Sleep Disorders
Name the REM parasomnia
vivid dreams with physical re-enactment of dreams
common in Parkinson's and Lewy Body dementia
can be assoc with ETOH withdrawal and antidepressant use
Sleep Behavior disorder
Name the other parasomnia
more common in male children
caused by large nocturnal urine production
difficulty awakening
bladder hyperactivity
Sleep enuresis
Treatment for Narcolepsy is......
Stimulants: methylphenidate , amphetamines, modafinil which are controlled substances
All of the following are are treatments for which disorder?
CPAP (Compliance, uncomfortable, anxiety producing)Modafinil for hypersomnolence
remove physical barriers
wt loss
Sleep Apnea
Name the REM parasomnia
recurrent distressing dreams with upsetting emotional content
anxiety driven
must be accompanied by impairment of fxning
Nightmare Disorder
Name the other parasomnia
sensation or noise that casues abrupt awakening with fear
happens when falling asleep or waking up
pain is present
r/t anxiety
Exploding Head Syndrome
Trazodone/Desyrel
diphenhydramine/Benadryl
melatonin
tryptophan/amnio acid
methylphenidate & amphetamines increase _______ & _______ (NTs) in the frontal cortex
DA & NE
Medications used to treat RLS
Ropinirole/Requip
Pramipexole/Mirapex
Gabapentin ER
meds are dosed at HS
side effects: insomnia, irritability, h/a
Name the REM parasomnia
can ot move during wakefulness
REM extend into waking period
may struggle to breath and have hallucinations
Isolated sleep paralysis
How to dx sleep disorder
conduct assessment to see why t is having sleep issues (FULL CPE)
evaluate psychiatric concerns
psychosocial assessment of recent stressors or changes
medical review of sxms- medical comorbidities
The following are meds are suggestions by the AASM but are considered ________
suvorexant
eszopiclone
zaleplon
zolpidem
temazepam
ramelteon
doxepin
weak
Modafinil blocks _________ to stimulate alpha receptor, glutamate, and histamine to promote wakefulness
The side effects of Modafinil are
DAT
anxiety, nausea, & dizziness
Nonpharmacological tx for RLS?
increase activity during the day
no caffeine, ETOH, Nicotine
stretching exercise
massage
biofeedback
activities that require mental effort
iron supplementation
Hallucinations that happen when falling asleep are called?
Hallucinations that happen while awakening are called?
***** Hallucinations are most common in women
hypnogogic
hypnopompic
(may become fearful of falling asleep)
All of the following are considered part of _______ ______
Environment (dark, cool, and comfortable)
activity ( sedentary lifestyle worsens sleep- need to burn fuel to need it)
Natural light
Sleep schedule
Eliminate stimulants ( nicotine & caffeine)
determine underlying cause
******pharmacotherapy IS NOT the 1st step
Sleep Hygeine
Per the American College of Physicians guidelines what is the gold standard for tx of Insomnia?
Medications should be used for _______ weeks or less
CBT-1
5
________ _________ is used to treat narcolepsy and cataplexy
Ture or False
Dosed 2 times/night in water and dose os 6-9 mg
The side effects of this med are
Sodium Oxybate
True
H/A, nausea, dizziness, and somnolence
***** can ot be given with sedatives
What do these meds have in common?
Diazepam
Estazolam
Esopiclone
Flurazeoam
Quazepam
Ramelteon
Temazepam
Triazolam
Zaleplon
Zolpidem
FDA approved for insomnia
All of the following are _______ _______ of Parasomnias
SUD
Insomnia
mood disorders
risk factors
What guides treatment for Sleep?
American Academy of Sleep Medicine (AASM) Guidelines
American College of Physicians recommends which medications for sleep?
Zolpidem/Ambien
Suvorent/Belsomra
Eszopiclone/Lunesta
Doxepin/Sinequan
Ramelteon/Rozerem
Treatment for Circadian Rhythm Disorder (shift work disorder)
Behavioral and Environmental changes 1st
Modafinil and Armodafinil FDA approved
melatonin also used
Eliminate nicotine & caffeine
sunglasses when lvg work
bright light therapy during shift
Name non FDA approved medications but used for insomnia?
hydroyzine
Melatonin
Antidepressants with sedative effects
trazodone, doxepin, & Mirtazapine
***** DO NOT USE quetiapine, olanzapine, or other antipsychotics for sleep d/t side effects