sleep, RLS, narcolepsy (NAPLEX)

Chronic insomnia is when patient has symptoms at least __ times per week for at least ___ months

3, 3

What is the preferred TX for chronic insomnia?

CBT

Meds worsening insomnia (14)

AAABFNVCDPASDI

ADHD meds

Acetylcholinesterase inhibitors

Aripiprazole

Bupropion

Fluoxetine (if taken late in day)

NRT

Varenicline

Caffeine

Decongestants

Phentermine

Alcohol

Steroids

Diuretics

INSTI

Sleep hygeine

kkaotieadd

Keep bedroom dark, comfortable, and quiet

Keep a regular sleep schedule

Avoid daytime naps, limit to 30 min

Only use bedroom for sleep

Turn face of clock to side

If unable to sleep, get up and do something to get mind of it

Establish a pre-bedtime ritual

Avoid exercising right before bed

Do not eat heavy meals right before bed

Do not have caffeine in the afternoon

HELP FALLING ASLEEP (4)

Eszopiclone (Lunesta)

Zolpidem (Ambien)

Ramelteon (Rozerem)

Zaleplon (Sonata)

HELP STAYING ASLEEP (4)

Eszopiclone (Lunesta)

Zolpidem (Ambien)

Doxepin (Silenor)

Suvorexant (Belsomra)

Patients may self treat insomnia with OTC first gen antihistamines such as _______ or _______

diphenhydramine, doxylamine

Eszopiclone brand

Lunesta

Zolpidem formulations

Ambien IR and ER tablets

Edluar: SL tablets

Zolpidem dosing

Females/older adults: 5mg PO/SL QHS

Male: 5-10mg PO/SL QHS

Is ramelteon a controlled substance?

No

Hypnotics options (3)

Eszopiclone (Lunesta)

Zolpidem (Ambien)

Zaleplon (Sonata)

Melatonin agonist options (2)

Ramelteon (Rozerem)

Tasimelteon (Hetlioz)

TCA option (1)

Doxepin (Silenor)

Preferred benzo for sleep

Temazepam (Restoril)

Orexin antagonist options (3)

Daridorexant (Quviviq)

Lemborexant (Dayvigo)

Suvorexant (Belsomra)

Doxylamine brand

Unisom sleep tabs

Antihistamines should be avoided in (2)

BPH

Glaucoma

Restless leg syndrome (3)

Iron supplementation if needed

Gabapentin, pregabalin

DA agonist (pramipexole, etc) - but not for long term TX

Narcolepsy TX

Stimulants: Modafinil, Armodafinil

Sodium oxybate

Modafanil warning *

SJS

Sodium oxybate is derived from ______

GABA

What narcolepsy med has a REMS?

Sodium oxybate used as a sexual assault med

Sodium oxybate is a C___

CIII