External stimuli: o Noise o Excessive heat or cold o Bright light o Partner with snoring or restless legs. Stimulants

Transcription

1 External stimuli: Nise Excessive heat r cld Bright light Partner with snring r restless legs Stimulants Cffee Chclate Tea Alchl and Sleep Alchl is mre disruptive t sleep than caffeine The bdy will prduce adrenaline t cmpensate fr the alchl in the system Alchl makes peple thirsty Causes - Physical Bdily dysfunctins: Pain. Decreased mbility. Disturbing sensatins r mvements Peridic limb mvements. Cardiac r respiratry prblems Asthma Heart failure Sleep apnea GI reflux, IBD Age. Peridic Limb Mvements, Restless Legs Familial cnsider megadses f flic acid mg Check ferritin irn deficiency may als prvke Fr ncturnal myclnus: Insmnia Causes - Exgenus Marijuana, alchl Slutins Remve Causal Factrs Stp alchl, stimulants, etc Treat pain Treat heart failure, sleep apnea, etc Earplugs/ heavy curtains, etc Treat partner Medicatins: Sleeping pills and Tranquilizers ( rebund ) Thyrid preparatins Oral cntraceptives Beta-blckers SSRI s Magnesium Vitamin E Parkinsn s Drugs Causes - CNS Alteratins in the central nervus system (CNS) that initiate and maintain sleep. Brain: strke, head injury, dementia. Metablic: liver disease, bld sugar, etc. Fr repetitive 3 am awakening, try a prtein snack befre bed. Hrmnal: thyrid, menpause. Causes - Psychlgical Persnality: Anxius, tense, smatic vs. Relaxed, phlegmatic. Stress. Life changes (birth, death, divrce, mve, etc.). Depressin Circadian rhythm sleep disrder Pr Sleep Hygiene

2 Slutins Principles f Sleep Hygiene G t bed and arise frm bed at the same time each day Avid daytime naps r limit them t ne midafternn nap Avid evening alchl use Avid caffeinated drinks late in the day Reduce r eliminate tbacc use, especially at night r in the evening Exercise in mderatin; avid evening exercise Use the bed nly fr sleep and sexual activity Keep the bedrm dark, quiet, and cl Avid stress and wrrisme thughts in the evening befre sleep Sleep Restrictin Therapy N Naps Rise at same time regardless f hw little sleep Limit sleep t 1-2 hurs less than reprted amunt f sleep Makes sleep mre cntinuus Then gradually increase sleep time Stimulus Cntrl Therapy Assciate bed, sleep envirnment nly with sleep, intimacy N reading, eating, r watching TV in bed. Get ut f bed and t d smething relaxing if unable t sleep after 15 t 20 minutes. (Nt TV light and cntent are arusing) Light Therapy Bright light in the mrning Avidance f bright light in the evening This wrks even in alchl withdrawal Relaxatin techniques Mental Prayer Jurnal Imagery Bifeedback Delta wave inducing sleep CD Music pstperative study in CABG patients Physical Breathing Prgressive Relaxatin Sunder Sleep System Nn-Drug Therapies Really D Wrk! Behaviral management f sleep disturbances secndary t chrnic pain. J Behav Ther Exp Psychiatry Dec;20(4): Dcumented effectiveness f a behaviral prgram n EEG and sleep architecture in patients with chrnic pain. The Sunder Sleep Slutin Snja Rseth Based n a prgram develped by Michael Krugman

