[ Psychiatric ] Sleep Disorders 2

Insomnia duration: Acute timeline

< 3 months.

Insomnia duration: Chronic timeline and frequency

≥ 3 months: ≥ 3 nights/week, causes.

Insomnia treatment (Sleep hygiene): Schedule recommendation

Regular sleep schedule.

Insomnia treatment (Sleep hygiene): Substance avoidance

Avoid caffeine/nicotine late.

Insomnia treatment (Sleep hygiene): Daytime resting recommendation

Limit naps.

Insomnia treatment (Sleep hygiene): Technology recommendation

Reduce screen exposure before bed.

Insomnia treatment (Pharmacologic): Z-drugs classification

Z-drugs (non-benzodiazepine hypnotics).

Insomnia treatment (Pharmacologic): Z-drugs examples

Zolpidem, zaleplon, eszopiclone.

Insomnia treatment (Pharmacologic): Z-drugs clinical effects

↓ sleep latency, improve sleep maintenance.

Insomnia treatment (Pharmacologic): Z-drugs risks

Risks: dependence, falls (elderly), cognitive impairment.

Insomnia treatment (Benzodiazepines): Recommended usage duration

Short-term only.

Insomnia treatment (Benzodiazepines): Mechanism of action

Work via GABA-A.

Insomnia treatment (Benzodiazepines): Sleep-related withdrawal risk

Rebound insomnia.

Insomnia treatment (Benzodiazepines): Specific contraindication

Avoided in pregnancy.

Insomnia treatment (Melatonin-related agents): Ramelteon mechanism

Ramelteon (melatonin receptor agonist).

Insomnia treatment (Antidepressants): General indication

Off-label, especially if depression present.

Insomnia treatment (Antidepressants): Most commonly used agent

Trazodone (most commonly used).

Hypersomnolence disorder: Core definition

Persistent excessive daytime sleepiness despite adequate or prolonged sleep duration.

Hypersomnolence disorder diagnostic features: Sleep duration context

Excessive sleepiness despite sleeping ≥7 hours/night.

Hypersomnolence disorder diagnostic features: Daytime episodes

Recurrent episodes of: unintentional sleep, difficulty maintaining alertness.

Hypersomnolence disorder diagnostic features: Frequency criterion

Occurs ≥3 times per week.

Hypersomnolence disorder diagnostic features: Duration criterion

Duration: ≥3 months.

Hypersomnolence disorder treatment: First-line pharmacotherapy

Modafinil (1st line).

Hypersomnolence disorder treatment (Behavioral): Nap strategy

Scheduled naps.

Hypersomnolence disorder treatment (Behavioral): Routine strategy

Regular sleep–wake schedule.

Hypersomnolence disorder treatment (Behavioral): General practice

Sleep hygiene optimization