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30 Cards in this Set
- Front
- Back
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Unsatisfactory sleep that impacts daytime functioning?
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Insomnia
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What are the four types of insomnia?
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Acute, Chronic, Primary, Secondary
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This is insomnia that is less than thirty days in duration?
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Acute insomnia
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This is when insomnia lasts 30 days or greater in duration, occurring 3x/wk or more. Likely due to a comorbidity.
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Chronic insomnia
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This is in 15-20% of cases, and there is no known medical/psychiatric cause for the insomnia.
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Primary insomnia
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This is insomnia due to other reasons - medical, psychiatric, chemical, environmental.
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Secondary insomnia
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What are the characteristics of insomnia?
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Early - Difficulty with sleep initiation
Middle - Nighttime awakening with difficulty falling back to sleep Late - Early morning awakening Poor Quality - Sleep that is non-restorative |
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What kind of therapy is preferred for insomnia?
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Non pharmacologic
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What are the non-pharmacologic therapies for insomnia?
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Sleep log
Exercise Cognitive Behavioral Therapy Good Sleep Hygiene: no caffeine/stimulants/alcohol no napping during the day Bed is for sleep only don't go to bed hungry If can't fall asleep in 20 minutes then get out of bed until tired |
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What is the preferred 1st choice of pharmacological therapy for treating insomnia?
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Enhancing GABA:
BZD - short to intermediate acting Non-BZD - Zolpidem, Zaleplon, Eszopiclone Stimulating melatonin: Remelteon (Rozerem) Other melatonin products OTC |
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What is the second choice pharmacologic therapy for insomnia?
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Blocking histamine, receptors centrally:
Antidepressant and others. Other antihistamines include cold and sleep preparations sold OTC - diphenhydramine, doxylamine (unisom) Pharmacotherapies for the cause of insomnia - Pain, pulmonary, GI, etc. |
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What BZD's are labeled as hypnotics and may be used in insomnia?
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Temazepam, flurazepam, quazepam, triazolam, estazolam
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The onset of effects for BZD's are related to what?
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lipophilicity
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These reduce sleep latency
Increase duration of sleep: Duration of action helps dictate one choice over another. Caution is required if used too frequently, most days for more than two weeks: May cause anxiety, may result in tolerance. |
BZD efficacy in insomnia
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These are more specific for the GABAa subtype compared to BZDs
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Non-BZD GABA enhancers
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What are three non-BZD GABA enhancers?
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Zolpidem (Ambien)
Short Acting Longer acting CR is available Zaleplon (Sonata) Short acting Eszopiclone (Lunesta) Longer acting Only agent FDA approved for treatment of insomnia over 35 days |
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What is the only NON-BZD GABA enhancer FDA approved for TX of insomnia over 35 days?
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Eszopiclone (Lunesta)
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The mechanism of action for this tx of insomnia is blockade of centrally located histamine-1 receptors.
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Antihistamines
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What are the Antidepressants used to help insomnia?
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Trazodone
Mirtazapine Tricyclics |
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These are not recommended as antidepressants for insomnia TX due to safety concerns?
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Atypical antipsychotics
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What are the non antidepressant antihistaminic agents used to help tx insomnia?
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Diphenhydramine
Doxylamine Both OTC Available by scrip: Promethazine Hydroxyzine |
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Some agents used for insomnia have strong anticholinergic effects, what are they?
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TCAs, diphenhydramine, doxylamine, promethazine, and hydroxyzine
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These are beneficial for insomnia if the GABAnergic options are a risk (falls, abuse/dependency, respiratory depression)
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Antihistaminic agents
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Antidepressant options are beneficial in TX insomnia if the patient has?
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Comorbid condition such as depression, chronic pain, or restless leg.
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The mechanism of this insomnia TX is by agonizing the melatonin receptor M1 and M2. M1 is likely to induce sedation. M2 is likely to reset sleep cycles.
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Melatonin Agents - Remelteon (Rozerem)
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What do the melatonin agents - Remelteon (Rozarem) lack that BZDs don't?
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They are less effective at sleep latency and total sleep time compared to BZDs and non-BZDs classes of hypnotics.
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What are the melatonin agents - Remelteon (Rozarem) benefits over BZDs?
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They are not abusable
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Most cases of this are transient.
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Insomnia
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Chronic cases of insomnia are likely?
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Secondary - Treat cause while providing therapy of insomnia
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What most likely dictates first choice for TX of insomnia?
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The patient's comorbidities.
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