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insomnia
| Question | Answer |
|---|---|
| What are the two main processes regulating sleep? | Sleep is regulated by circadian rhythm (internal clock) and homeostatic sleep drive (need to sleep based on hours awake). (Like a phone: circadian rhythm is your alarm schedule, and homeostatic drive is your battery level dropping.) |
| What neurotransmitters promote wakefulness? | Norepinephrine, histamine, acetylcholine, glutamate, and hypocretin. (Like caffeine hitting your “on” switch.) |
| What neurotransmitters promote sleep? | Serotonin, GABA, adenosine, opioids, and interleukins. (Like pressing your system’s “sleep” button.) |
| What are the main sleep stages? | Non-REM (75%) and REM (25%). Non-REM includes stages 1-4; REM is active dreaming. (Like quiet rest vs. dream movie time.) |
| What is the DSM-5 definition of insomnia? | Sleep difficulty ≥3 nights/week for ≥3 months, despite adequate sleep opportunity, causing daytime impairment. (Like missing practice even when the field is open.) |
| Common medical causes of insomnia? | Arthritis, pain, GERD, diabetes, asthma, COPD, depression, anxiety, menopause, pregnancy. (Like anything that keeps your body or mind restless.) |
| Which medications can cause insomnia? | Caffeine, corticosteroids, antidepressants (fluoxetine), decongestants (pseudoephedrine), thyroid meds, beta-blockers, nicotine, alcohol. (Like drinking coffee before bed—your body can’t rest.) |
| Non-pharmacologic therapy for insomnia? | Maintain regular sleep/wake schedule, avoid caffeine and screens before bed, exercise but not late, and keep a dark, quiet room. (Like setting the mood for sleep instead of chaos.) |
| What is “stimulus control”? | Go to bed only when sleepy, get up if not asleep in 20 min, avoid naps, wake up same time daily. (Like training your dog where to sleep—consistency matters.) |
| How long can OTC insomnia treatments be used? | Short term only—no more than 2 weeks (ideally 4-7 days). (Like using crutches temporarily, not forever.) |
| Who should NOT use OTC sleep aids? | Children under 12, adults over 65, pregnant/breastfeeding women, chronic insomnia (>3 months), or secondary insomnia from other disorders. (Like calling tech support when it’s a system issue, not a settings issue.) |
| Which OTC antihistamines are used for insomnia? | Diphenhydramine and doxylamine. (Like using NyQuil without the cold meds.) |
| What is diphenhydramine’s mechanism? | Blocks H1 and M1 receptors in the CNS, causing sedation and anticholinergic effects. (Like turning off your body’s “alert” lights.) |
| What is the half-life of diphenhydramine? | 7–12 hours (longer in elderly). (Like a strong cup of coffee that won’t wear off.) |
| What is the diphenhydramine dose for insomnia? | 25–50 mg at bedtime. (Like one to two standard “sleep aid” capsules.) |
| When does tolerance to diphenhydramine develop? | After about 4–7 days of continuous use. (Like getting used to background noise—you stop noticing it.) |
| How long can diphenhydramine be used safely? | No more than 14 nights—long-term insomnia needs medical evaluation. (Like putting duct tape on a leaking pipe—it’s temporary.) |
| Why should older adults avoid diphenhydramine? | They are more sensitive to confusion, sedation, and falls. (Like giving a sleeping pill to someone already drowsy.) |
| What are diphenhydramine’s key adverse effects? | Morning grogginess, dry mouth, urinary retention (BPH risk), blurred vision, constipation. (Like waking up with a hangover minus the fun.) |
| Which conditions contraindicate diphenhydramine? | BPH, glaucoma, cardiovascular disease, chronic bronchitis, or emphysema. (Like closing all the vents and then trying to breathe.) |
| Why avoid alcohol with diphenhydramine? | Both depress the CNS and can cause severe drowsiness or accidents. (Like doubling up on sedatives.) |
| Why avoid diphenhydramine in pregnancy or breastfeeding? | It may increase uterine activity and reduce milk supply. (Like using something that disrupts the baby’s nap.) |
| Common brands containing diphenhydramine? | Unisom SleepGels, Sominex, Tylenol PM, Advil PM, Excedrin PM, Bayer PM. (Like different sodas—same caffeine inside.) |
| What is the active ingredient in Unisom regular strength? | Doxylamine 25 mg. (Like its cousin diphenhydramine but slightly milder.) |
| Is there strong evidence for doxylamine in insomnia? | Limited evidence, less studied than diphenhydramine. (Like using a backup plan without full research.) |
| What is melatonin? | A hormone from the pineal gland that regulates circadian rhythm—secreted at night. (Like your body’s built-in nightlight timer.) |
| What is melatonin’s role in sleep? | Best for circadian rhythm disorders (jet lag, shift work), not for chronic insomnia. (Like resetting your clock, not fixing a broken engine.) |
