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CC Jan 2016 Chronic insomnia

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echoecho's version from 2016-04-13 06:36

Section

Question Answer
Define insomnia?the subjective perception of difficulty with sleep initiation, duration, consolidation or quality that occurs despite adequate opportunity for sleep and that results in some form of daytime impairment
Insomnia is the most prevalent sleep disorder in what population?the general population
Insomnia symtpoms are estimated to occur in ____ to _____ of the general population?1/3; 1/2
Insomnia disorder (associated with daytime impairment) is estimated to occur in what % of patients?10-15%
List the 5 risk factors of insomnia?1) increasing age 2) female gender 3) chronic illness 4) substance abuse 5) shift work
List 7 s/s as a result of daytime impairment?1) fatigue 2) sleepiness 3) difficult with memory 4) difficulty with concentration/attention 5) worry about or preoccupation with sleep 6) mood disorders 7) irritability
What helps to establish the dx of insomnia and may point to contributing and possibly modifiable risk factors?a good sleep hx
List the 5 parts of a sleep hx?1) primary complaint 2) pre-sleep conditions 3) sleep-wake schedule 4) nocturnal symtposm 5) daytime activities and function
Regarding the sleep history, list the 7 examples to ask about under primary complaint?1) difficulty falling asleep / frequent awakenings / poor sleep quality 2) onset of symptoms 3) duration of symptoms 4) frequence of symptoms 5) severity of symptoms 6) aggravating factors 7) past and current treatment(s) and response
Regarding the sleep history, list 3 examples to ask about under pre-sleep conditions?1) pre-bedtime activities 2) bedtime environment 3) evening physical and mental status
Regarding the sleep history, list 7 examples to ask about under sleep-wake schedule?1) bedtime 2) average time to fall asleep 3) factors prolonging or shortening sleep 4) number, characterization and duration of awakenings 5) associated symptoms and behaviors 6) final awakening vs. time out of bed 7) hours of sleep obtained
Regarding the sleep history, list 4 examples to ask about under nocturnal symptoms?1) respiratory 2) motor 3) other medical 4) behavioral and psychological
Regarding the sleep history, list 6 examples to ask about under daytime activities and function?1) sleepiness vs. fatigue 2) napping 3) work 4) lifestyle 5) travel 6) daytime consequences (quality of life, mood disturance, cognitive dysfunction, exaceration of comorbid conditions)
Regarding co-morbid medical illness associated with insomnia, list 7 examples under the neurological system?1) CVA 2) Parkinson's disease 3) seizure disorder 4) headache 5) traumatic brain injury 5) chronic pain 6) neuromuscular disorders
Regarding co-morbid medical illness associated with insomnia, list 3 examples under cardiovascular system? 1) angina 2) heart failure 3) dyspnea
Regarding co-morbid medical illness associated with insomnia, list 2 examples under pulmonary system?1) COPD 2) asthma
Regarding co-morbid medical illness associated with insomnia, list 4 examples under the GI system?1) GERD 2) PUD 3) cholelithiasis 4) irritable bowel syndrome
Regarding co-morbid medical illness associated with insomnia, list 2 examples under the endocrine system?1) hypo-/hyperthyroidism 2) DM
Regarding co-morbid medical illness associated with insomnia, list 4 examples under the musculoskeletal system?1) rheumatoid arthritis 2) OA 3) fibromyalgia 4) Sjogren's syndrome
Regarding co-morbid medical illness associated with insomnia, list 2 examples under the reproductive system?1) pregnancy 2) menopause
Regarding co-morbid medical illness associated with insomnia, list 4 examples under sleep disorders system?1) OSA 2) RLS 3) periodic limb movement disorder 4) parasomnias
Regarding co-morbid medical illness associated with insomnia, list 4 examples under the "other" category/1) allergic rhnitis 2) sinusitis 3) alcohol and substance abuse 4) alcohol and substance withdrawal
List 7 common co-morbid psychiatric illness?1) major depressive disorder 2) bipolar disorder 3) generalized anxiety disordre 4) PTSD 5) OCD 6) dementia 7) personality disorders
List 7 common medication classifications that can contribute to chronic insomnia?1) alcohol 2) antidepressants 3) cardiovascular 4) decongestants 5) narcotics 6) pulmonary 7) stimulants
Regarding common medications that contribute to chronic insomnia, list 3 examples under the antidepressant class?1) SSRIs 2) venlafaxin (Effexor) 3) duloxetine (Cymbalta)
Regarding common medications that contribute to chronic insomnia, list 3 examples under the cardiovascular class?1) beta-blockers 2) diuretics 3) HMG CoA reductase inhibitors (statins)
Regarding common medications that contribute to chronic insomnia, list 2 example under the narcotics class?1) oxycodone 2) codeine
Regarding common medications that contribute to chronic insomnia, list 1 example under the pulmonary class?1) beta-agonists
