INSOMNIA IJNIP

Stage 1

Is a transition between sleep and wakefulness known as relaxed wakefulness

To initiate sleep

What is the function of stage 1

Stage 2

Approximately 50% of total sleep is spent

Stage 2

Provide rest for the muscles and brain through muscle atonia

Stage 3 and 4

are slow wave(delta) or deep sleep.

Stage 3

Occupies an average OF 5% of sleep time

Stages 1 and 2.

Arousability from sleep is higher during what stages?

Stages 3 and 4

Are also known as delta sleep

Delta sleep

also known as restorative sleep, is enhanced by serotonin, adenosine, cholecystokinin, and IL-1.

REM sleep

has aspects of both deep sleep and light sleep.

Dreaming

Is associated closely with REM sleep.

90 minutes

REM periods cycle approximately every _______ throughout the night.

Wakefulness and sleep

Are antagonistic states competing for control of brain activity

False - Wakefulness

True or False: Noradrenergic, histaminergic, and acetylcholine-containing neurons promote sleep

True

TRUE OR FALSE: Opiate peptides (endorphin) and GABA also promote sleep.

True

Hypnotics exert their effects by modulating brain neurotransmitters and neuropeptides (serotonin, norepinephrine, acetylcholine, histamine and γ – aminobutyric acid [GABA])

2 or 3 nights

How long is transient insomnia?

1 month

How long is the. Short term insomnia?

Good sleep and care use of sedative-hypnotics

Transient and short term insomnia should treated with

Nonpharmacological treatment

It is considered as the first line treatment of insomnia

Cognitive behavioral therapies

include sleep hygiene education, stimulus control therapy, relaxation therapy, and sleep-restriction therapy.

Sleep Hygiene

maintaining a regular sleep schedule; avoiding vigorous activity, alcohol, and nicotine before bedtime; creating a comfortable bedroom environment; and minimizing negative thoughts or focus on sleep.

Stimulus - control and. Relaxation therapies

minimize hyperarousal before bedtime and to promote a calm environment used for only for sleep.

Benzodiazepines

They are used in the treatment of insomnia

Benzodiazepine 1 receptor

Is the only benzodiazepine that confers sedation

Shorter acting agents

Better effect on reducing time to sleep

Longer actin agents

Better effect on total sleep time

True

TRUE OR FALSE: all hypnotics should be slowly titrated over the course of weeks to a

month.

TRUE

All hypnotics are schedule IV medication.

Benzodiazepine receptor agonist

bind to BZD type 1 receptor and cause sedation without anticonvulsant effect or skeletal muscle relaxation.

Zolpidem

has been associated with parasomnias including sleepwalking, eating, and driving.

Ramelteon

is a melatonin-receptor agonist selectively targeting the melatonin receptors MT1 and MT2 located in the hypothalamus. Stimulating these receptors is thought to affect the sleep–wake cycle and promote sleep

Doxepin

Is FDA approved for the treatment of Insomnia.

Doxepin

Is a TCA that produces its effects through histamine blockade

Diphenhydramine and Doxylamine

Are antihistamines found in nonprescription sleeping aids

Diphenhydramine and Doxylamine

Tolerance to these agents develop quickly.

Melatonin and. Valerian

Are two commonly used natural remedies for insomnia