| What is melatonin’s onset and half-life? | Tmax 0.5–2 hours, half-life 30–50 minutes. (Like a short nap for your brain.) |
| What are melatonin’s drug interactions? | Warfarin (↑ bleeding), nifedipine (↑ BP), fluvoxamine (↑ sedation), corticosteroids (↓ steroid effect). (Like mixing two cleaning chemicals—it can backfire.) |
| Why caution melatonin in renal/hepatic impairment? | It’s metabolized in the liver; buildup can occur. (Like draining water into a clogged pipe.) |
| What is the AHRQ conclusion on melatonin? | More effective for circadian rhythm issues than insomnia; no significant effect on sleep latency. (Like setting the alarm, not helping you fall asleep faster.) |
| What is valerian root’s mechanism? | Increases GABA release in the brain, promoting relaxation. (Like turning down the volume on your thoughts.) |
| What are valerian’s common forms? | Tea, tincture, extract (225–1215 mg/day). (Like choosing your favorite flavor of calm.) |
| What is the evidence for valerian? | Weak—may slightly improve sleep quality but studies are inconsistent. (Like an herbal tea that helps some but not all.) |
| What are valerian’s drug interactions? | Avoid with alcohol, opioids, barbiturates, or benzodiazepines—can cause excess sedation. (Like stacking too many sleep buttons.) |
| Which herbals should be avoided for insomnia due to poor evidence or safety? | Kava (hepatotoxic), L-tryptophan (linked to eosinophilic myalgia), chamomile, passionflower, lavender, and GABA—no proven benefit. (Like buying “miracle” sleep teas that don’t work.) |
| What is CBD’s effect on sleep? | No consistent benefit; may cause sedation in some but lacks solid evidence. (Like flipping a coin for results.) |
| Why should alcohol never be used as a sleep aid? | It reduces sleep latency but disrupts REM and causes rebound wakefulness. (Like falling asleep fast but waking up groggy and restless.) |
| What are “relaxation drinks”? | Drinks like Dream Water or Zenify that contain GABA, melatonin, theanine, valerian, or CBD—no proven benefit, possible side effects (nausea, fatigue). (Like trendy drinks that promise calm but don’t deliver.) |
| What’s the difference between fatigue and sleepiness? | Fatigue = tired body or mind; sleepiness = urge to sleep. (Like feeling tired after a long meeting vs. nodding off.) |
| Causes of fatigue? | Stress, depression, chronic illness (anemia, CHF, lupus, cancer), pregnancy, or medication effects. (Like having your battery drain faster from too many background apps.) |
| Which medications can cause fatigue? | Beta-blockers, TCAs, clonidine, etc. (Like slowing your engine.) |
| What OTC medication treats sleepiness? | Caffeine 100–200 mg every 3–4 hours (max 600 mg/day). (Like jump-starting your energy.) |
| How does caffeine work? | Blocks adenosine A1/A2a receptors in the brain to promote alertness. (Like cutting off your body’s “time to sleep” signal.) |
| What are caffeine’s kinetics? | Tmax 0.5–0.6 hr, half-life 4–5 hr, metabolized in liver (CYP1A2). (Like your morning coffee lingering till lunch.) |
| Who should avoid caffeine self-treatment? | Children under 12, people with heart disease, hypertension, anxiety, or chronic fatigue. (Like giving espresso to someone already jittery.) |
| Caffeine precautions in pregnancy? | Limit to <300 mg/day—high doses may cause low birth weight. (Like keeping the thermostat from overheating.) |
| Caffeine and bone health? | High intake decreases calcium reabsorption—risk of osteoporosis. (Like slowly leaking minerals from your bones.) |
| Caffeine withdrawal symptoms? | Headache, irritability, anxiety, lethargy. (Like a mini flu after skipping coffee.) |
| Caffeine drug interactions (CYP1A2)? | Increased stimulation with fluoroquinolones; decreased sedation with benzodiazepines; decreased lithium; increased BP with MAOIs; increased theophylline levels. (Like mixing too many signals—your body goes haywire.) |
| What are caffeine’s side effects? | Nervousness, tremor, insomnia, tachycardia, increased BP. (Like drinking too many energy drinks.) |
| What is “caffeinism”? | Overuse of caffeine causing restlessness, anxiety, and headache. (Like too much fuel in a small engine.) |
| Why should caffeine not be used in certain elderly patients? | They may have slower metabolism and higher risk of insomnia or heart issues. (Like keeping your car engine revving overnight.) |
| What are “alertness inhalers”? | Ammonia-based inhalants marketed for energy—cause airway irritation, coughing, and even seizures; FDA warns against use. (Like sniffing cleaning chemicals—not safe.) |
| What should you tell a 68-year-old on phenelzine who buys caffeine tablets? | Avoid—MAOIs plus caffeine can dangerously raise blood pressure. (Like mixing dynamite with fire.) |
Created by:
eskay264