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9 Cards in this Set

  • Front
  • Back

Subjective Work Up for Insomnia?

1 Questionnaires


Insomnia Severity Index


Epworth Sleepiness Scale


Pittsburgh Sleep Quality Index



2 Sleep logs/ diaries


3 Sleep History


How long? How much? Daytime tiredness? Comments from sleep partner? H/p prior to TBI, asthma, COPD, GERD, Inct, BPH, Anxiety, Depression, Pain


4 Cigarette, caffeine, ETOH use


5 Current meds (OTC, diet pills caffeine containing meds, allergy meds (sudafed)

Objective Measures for Insomnia?

Nocturnal polysomnography (NPSG) gold standard for insomnia


records EEG, eye movement (EMG), O2 levels


Actigraphy (a device worn around the arm, leg or waist

Behavioral tx for Insomnia?

Sleep hygeine


Conitive behavioral tx


chronotherapy


relaxation tech


light therapy

Sleep hygiene

1 consistent sleep schedule


2 avoid daytime naps


3 no caffeine 4-6 h before bed


4 avoid nicotine (stimulant) and alcohol


5 avoid drinking fluids prior to sleep (nocturnal micturition)


6 Modify environment by minimizing light and noise, adjust temp


Relaxation therapies


Breathing exercises, guided imagery


light therapy

Meds for Sleep aid

1 Ramelteon (Melatonin agonist)


2 Traodone (Antidepressant)


3 Mirtazapine (Antidepressant)


4 Nortriptyline (Antidepressant)


5 Trazadone (Antidepressant)


6 Non benzodiazepine (Z drugs) Zolpidem (Ambien and Ambien CR)


Zaleplon (Sonata) Zopiclone (Lunesta)

SE of nonbenzodiazepine (Z drugs)


headache, hallucinations, amnesia, fall risk

SE of Ramelteon

Dizziness, fatigue, worsened insomnia

Rx Ramelteon


Mech of action

Ramelteon 4-8 mg po q hs


decreases sleep latency and improved total sleep time

SE of antidepressants?

1 arrhythmia


2 agitation


3 ataxia


4 confusion


5 seizure constipation