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29 Cards in this Set
- Front
- Back
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causes: travel, hospitalization, anticipation for important stressful event
transient, short term, chronic |
transient
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death of loved one, recovery from surgery, job loss, divorce.
transient, short term, chronic |
short term
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substance abuse, medical problems
transient, short term, chronic |
chronic
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what are exclusions to self treatment of insomnia
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a. Frequent nocturnal awakenings or early morning awakenings
b. Insomnia > 3 weeks (chronic or long-term insomnia) c. Sleep disturbance occurring nightly for several days d. Sleep disturbance secondary to psychiatric or general medical disorders |
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Describe methods to good sleep hygiene
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a. Follow regular sleep pattern: go to bed & arise about the same time daily, even on weekends
e. Exercise regularly but not late in evening h. If hungry, eat light snack, but avoid eating meals or large snacks immediately prior to bedtime j. Avoid caffeine, alcohol, nicotine for 4-6 hours before bedtime |
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what is the efficacy of diphenhydramine
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transient and short term sleep difficulty
effective in reducing sleep latency |
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what is the dose of diphenhydramine
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25-50mg per dose (max 50mg)
asian pt 75mg |
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how long can pt take diphenhydramine
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7-10 consecutive nights
14 days max -take for 3 days then reevaluate sleep for one night w/o medication |
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what are SE of diphenhydramine
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sedation
anticholinergic effects paradoxical excitation (seen often in pt with organic mental disorders [alz, mental retard, autism]) |
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diphenhydramine isn't recommended in pts of what age
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<12 years
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what are contraindications to Diphenhydramine
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prostatic hyperplasia and difficulty urinating
angle closure glaucoma dementia CV disease (angina or arrhythmias) |
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antihistamines aren't recommended in what populations
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elderly
children |
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what is the dose of L tryptophan
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1-3g
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what are SE of L tryptophan
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eosinophilia-myalgia syndrome
serotonin storm when used with MAO-I or SSRI` |
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what type of insomnia can Valerian not treat
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acute insomnia
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what is the DOSE OF VALERIAN
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150-300 MG AT BEDTIME
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what sleep aid must you be cautious with long term use due to BZD like withdrawal syndrome or rebound insomnia
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valerian
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what is the effect of melatonin
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reduces sleep latency and REM latency
may relieve jet lag |
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what is the effect of morning and night admin of melatonin
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morning admin - delays circadian rhythm
evening admin - advances circadian rhythm |
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what kind of insomnia is melatonin good for treating
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short term
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what is the dose of melatonin
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0.3-5mg at bedtime
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what is alcohols effect on sleep
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decreases sleep latency
decreases total sleep time REBOUND INSOMNIA MAY OCCUR FROM D/C |
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what are exclusions to self treatment of dowsiness
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<12 years of age
medication preclude caffeine use medication induced drowsiness chronic fatigue pregnant/breast feeding |
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what is chronic fatigue
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symptoms not resolved after 7 days of self treatment
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how do you take sleep stimulants
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don't exceed 200mg q 3-4 hrs for a max of 600mg/day
chronic use of caffeine may cause tolerance and withdrawl symptoms don't use if pregnant or breast feeding don't use if <12 years take for only 2-3 days, intermittent use decreases likelihood of tolerance increased alertness should occur within 30 minutes always use in conjunction with good sleep hygiene caution or consult PCP in pt with symptomatic GERD, hx of kidney stones, peptic ulcer disease, psychiatric disorders |
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what does Caffeine interact with
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aspirin
smoking clozapine, OC, ciprofloxacin, fluvoxamine |
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what is caffeine's interaction with aspirin
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increases aspiring absorption
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what is caffeine's interaction with smoking
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smoking induces CYP1A2 so upon smoke cessation cut caffeine dose in half
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what is caffeine's interaction with clizapine, hormonal contraceptives, ciprofloxacin, fluvoxamine
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they inhibit CYP1A2
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