Differential Diagnosis
This disease is characterized by subjective difficulty falling asleep or staying asleep (despite adequate opportunity) and results in daytime impairment.
What is insomnia?
As you begin to fall asleep, you enter which state of sleep? REM or Non-REM?
What is Non-REM (stage 1, 2, then 3)
Getting up and going to sleep at the same time every day.
What is a consistent sleep schedule?
Avoid these 90 minutes before bed and in bed.
What are electronic devices or clock watching (phone, computer, video games, e-reader)?
Avoid taking these in evening as it increases nocturnal urination. (name at least 1 drug class),
What are diuretics or SGLT2 inhibitors (furosemide, indapamide, chlorthalidone, hctz, empagliflozin, etc)?
This tool is used to assess for obstructive sleep apnea (OSA).
What is STOP-BANG?
Name 2 medical conditions that may contribute to sleep disruptions.
Chronic pain, BPH, GERD, allergies, migraines, COPD, heart disease, diabetes, HTN, RLS, sleep apnea, etc.
This is recommended if obstructive sleep apnea (OSA) is suspected.
What is a sleep study?
Drinks containing this is not recommended after 3pm.
What is caffeine?
Initial Dose = 3.75mg qhs, max 7.5mg/d in most adults. Max 5mg/d in elderly.
What is zopiclone (Imovane)?
This is a patient-reported questionnaire used to assess the patient’s perception of sleepiness.
What is the Epworth Sleepiness Scale?
The average time to fall asleep.
What is 30 minutes?
Leave bed after 15-20 minutes of not sleeping.
What is stimulus control?
These prescription drug(s) can cause insomnia or disrupt sleep (name 2).
What are bupropion, duloxetine, varenicline, salbutamol, beta-blockers, statins, corticosteroids, opioids, etc.?
This drug class can cause dependence, memory impairment, falls, urinary incontinence.
What are benzodiazepines?
This 7-question tool can help classify insomnia.
What is the insomnia severity index?
The type of sleep that reduces as we age.
What is deep (delta or stage 3-4) sleep?
This is NOT recommended in untreated OSA, seizures, unstable bipolar disorder/mental health.
What is sleep restriction?
Substances (not prescriptions) that can affect sleep (name at least 2 products).
What is THC, cocaine, alcohol, or nicotine? (name 2)
"Newer" sleep drugs that can cause complex sleep behaviour (amnesia, paralysis, sleep driving).
What are orexin antagonists, lamborexant (Dayvigo) or daridorexant (Quviviq)?
For restless leg syndrome, monitor ____ and target level > ___ mcg/mL.
What is ferritin and level > 75mcg/mL or > 100mcg/mL for moderate-severe RLS. (ref: Dynamed)
The type or stage of sleep increases as we age (name 2)
What is medium/light (stage 1, 2) and wakefulness?
At least 4 things to avoid or minimize within 4 hours of bedtime.
What is caffeine, nicotine, intense aerobic exercise, heavy meals or excessive liquids.
The ideal sleeping temperature.
What is below 70 degrees Fahrenheit or < 21 degrees Celsius?
The time it takes to taper benzodiazepine using the EMPOWER brochure?
What is 17-18 weeks?