Insomnia Lecture Review

Flashcards covering key concepts related to insomnia, including facts, evaluation tools, differential diagnoses, and treatment options (pharmacologic and non-pharmacologic) from the lecture notes.

What is the recommended amount of sleep for adults per night?

7-9 hours

What are the acute effects of lack of sleep?

Impaired judgment, inability to focus, decreased memory, lack of coordination

What are the chronic effects of lack of sleep?

Metabolic disorders (HTN, Hyperlipidemia, Obesity, Hyperglycemia), Depression, Anxiety

What characteristics are important to assess in the History of Present Illness for insomnia?

Onset, Location, Duration, Exacerbation, Radiation, Relief, Associated signs & symptoms

What are the main evaluation tools used for insomnia assessment?

Epworth Sleepiness Scale, Insomnia Severity Index, Pittsburgh Sleep Quality Index, PHQ-9, GAD-7

What does the Epworth Sleepiness Scale measure?

The likelihood of dozing off or falling asleep in various situations.

According to the Insomnia Severity Index, what score indicates no clinically significant insomnia?

0-7

What are some common differential diagnoses for insomnia?

Restless Legs Syndrome, Anxiety, Depression, Bipolar Disorder, Caffeine intake, Alcohol intake, Pain, Nightmares, Nocturia, Sleep Apnea, Drug use, Jet lag, Shift-Work Sleep Disorder

What are the four main categories of insomnia treatment?

Sleep hygiene, Non-pharmacologic/Complementary & Alternative Medicine (CAM), Over-the-Counter, Prescription

What is considered the best long-term treatment for insomnia?

Sleep hygiene

How long can it take for sleep hygiene practices to make a true difference in sleep?

4-8 weeks

What is a key recommendation for the sleep environment?

The bed is for sleep and sex ONLY; turn off and remove technology from the bedroom.

What is a crucial component of a healthy bedtime routine for circadian rhythm?

Commit to going to bed and waking up at the same time every night and morning.

How long before bedtime should alcohol intake be avoided?

At least 2 hours prior

How long before bedtime should caffeine intake be avoided?

At least 4-6 hours prior

What should a person do if they cannot fall asleep within 20 minutes?

Get out of bed, stretch or drink warm tea, then try again.

What is discouraged during the daytime to improve sleep at night?

Napping (to maintain sleep pressure)

Name two relaxation techniques that can be used once in bed.

4-7-8 Relaxing Breath Exercise, Progressive Muscle Relaxation, Meditation, Biofeedback

Name three non-pharmacologic or CAM approaches for insomnia.

Herbal supplements, Essential Oils, Acupuncture, Yoga, Massage, Meditation

List three herbal supplements commonly used for sleep.

Melatonin, Chamomile, Valerian, Kava, Tart Cherries, Marijuana

What is Cognitive Behavioral Therapy (CBT) for insomnia?

A type of psychotherapy that helps people identify and change negative thought patterns and behaviors to improve their mental and emotional health related to sleep.

What is the general rule for using pharmacologic treatment for insomnia?

Short-term use only (less than two weeks).

What are some common downsides and risks of pharmacologic treatment for insomnia?

Rebound insomnia, daytime fatigue/sleepiness/hangover, habit-forming risks, anticholinergic effects.

What is the mechanism of action for common OTC sleep aids like Nytol and Sominex?

H1 receptor antagonist

What are common side effects of H1 receptor antagonist OTC sleep aids?

Daytime drowsiness/grogginess, daytime impairment, dizziness, xerostomia, urinary retention.

Which on-label nonbenzodiazepine benzodiazepine receptor agonist is useful for problems falling asleep only?

Zaleplon (Sonata) or Zolpidem tartrate (Ambien)

Which on-label nonbenzodiazepine benzodiazepine receptor agonist is useful for problems both falling asleep and staying asleep?

Zolpidem tartrate extended-release (Ambien CR) or Eszopiclone (Lunesta)

What advantage does Ramelteon (Rozerem) have as a melatonin receptor agonist for insomnia?

Little negative effect on cognition, somnolence, motor coordination, or nausea.

What are common anticholinergic side effects associated with off-label tricyclic antidepressants like doxepin and amitriptyline for sleep?

Anticholinergic side effects and weight gain.

What is a significant risk associated with trazodone (Desyrel) as an off-label sleep aid?

Orthostatic hypotension and falls.

What U.S. Boxed Warnings are associated with benzodiazepines?

Abuse, Misuse, Addiction; Dependence & Withdrawal (especially with opioids).

What U.S. Boxed Warnings are associated with zolpidem (Ambien) and eszopiclone (Lunesta)?

Complex sleep behaviors including sleep-walking, sleep-driving, and other activities, with a risk of serious injury and death.

What medication is commonly used to treat nightmares?

Prazosin (Minipress)

What are common side effects of Prazosin when used for nightmares?

Hypotension, syncope

In the summary of insomnia management, what is the first recommended step?

Education and counseling in proper sleep hygiene practices.