3 Prs Wrk quickly Cvered by insurance Pills and Ptins Herbs and Medicatins t Aid Sleep Medicatins Prs and Cns Cns Stp wrking (Tlerance) Dependence Rebund Sedatin Amnesia Natural Substances Minerals Calcium and Magnesium Amin Acids: Tryptphan, 5HTP Hrmnes: Melatnin Herbs Armatherapy Sertnin Neurtransmitter in the brain that triggers sleep Made frm tryptphan amin acid fund in fds such as milk, turkey 5HTP Increase REM sleep (typically by abut 25%) Increase deep sleep stages 3 and 4 N increase in ttal sleep time mg minutes befre retiring Melatnin Hrmne prduced by the pineal gland part f the system that aligns ur bdy with light and dark Dsage: 3 mg at bedtime is mre than enugh Dsages as lw as 0.1 and 0.3 mg have been shwn t prduce a sedative effect when melatnin levels are lw Cautin: Culd disrupt the nrmal circadian rhythm. In ne study, a daily dsage f 8 mg/day fr nly 4 days resulted in significant alteratins in hrmne secretins Passinflwer The herbal specific fr staying asleep Studied vs. serax (benzdiazepine) fr anxiety: Equally effective fr anxiety N cgnitive r mtr impairment Valerian Takes 2 3 weeks t start wrking Shwn t significantly reduce sleep latency imprve sleep quality reduce night-time awakenings Usually reduces mrning sleepiness. Valerian Studies: Cmpared with placeb, valerian shwed a significant effect 44% reprting perfect sleep 89% reprting imprved sleep. Studies:

4 Duble-blind study f insmniacs: Valerian rt extract (160 mg) and Melissa fficinalis extract (80 mg) Benzdiazepine (triazlam mg) Placeb. Results: Valerian effect cmparable t drug Able t increase deep sleep stages 3 and 4. Did nt cause daytime sedatin N evidence f diminished cncentratin based n the Cncentratin Perfrmance Test N impairment f physical perfrmance Other Herbs Used Traditinally Lemn Balm Hps Chammile Skullcap Kava End Fatigue Revitalizing Sleep Frmula Armatherapy Essential il scent r in hydrtherapy Lavender nursing hme study Rse Ylang-ylang Nerli Drugs The Ideal Sleeping Pill Shrten latency t sleep Maintain nrmal physilgical sleep all night withut blcking nrmal behaviral respnses t the crying baby r the alarm clck Leave neither hangver nr withdrawal effects the next day N tlerance r side effects, such as impairment f breathing, cgnitin, ambulatin, and crdinatin Nt habit-frming r addicting. Has nt been develped Over-the-cunter Drugs e.g. Nytl, Sleep-Eez, Sminex, Anacin PM, Excedrin PM, Tylenl PM, Unism antihistamines nt addictive nt effective in sustaining stage IV sleep can affect the quality f sleep adversely. Lng vs. Shrt-Acting Hypntics Shrt Lng Hangver Accumulatin Tlerance Withdrawal insmnia Decrease anxiety Amnesia

5 Table 1 -- Drugs with a Fd and Drug Administratin indicatin fr insmnia Drug name Mechanism f actin Dse range Eliminatin half-life Estazlam (PrSm) BzRA 1 2 mg h Flurazepam (Dalmane) BzRA mg h [a] Temazepam (Restril) BzRA mg 8 20 h Triazlam (Halcin) BzRA mg 2.4 h Quazepam (Dral) BzRA mg h [a] Zlpidem (Ambien) BzRA 5 10 mg h Zlpidem ER BzRA mg 2.8 h Zalepln (Snata) BzRA 5 20 mg 1 h Eszpiclne (Lunesta) BzRA 1 3 mg 6 h Ramelten (Rzerem) MtRA 8 mg h Mre Medicatins Used fr Insmnia Imidazpyridines Selective fr alpha-1 GABA R Zlpidem (Ambien) 5-10 mg Zalepln (Snata) 5-10 mg Less selective GABA R agnist Eszpiclne (Lunesta) 2-3 mg Melatnin receptr agnist Rzerem 8 mg Antihistamines Diphenhydramine (Benadryl) mg Sedating antidepressants Amitriptyline (Elavil) 10 75mg Anticnvulsants Muscle relaxants Other Trazdne(Desyrel) mg Dxepin mg Imipramine mg Remern 15 mg Neurntin mg Helps pain and PLM/Restless legs Gabitril 4 mg 1-3 at bedtime Sma 350 mg Addictive Flexeril mg at bedtime GHB (Xyrem)