Regarding common medications that contribute to chronic insomnia, list 5 examples under the stimulants class?1) caffeine 2) methylphenidate (Ritalin) 3) amphetamines 4) ephedrine 5) cocaine
What is recommended at baseline and following specific interventions?insomnia questionnaire
List one commonly used questionnaire?Epworth Sleepiness Scale (http://www.epworthsleepinessscale.com)
List 7 things to list on a 2-week sleep log?1) detailing bedtime 2) sleep latency 3) number of awakenings 4) duration of each awakening 5) time in bed 6) total sleep time 7)naps
*** Do most patients with insomnia require laboratory testing or polysomnography?no
Treatment of chronic insomnia is indicated when the insomnia does what?has a significant negative impact on a patient's sleep quality, health, comorbid conditions or daytime function
All patients should be counseled on good sleep hygiene (list 7 topics to discuss)?1) avoiding stimulants 2) avoiding vigorous exercise prior to sleep 3) eliminating light in the bedroom 4) sleeping in a cool environment 5) avoiding nonsleep related activities in the bed (e.g. watching TV) 6) having the same routine prior to sleep and awakening at approximately the same time every day
What therapy may also be useful for patients with chronic insomnia?behavorial therapy and relaxation training
*** In one small study, geriatric patients randomized to brief behavioral treatment for insomnia (an individual intervention session followed by a brief follow-up session and telephone follow-up) vs. informational only (patients were provided with literature on healthy sleep) had significantly less insomnia at ____ weeks?4 (the effects persisted at 6 months)
Studies have also demonstrated that such cognitive behavioral therapy to treat chronic insomnia can be taught to whom?primary care physicians
List 3 benzodiazepine receptor agonists?1) Eszopiclone 2) Zolpidem 3) Zaleplon
Give the dosing and comments of Eszopiclone (Lunesta)?1) Eszopiclone (Lunesta) 1, 2, 3 mg tablets (Dose: 2-3 mg at hs; 1 mg for elderly). Primarily used for sleep-onset and maintenance insomnia. NO SHORT-TERM USAGE RESTRICTION
Give the dosing and comments of Zolpidem (Ambien)?1) Zolpidem (Ambien) immediate release (5,10 mg) 10 mg q hs, 5 mg for elderly. Primarily for sleep-onset insomnia 2) Controlled release (Ambien CR) 6.25 and 12.5 mg (12.5 at hs, 6.25 mg for the elderly). Primarily used for sleep onset and maintenance insomnia; some long-term safety data 3) Sublingual (Intermezzo)1.75, 3.5 mg (3.5 for men, 1.75 for women). Used for middle-of-the-night wakening when there are at leat 4 hours of bedtime remaining)
Give the dosing and comments of Zaleplon (Sonata)?1) Zaleplon (Sonata) 5, 10 mg (10 mg at hs; 5 mg for the elderly). Primarily for sleep-onset insomnia. May be used for middle-of-the night wakening when there are at leat 4 hours of bedtime remaining
List the FDA approved medications for insomnia?1) benzodiazepine receptor agonits 2) benzodiazepines = estazolam (Prosom); flurazepam (Dalmane); quazepam (Doral); temazepam (Restoril); triazolam (Halcion) 3) melatonin receptor agonits (ramelteon
Are the benzodiazepines meant for short term or long term use?short term
What are the rules for the use of benzodiazepines?1) are not recommended during pregnancy or breastfeeding. 2) should be administered on an empty stomach 3) should not be combined with alcohol or CNS depressants 4) should be avoided in patients with depression, compromised respiratory status or live disease. 5) used with caution in geriatric patients 6) started at low dose with gradual titration
Unlike the other benzodiazepine receptor agonist, which one is not s controlled medication and is FDA approved for long term use?rarely eon (Rozerem)
Data supports both ______ and __________ administration of the benzodiazepines receptor agonists?nightly; intermittent
Lower dosages are indicated for what group of patients?the elderly
In 2013 th FDA recommended lower doses of Zolpidem for what gender?women
True or false? Some patients may be appropriate candidates for long term use of these medications?true
If one medication fails, it is reasonable to try a medication from another _______?class
In choosing a benzodiazepines receptor agonist, what should you know?th pattern of insomnia (difficulty falling asleep, difficulty maintaining sleep, early morning awakening)
What is recommended to prevent rebound insomnia? What causes rebound insomnia?1) gradual taper 2) may occur with abrupt discontinuation
List the medications that are sometimes prescribed for insomnia but do not have FDA approval?1) low dose sntidepressants. 2) amitriptyline (Elavil). 3) doxepin (Seroquel). 4) mirtazapine (Remeron). 5) paroxetine (Paxil). 6) trazodone (desyrel)
*** Over the counter medications such as ________________ contain an histamine (usually Benadryl) but the safety and efficacy of these medications in the treatment of chronic insomnia is not well established?antihistamine
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