Term
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Definition
| repetitive cessation of breathing during sleep; central vs. obstructive |
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Term
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Definition
| involuntary urge to move limbs; worsened at rest |
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Term
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Definition
| characteristics: sleep attacks, cataplexy, hypnagogic hallucinations, sleep paralysis |
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Term
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Definition
| unsatisfactory sleep that impacts daytime functioning |
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Term
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Definition
| primary (not linked to anything else); situational (shift work, jet lag); medical (CV, respiratory, pain, endocrine, neuro, GU); Medication-induced (anticonvulsants, bupropion/NRT, diuretics, SSRIs, steroids, stimulants); Psychiatric (mood disorder, anxiety, substance abuse, grief) |
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Term
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Definition
| sleeps aprox. 20 hrs/day; after 3-6 months, REM vs. NREM differentiation starts; by 3 yrs, circadian rhythm begins; |
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Term
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Definition
| gradual decline in time & efficiency of sleep |
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Term
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Definition
| sleep becomes more fragmented with intermittent arousals; gradual reduction of slow wave sleep |
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Term
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Definition
| establish consistent sleep & wake times; exercise routinely (3-4x/wk); create comfortable sleep environment; d/c or reduce consumption of nicotine, alcohol, or caffeine; avoid drinking large amts of liquid before bedtime; do something relaxing prior to bedtime; minimize or eliminate daytime naps |
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Term
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Definition
| sleep latency; total sleep time; sleep efficiency; sleep quality; wakefulness; impact on individual sleep cycles |
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Term
| antihistamines - diphenhydramine (Benadryl OTC), doxylamine (Unisom OTC), hydroxyzine (Vistaril Rx) |
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Definition
| most used sleep aid; uses side effect to treat insomnia; Advantages: OTC, generally safe; Disadvantages: rapid tolerance, may reduce sleep quality, residual drowsiness |
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Term
| diphenhydramine (Benadryl OTC) |
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Definition
| antihistamine used alone or in combo products (Tylenol PM); peak: 1-3 hrs; half-life: 8 hrs |
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Term
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Definition
| antihistamine; peak: 2-3 hrs; half-life: 10 hrs |
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Term
| hydroxyzine (Vistaril Rx) |
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Definition
| antihistamine; peak: 2 hr; half-life: 3-7 hrs; NOT FDA approved for insomnia but still used |
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Term
| antidepressants - amitriptyline (Elavil), trazadone (Desyrel), mirtazapine (Remeron) |
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Definition
| mechanism: blocks ACh, NE, and SE pre-synaptic receptors; all uses for insomnia are OFF-LABEL; Advantages: decreases sleep latency & wakefulness after sleep onset, increases total sleep time, sleep efficiency, & sleep quality, tx for depression; Disadvantages: decreases REM sleep, residual drowsiness, increased ADRs |
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Term
| melatonin receptor agonist - ramelteon (Rozerem) |
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Definition
| MoA: melatonin MT1 & MT2 receptor agonist; decreases sleep-onset latency & increases total sleep time, decreases likelihood of dependence, rare SEs; Disadvantages: no studies to see if it works on other types of insomnia; ONLY non-controlled Rx for insomnia; peak: 0.3 hr; half-life: 2-5 hrs; EXPENSIVE!!! |
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Term
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Definition
| antidepressant; peak: 2-4 hrs; half-life: 17-40 hrs |
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Term
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Definition
| antidepressant; peak: 0.5-2 hr; half-life: 8 hr |
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Term
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Definition
| antidepressant; peak: 1.5 hrs; half-life: 20-40 hrs; increases appetite |
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Term
| benzodiazepines - triazolam (Halcion), flurazepam (Dalmane), temazepam (Restoril), estazolam (ProSom), quazepam (Doral) |
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Definition
| MoA: GABA receptor agonists; Advantages: increases sleep time, sleep efficiency & sleep quality; decreases sleep-onset latency & wakefulness after onset; Disadvantages: dependence & tolerance, antegrade memory impairment, respiratory depression; PROLONGS stage 2 sleep, DECREASES stage 3,4, REM sleep; best used in SHORT TERM RELIEF |
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Term
| GABA receptor agonists (non-benzodiazepines) - zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta) |
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Definition
| selective GABA(a) receptor agonists; ADV: increases sleep time, sleep efficiency & sleep quality, decreases sleep onset & wakefulness after onset, low risk of dependence; Disadvantages: no direct efficacy comparisons with benzodiazepines; minimal effect on time in various sleep stages |
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Term
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Definition
| benzodiazepine; peak: 1-2 hrs; half-life: 2 hrs |
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Term
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Definition
| benzodiazepine; peak: 1 hr; half-life: 8 hrs, active metabolites for 50-100 hrs |
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Term
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Definition
| benzodiazepine; peak: 1.5 hrs; half-life: 10-15 hrs |
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Term
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Definition
| benzodiazepine; peak: 2 hrs; half-life: 12-15 hrs |
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Term
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Definition
| benzodiazepine; peak: 2 hrs; Half-life: 39 hrs, active metabolites for 50-100 hrs |
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Term
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Definition
| GABA receptor agonist (non-benzodiazepine); peak: 0.5 hrs; Half-life: 2-3 hrs; take on empty stomach |
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Term
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Definition
| GABA receptor agonist (non-benzodiazepine); peak: 0.5 hrs; half-life: 1 hr; assists sleep initiation but NOT maintenance; may be used for middle of the night awakenings |
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Term
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Definition
| GABA receptor agonist (non-benzodiazepine); peak: 1 hr; half-life: 4-6 hrs; labeled for "long-term use" (up to 6 months) |
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Term
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Definition
| MoA: supplementation of melatonin hormone; ADV: OTC availability; DIS: high doses cause sleep disruption & daytime fatigue, limited efficacy evidence, NOT FDA approved or regulated; peak: 1 hr; half-life: 0.5-2 hrs |
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Term
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Definition
| Proposed MoA: inhibits breakdown of GABA, adenosine A1 receptor agonist; ADV: OTC availability; DIS: limited evidence of efficacy, daytime sedation, NOT FDA approved or regulated; Peak: 1 hr; half-life: unknown |
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Term
| non-recommended therapies |
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Definition
| barbiturates, opiates, alcohol |
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Term
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Definition
| effective in tx of insomnia for early therapy; high risk of ADRs w/ prolonged use; not recommended |
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Term
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Definition
| fragment sleep by decreasing REM & stage 1 sleep; may be useful if sleep is source of insomnia; generally not recommended |
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Term
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Definition
| reduces sleep onset latency; increased wakefulness & potential for abuse; suppresses REM sleep; not recommended |
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Term
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Definition
| altered pharmaockinetics: may increase peak or extend half-life; increased freq. of primary sleep disorders |
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Term
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Definition
| consider alternatives to benzodiazepines in this population |
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Term
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Definition
| use benzodiazepines or GABA receptor agonists before trying other |
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Term
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Definition
| duration/frequency of hypnotic use; compliance with sleep hygiene recommendations; address 2ndary causes of insomnia; limit activity plans for day following 1st dose; monitor for adverse effects (daytime drowsiness, withdrawal symptoms/rebound insomnia) |
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