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30 Cards in this Set
- Front
- Back
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24. What antidepressants are used for sleep?
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a. Trazodone
b. Amitriptyline c. Doxepin (off-label). |
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25. Side effects of Trazodone, amitriptyline, and doxepin for sleep?
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1. Sedation
2. Dizziness 3. Psychomotor impairment. b. Trazodone is the most prescribed sedating antidepressant for pts w/chronic insomnia and depressive symptoms. |
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26. Note: Insomnia is the most common approved and accepted reason to put a pt on long-term benzos.
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26. Note: Insomnia is the most common approved and accepted reason to put a pt on long-term benzos.
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27. What physiological changes is REM sleep characterized by?
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a. ↑ Blood pressure, heart rate, and respiratory rate.
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28. Obstructive Sleep Apnea?
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a. Chronic breathing-related disorder characterized by repetitive collapse of the upper airway usually associated w/a reduction in blood oxygen saturation.
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29. Features of Obstructive Sleep Apnea?
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a. Excessive daytime sleepiness
b. Apneic episodes characterized by cessation of breathing c. Sleep fragmentation (sleep maintenance insomnia) d. Loud stertor (snoring) Frequent awakenings due to gasping or choking e. Non-refreshing sleep f. Morning headaches. |
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30. 3 Risk factors for OSA?
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1. Obesity
2. ↑ Neck circumference 3. Airway narrowing |
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31. Tx of OSA?
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a. Positive airway pressure: Continuous (CPAP) and in some cases bilevel (BiPAP).
b. Behavioural strategies such as weight loss and exercise. c. Surgery. |
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32. Narcolepsy?
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a. Narcolepsy is characterized by excessive daytime sleepiness and falling asleep at inappropriate times.
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33. Features of Narcolepsy?
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a. Irresistible attacks of refreshing sleep that occur daily for at least 3 months.
b. Cataplexy (brief episodes of sudden bilateral loss of muscle tone, most often associated w/intense emotion). c. Hallucinations and/or sleep paralysis at the beginning or end of sleep episodes. |
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34. Pathophysiology of Narcolepsy?
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a. Linked to a loss of hypothalamic neurons that contain hypocretin.
b. May have autoimmune component. |
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35. Hypnagogic hallucination?
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a. Going to sleep
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36. Hypnopompic hallucination?
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a. Waking up.
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37. Note: Don’t confuse narcoleptic cataplexy with catalepsy (unprovoked muscular rigidity)
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37. Note: Don’t confuse narcoleptic cataplexy with catalepsy (unprovoked muscular rigidity)
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38. Tx of Narcolepsy?
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a. Sleep hygiene
b. Scheduled daytime naps c. Avoidance of shift work. |
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39. Rx for excessive daytime sleepiness due to narcolepsy:
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1. Amphetamines (D-amphetamine, methamphetamine)
2. Non-amphetamines such as methylphenidate, modafinil, and sodium oxybate. |
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40. DOC for Cataplexy?
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a. Sodium oxybate.
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41. Other drugs used for cataplexy?
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a. TCAs: Imipramine, protriptyline, and clomipramine.
b. SSRI and SNRIs: Fluoxetine, fluvoxamine, venlafaxine. |
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42. Delayed Sleep Phase Disorder (DSPD)?
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a. Chronic or recurrent delay in sleep onset and awakening times w/preserved quality and duration of sleep.
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43. Risk factors for Delayed Sleep Phase Disorder?
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a. Puberty (secondary to temporal changes in melatonin secretion.
b. Caffeine and nicotine use c. Irregular sleep schedules. |
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44. Treatments Delayed Sleep Phase Disorder (DSPD)?
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a. Timed bright light phototherapy during early morning.
b. Administration of melatonin in the evening. c. Chronotherapy (delaying bedtime by a few hours each night). |
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45. Advanced Sleep Phase Disorder?
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a. Normal duration and quality of sleep w/sleep onset and awakening times earlier than desired.
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46. Risk factor for Advanced Sleep Phase Disorder?
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a. Older age.
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47. Tx for Advanced Sleep Phase Disorder?
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a. Timed bright light phototherapy prior to bedtime
b. Early morning melatonin not recommended (may cause daytime sedation) |
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48. Shift-Work Disorder (SWD)?
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a. Sleep deprivation and misalignment of the circadian rhythm secondary to non-traditional work hours.
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49. Risk factors for Shift-Work Disorder?
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a. Night shift work
b. Rotating shifts c. Shifts > 16 hrs d. Being a medical resident. |
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50. Tx for Shift-Work Disorder?
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a. Avoid risk factors
b. Bright light phototherapy to facilitate rapid adaptation to night shift. c. Modafinil (Provigil) many be helpful for pts w/severe SWD. |
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51. Jet Lag Disorder?
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a. Sleep disturbances (insomnia, hypersomnia) associated with travel across multiple time zones.
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52. Risk factors for Jet Lag Disorder?
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a. Recent sleep deprivation.
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53. Tx of Jet Lag Disorder?
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a. Disorder is usually self-limiting.
b. Sleep disturbances generally resolve 2-3 days after travel. |
