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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) |
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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 |
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Behavioral tx for Insomnia? |
Sleep hygeine Conitive behavioral tx chronotherapy relaxation tech light therapy |
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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 |
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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) |
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SE of nonbenzodiazepine (Z drugs)
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headache, hallucinations, amnesia, fall risk |
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SE of Ramelteon |
Dizziness, fatigue, worsened insomnia |
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Rx Ramelteon Mech of action |
Ramelteon 4-8 mg po q hs decreases sleep latency and improved total sleep time |
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SE of antidepressants? |
1 arrhythmia 2 agitation 3 ataxia 4 confusion 5 seizure constipation |