Addressing the Multiple Causes and Lifestyle Impacts of Insomnia: A Guide for Patient Counseling Educational Objectives: At the completion of this knowledge-based activity, participants will be able to: 1. Describe the impact of insomnia on overall health, well-being, and productivity 2. Assist in the assessment of insomnia for patients of all ages and for patients with comorbid conditions 3. Provide education to patients and families on how sleep hygiene and cognitive behavioral interventions can improve sleep 4. Compare the advantages and disadvantages of available pharmacologic treatments for insomnia 5. Provide counseling to patients and families regarding the safe and effective use of prescription and non-prescription sleep aids Post-Test/Rationale 1. Individuals with persistent insomnia who sleep fewer than 6 hours nightly are at increased risk for what chronic health condition? A. Asthma B. Hypothyroidism C. Obesity*** D. Anemia Obesity is a well-established consequence of persistent insomnia; the other medical conditions listed are not consequences of persistent insomnia. 2. In order to keep track of factors that impact quality and quantity of sleep, the National Sleep Foundation s sleep diary asks a person to record which of the following in the morning upon awakening? A. The number of midnight awakenings*** B. The amount of exercise the day before C. The amount of alcohol consumed the night before D. A list of medications ingested the previous morning Correct answer: A The National Sleep Foundation s sleep diary prompts individuals to record the number of middle-of-the-night awakenings each morning. The amount of exercise, alcohol ingested, and medications should be recorded at the end of the day. 3. According to the Centers for Disease Control and Prevention, drowsy driving is a factor in % of traffic accidents.
A. 5% B. 10% C. 20%*** D. 30% Drowsy driving is a factor in 20% of traffic accidents. 4. According to the Agency for Healthcare Research and Quality s executive summary on managing insomnia, a 35-year-old with trouble falling asleep and staying asleep is most likely to benefit from which of the following sleep aids? A. Eszopiclone*** B. Trazodone C. Diphenhydramine D. Temazepam Correct answer: A According to available research, the Agency for Healthcare Research and Quality lists eszopiclone as the most effective agent for trouble falling asleep and staying asleep. 5. A 60-year-old man with major depression and generalized anxiety disorder has been taking sertraline 100 mg daily for 2 weeks with partial improvement in depressive symptoms but ongoing difficulty falling asleep. He has no history of substance abuse. Which of the following agents is effective for insomnia in patients with depression and anxiety disorders and could help this patient? A. Ramelteon 8 mg B. Suvorexant 10 mg C. Zolpidem 5 mg*** D. Doxepin 6 mg Zolpidem would be the best choice for this patient. None of the other agents have been systematically studied and found to be safe and effective for managing insomnia in patients with comorbid depression and anxiety. 6. Which of the following statements is most important to include when counseling a 45- year-old woman receiving a prescription for zolpidem 10 mg for insomnia? A. Take it with a snack in order to increase absorption and effectiveness B. Do not take it longer than 7 consecutive days to prevent rebound insomnia C. Rarely, this medicine can cause sleep paralysis, nightmares, and hallucinations D. Ask your prescriber about only taking 5 mg if you experience next-day impairment***
Correct answer: D Zolpidem is best taken on an empty stomach for fast onset. It is not associated with rebound insomnia. Choice C is an accurate counseling point, but it is not as important as preventing next-day impairment by taking a lower dose. 7. Which of the following techniques involves counseling a patient to get out of bed and go into another room when unable to sleep instead of tossing and turning in bed? A. Stimulus control B. Sleep restriction*** C. Cognitive therapy D. Sleep hygiene Correct answer: B The behavioral technique of sleep restriction involves limiting time in bed to sleeping; patients are encouraged to get out of bed and do another activity before getting back into bed. 8. An obese person with trouble falling asleep and staying asleep may require a lower than usual dose of which hypnotic? A. Zaleplon B. Triazolam C. Zolpidem CR D. Suvorexant*** Correct answer: D Suvorexant blood levels are higher in obese patients, which means that obese patients may need a lower dose than non-obese patients to achieve the same outcomes. This is not the case for the other hypnotics listed. 9. On average, cognitive behavioral therapy for insomnia takes how many weeks to implement? A. 1 to 2 B. 2 to 4 C. 3 to 6*** D. 6 to 8 It can take 3 to 6 weeks for cognitive behavioral strategies to improve insomnia, according to the review paper by Morin and Benca that was published in 2012. 10. Next-day irritability and dysphoria are possible side effects of which agent commonly prescribed for difficulty falling asleep and staying asleep?
A. Zolpidem B. Trazodone*** C. Temazepam D. Amitriptyline Correct answer: B Trazodone has been associated with irritability and dysphoria in some patients receiving trazodone for insomnia, particularly if they also take a cytochrome P450 2D6- inhibiting antidepressant such as fluoxetine or paroxetine. This side effect is thought to be caused by the active metabolite, meta-chlorophenylpiperzine.
Post-test Answer Key: 1. C 2. A 3. C 4. A 5. C 6. D 7. B 8. D 9. C 10. B