Self Care: Insomnia/Drowsiness/Fatigue

What are the five stages of sleep?

stages 1, 2, 3, 4, and REM

What is the clinical presentation of insomnia?

- difficulty falling asleep (30+ min)

- frequent awakenings

- inability to back asleep

- poor sleep quality

What are the treatment goals of insomnia?

improve patient's symptoms, quality of life, functioning

What are the two OTC pharmacological therapy options?

1. antihistamine

2. antihistamine/analgesic combination

What are some exclusions for self-treatment of insomnia?

- < 12 years old

- 65+ years old

- pregnant/breastfeeding

- frequent nocturnal awakenings

- chronic insomnia

- secondary to other disorder

- significant sleep disturbances

(T or F) Antihistamine/analgesic combination OTC drugs are first-line for insomnia.

false (avoid combination products, unless necessary)

What's the MOA for diphenhydramine and doxylamine?

competitively blocks H1 receptors

Are the following listed complementary therapies considered effective for insomnia?

- melatonin

- valerian

- chamomile

evidence to support use is lacking

What are commonly used over-the-counter drugs that can cause insomnia?

- alcohol

- caffeine

- corticosteroids

- decongestants

- nicotine

What are commonly used over-the-counter drugs that can produce withdrawal insomnia?

- alcohol

- first gen antihistamines

- illicit drugs

When are antihistamines indicated for patients with insomnia?

manage short-term sleep difficulties

When are ethanol indicated for patients with insomnia?

manage chronic sleep difficulties

For Benadrayl, after ___ days of improved sleep, discontinuing for ___ night to see if insomnia is resolved.

3, 1

Take Benadryl ___ mg ___ min before bedtime.

50; 30

What is the recommendation for the use of diphenhydramine during pregnancy?

need a referral

note: some evidence of teratogenicity BUT not completely contraindicated)

What is the recommendation for the use of diphenhydramine in nursing mothers?

should NOT be used (increase risk of CNS ADE in neonates)

What is the recommendation for the use of diphenhydramine in children?

NOT indicated for children under 12 years old

note: can cause paradoxical excitation

What is the recommendation for the use of diphenhydramine in adolescents?

ask teens about other non-prescription remedies use and use of nicotine, alcohol, and caffeine

What is the recommendation for the use of diphenhydramine in elderly patients?

recommended to avoid use of diphenhydramine because of anticholinergic effects (BEERs criteria)

note: need referral because can cause delirium, confusion, cognitive decline

What are some exclusions for self-treatment of drowsiness/fatigue?

- <12 years old

- pregnancy/ breast feeding

- heart disease

- anxiety disorders

- medication-induced drowsiness

- chronic fatigue (<6 months)

What is the clinical presentation of drowsiness/fatigue?

- inadequate sleep

- circadian process

- not fully alert

- dream-like thoughts

What's an OTC pharmacological therapy of drowsiness/fatigue?

caffeine

What's the MOA of caffeine?

inhibit phosphodiesterase to increase 3',5' cyclic adenosine monophosphate

note: a CNS stimulant that'll increase sensitive medullary respiratory center to CO2

Are the following listed complementary therapies considered effective for insomnia?

- ginseng

- kola nut

- guarana

- taurine

- yerba mate

not proven to be effective

How long does caffeine take to become effective?

onset 15 minutes

note: peak concentration is ~30-120 minutes

What's the differences between nonprescription caffeine-only vs nonprescription combination products?

non-prescription caffeine-only = typically contain 200 mg

nonprescription combo = contain 60-65 mg

What's the effective caffeine dosages for adults and children (>12 years old)?

100-200 mg every 3-4 hours PRN

How much caffeine can pregnant women take?

200 mg/day in moderation!

How much caffeine can a woman who's breastfeeding take?

no more than 300 mg/day (max = 2-3 cups of coffee)

What are some dietary supplements that can increase energy or decrease fatigue (complementary therapies)?

increase energy

- ginseng

- kola nut

- yerba mate

counteract fatigue

- guarana

- taurine