Self Care: Insomnia, Drowsiness, Fatigue

What is stage 1 of sleep cycle?

transitional stage, EEG is in waking state

What is stage 2 of sleep cycle?

50% of sleep, light

What is stage 3 and 4 of sleep cycle?

deep sleep (delta)

What is stage REM of sleep cycle?

rapid eye movement, not light or deep EEG high-freq waves

Exclusions for Insomnia?

• <1 2 years

• > 65 years

• Pregnancy

• frequent awakenings

• chronic insomnia (> 3 weeks)

What is the non-pharma treatment for insomnia?

FOR TRANSIENT and SHORT-TERM insomnia

• Sleep hygiene

Diphenhydramine MOA?

competes with histamine for H1-receptor on effector cells in gastrointestinal tract

Diphenhydramine used for?

manage transient and short-term sleep difficulty

Diphenhydramine dosing?

• 50 mg at bedtime or 25 mg

• after 3 days, take 1 day off

• do not use more than 7-10 nights

Diphenhydramine side effects?

• anticholinergic: dry mouth, constipation, blurred vision

• drowsiness

Diphenhydramine drug interactions?

2d6 inhbitors

when does Diphenhydramine work?

• 3-6 hours after dose

• half-life: 2.4-9.3 hours

What are the side effects of antichlinergics?

SLUD

• salivation

• lacrimation (tears)

• Urination

• Defecation (constipation)

Counseling points for Diphenhydramine?

• avoid driving, cooking, operating heavy machinery

• no alcohol

• paradoxial excitation

Contraindications for Diphenhydramine?

• older men with BPH, bad urination

• angle-closure glaucoma

• angina, arrhythmias

• dementia

1st generation antihistamines cause what side effects?

drowsiness, anticholinergic

1st generation antihistamines examples..

• chlorpheniramine

• clemastine

• Diphenhydramine

• doxylamine

• pheniramine

• dexchlorpheniramine

• dexbrompheniramine

• brompheniramine

• chlorcyclizine

-INE ending

Doxylamine

Do not recommend

Ethanol

induce sleep, equal to bad driving

What happens if you take ethanol in high doses?

sleep disturb in second half of night, tolerance is quick → higher doses

• can become chronic

Melatonin (CAM)

Dosing: 0.3-5 mg at bedtime, 30 min prior bedtime

5-HTP (CAM)

Do not recommend

Valerian (CAM)

• limited benefit

• continuous night effect for days/weeks for effects

• taper

Kava (CAM)

• severe hepatoxicity

• do not reccommend

Chamomile, other teas

eh kinda mid tbh

Exclusions to drowsiness and fatigue

• < 12 years

• pregnancy

• breastfeeding

• heart disease

• medication-induced

• chronic-fatigue

drowsiness and fatigue non-pharma

sleep hygiene boo

drowsiness and fatigue: caffeine pharma MOA

• increases 3’5 cyclic AMP, phosphodiesterase inhibited

• CNS stimulant, increases medullary

• prevention of apnea, competitive inhibit adenosine

caffeine is used for?

restore mental alertness

dont drink take high doses= anxiety :(

caffeine dosing

100-200 mg every 3-4 hours as needed, rapid tolerance

Side effects of caffeine?

• withdrawal with abrupt discontinuation

• Peptic ulcer (PUD), gastric reflex

• increase in BP

• increase risk of kidney stones

Caffeine drug effects?

cig smoking, increase 1A2

Caffeine contraindications?

• if taking MAOIs

• any coronary artery disease

• uncontrolled hypertension

• pre-existing arrhythmias