

Which two classes of insomnia drugs should be tapered before d/c?

A

Z-drugs, BZDs

29
Q

What issues are there with using Z-drugs in pregnant women?

A

May cause low birth wt, preterm deliveries, C-sections

30
Q

Which BZD is recommended in pregnant women if one is absolutely necessary? Why?

A

Lorazepam > no active metabolites and low levels in breast milk

31
Q

Which drug is safe in pregnancy during the 1st trimester?

A

Trazodone

32
Q

T or F: Melatonin is safe during pregnancy

A

F

Not enough evidence/studies

33
Q

Safest drugs for insomnia in elderly:

A

doxepin ≤ 6 mg/day
melatonin
zolpidem

34
Q

What should we inform elderly pts if they complain about insomnia?

A

Tell them it’s normal to sleep less as ppl age

35
Q

Strategies for night shift workers to deal with/avoid insomnia

A
  1. Eat enough to manage hunger (don’t eat too much during shift)
  2. avoid screens (tv, phone)
  3. wear ear plugs, eye masks, use blinds
  4. avoid stimulants/caffeine
  5. Perform relaxing activities (read, bath, etc.)