Insomnia

Question 1

Dyssomnia is defined as

Answer 1

sleep disorder characterized by problems in timing, quality, or amount of sleep (e.g. insomnia, sleep apnea, narcolepsy, or hypersomnias like RLS, circadian rhythm sleep disorder)

Question 2

Parasomnia is defined as

Answer 2

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep (think nightmare disorder, sleeping disorder, bruxism, REM sleep behavior disorder)

Question 3

In the DSM 5, insomnia is a ____ with at least one of the following symptoms; disturbances in

Answer 3

complaint of dissatisfaction with sleep quality/quantity;
can’t initiate, maintain sleep, or early-morning awakening and can’t go back to sleep;
BEASO (distress and impairment), and NOT attributable to a substance or a coexisting medical/mental disorder

Question 4

About ___ of adults report insomnia symptoms; prevalence of insomnia; who reports insomnia more?

Answer 4

1/3; will increase with age;

WOMEN (because they see the doctor more and will report more!!)

Question 5

Endogenous causes of insomnia? Exogenous?

Answer 5

Endogenous: excitatory NT in excess at night (NE from locus ceruleus, serotonin from raphe nucleus, dopamine from ventral tegmental area, histamine from TMN); also inhibitory NT deficiency at night (lose GABA, melatonergic, adenosinergic tones, or MAG-azine reading!!)
Exogenous: 1. use of CNS stimulants (coffee)
2. sedating agent withdrawal (alcohol, barbituates, benzodiazepines)
3. Medical conditions (chronic pain, pulmonary disease, endocrine disorders)

Question 6

Insomnia secondary to mental disorder would include:

Answer 6

1. Major depressive disorder
2. Bipolar disorder
3. PTSD/generalized anxiety disorder

Question 7

___ symptoms can lead to insomnia; after many nights of insomnia

Answer 7

Anxiety (worried about past events, future ones, too much responsibilites, like POP);
one becomes anxious about not being able to get enough sleep (one sees bed as a place where they will be wide awake and they’re worried about failing to sleep)

Question 8

Effects of insomnia: what’s the big one?

Answer 8

Worried about self-medication and risk of substance abuse (also decreased quality of life, complaints of impaired daytime performance, maybe an impairment for mass production!!)

Question 9

First step in managing insomnia? Second step?

Answer 9

1. Diagnosis, informed consent, education (plenty of time to sleep if you DIE)
2. Behavioral counseling (sleep hygiene and stimulus control, an example of the latter just using the bed for sleep and sex, not to stay awake any longer)

Question 10

3rd step of managing insomnia?

Answer 10

Sleep restriction, cognitive (talking out, images), behavioral (diary,/log book, progressive relaxation, self hypnosis)

Question 11

4th step of managing insomnia

Answer 11

1. Start with OTC agents (melatonin, antihistamines)
2. Rx agents/non-habit forming (antihistamines like dopexin, or melatonin 1+2 agonists like ramelteon and tasimelteon) TAke RAMEn
3. Rx agents/mild habit forming (benzo agonists like zolpidem, zaleplon, ezopiclone, thought NOT true benzos; or orexin 1+2 antagonists like suvorexant) Easy for ZAne and ZOLlman
4. Habit forming benzodiazepines (trazolam, temazepam, flurazepam; or trazodone, a sedating antidepressant or quetiapine, a sedating antipsychotic) FLOUrishing TRAck TEam; QUEck TRAck