Sleeping Disorders

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Author:
alvo2234
ID:
205111
Filename:
Sleeping Disorders
Updated:
2013-03-05 09:41:58
Tags:
Cheung
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Description:
PT I exam
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  1. what is difficulty falling asleep
    > 30 min
  2. what is early morning awakening
    EMA < 6hrs
  3. what is the most effective treatment for insomnia
    CBT cognitive behavior therapy
  4. what is stimulus control
    train the brain to re-associate the bed and bedroom with sleep and re-establish a consistent sleep-wake schedule
  5. what is sleep restriction
    creat sleep debt by curtailing amt of time in bed, then increasing time in bed as sleep efficiency improves
  6. what is relaxation therapy
    progressive tensing and relaxation of muscles
  7. paradoxical intention
    encourage pt to engage in most feared behavior to reduce performance anxiety with trying to sleep
  8. antihistamine treatment
    • can cause drowsiness and help sleeping but with:
    • 1. high incidence of daytime sedation and cognitive impairment the next day
    • 2. tolerance may develop after 3-7 days of continued use
  9. chloral hydrate treatment
    • hepatic metabolism to active metabolite
    • AVOID use if ClCr < 50 ml/min
    • tolerance may develop over a 5-14 days of continued use
  10. z-hypnotics
    • 1. hypnotic effects w/out anxiolytic, muscle relaxant, or anticonvulsant effects
    • 2. lower risk of abuse, withdrawal and tolerance as compared to nonselective BZDs
    • 3. C-IV controlled substance (more abuse potential than ramelteon
    • 4. little or no change in sleep stages and sleep architecture
  11. zolpidem
    • ambien: onset 30 min
    • 1. major substrate of 3a4
    • 2. 5-10 mg PO at HS
    • 3. rare effects; perform activities while half asleep
  12. zaleplon
    • sonata:
    • 1. onset 30 min
    • 2. least likely of all hypnotics to cause residual daytime sedation
    • 3. no active metabolites
    • 4. usual dose 10mg PO
  13. eszopiclone
    • lunesta:
    • 1. major substrate of 3a4
    • 2. fda approved for long term use
    • 3. usual dose 2-3 mg at bedtime
    • 4. less receptor selectivity
  14. non-selective benzodiazepines
    • 1. have anziolytic and muscle relaxant activities
    • 2. dependence can occur after continued use over 2-4 mths
  15. triazolam
    • halcion:
    • 1. major substrate of 3a4
    • 2. SHORT¬†TERM use to avoid rebound insomnia
    • 3. 0.25 usual dose
  16. temazepam
    • restoril:
    • 1. hepatic metabolism, no active metabolite
    • 2. usual dose 15-30mg
    • 3. low risk of drug interactions, accumulation, and daytime impairment
  17. flurazepam
    • dalmane; very old drug
    • 1. major substrate of 3a4
    • 2. hepatic metabolism
    • 3. usual dose 15-30mg, AVOID use in elderly
    • 4. accumulation and daytime impairment
    • 5. little chance for rebound insomnia
  18. trazodone
    • 1.normally given as adjunctive agent to induce sleep while waiting on primary antidepressant effect
    • 2. major 3a4 substrate
    • 3. usual dose 25-50
    • 4. tolerance does not develop in short term use (<6wks)
  19. stepwise approach for selecting hypnotic agent for insomnia
    • 1. determine type of insomnia
    • 2. consider possible causes
    • 3. CBT and sleep hygience
    • 4. assess type of pt
  20. trazodone helps for what sleep type
    DFA, EMA
  21. chloral hydrate helps with what types of insomnia
    DFA, DMS
  22. flurazepam treats which type of insomnia
    DFA, DMS
  23. temazepam treats what type of insomnia
    DMS
  24. zolpidem, zaleplon, triazolam treat which type of insomnia
    DFA
  25. contraindications in sleep apnea
    • hypnotics
    • alcohol
    • CNS depressant
  26. what is sleep apnea
    mini-episodes of breathing cessation
  27. narcolepsy is characterized by what 2 main features
    • irrepressible sleep attacks
    • cataplexy
  28. how to treat narcolepsy
    • stimulants;
    • methylphenidate (ritalin)
    • dextroamphetamine (dexedrine)
    • dextroamph and amphetamine (adderall)
    • modafinil (provigil) class IV
  29. how to treat cataplexy
    • sodium oxybate (xyrem)
    • -only FDA approved tx
    • -can be administered safely with stimulants
    • -CONTRAINDICATED with other cns depressants including hypnotics
  30. melatonin IND/administration
    • 1. used for circadian rhythm slee disorder
    • 2. take clsoe to the target bedtime in the new time zone
  31. Ramelteon IND/MOA/evidence
    • 1. MT1(sleepiness),2(phase shifts)¬†selective agonist
    • 2. FDA approved for insomnia by DFA
    • 3. no evidence of cognitive impairment, rebound insomnia, withdrawal effects, or abuse potential
  32. how to treat slep-related movement disorders
    • pramipexole (mirapex)- may cause HF
    • ropinirole (requip)

    • BZDs
    • anticonvulsants
    • analgesics

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