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Insomnia - Coggle Diagram
Insomnia
Common Features
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Physiological changes associated with stress/hyperarousal (whole body metabolic rate, HR variability, Adrenaline/dopamine metabolites)
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Stressors are likely self-limited, resolving in days to a couple of weeks
Chronic insomnia
DSM-5
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Specificity
Early mronign awakening, intiial insomnia
Features
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Comorbidities
GAD, Panic Disorder, PTSD, Illness anxiety disorder
Mood Disroders
Bipolar disroder, Major depression, persistent depressive disorder
Psychotic Disorders
Shcizophreani/Schizoaffective disroder, delusional disorder
Others
Diabetes, CAD< COPD,a rthirtis, chronic pain
Other features
Erratic sleep-wake schedules, poor sleep hygiene, unreasonable expectations, beleif not sleeping, hypervigilance, increased sensitivity
Treatment
Acute Insomnia
Yes
Reassurance, support, psyschoeducation (Response?)
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No
Short term benzo, SARI, orexin antagonist (Response?)
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No
Identify and treat medical, surgical or enviornemntal causes
No
Ask about sleep hygiene, naps, caffeine, shift work
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Medications
Trazadone, Doxepin, Temazepam, Lorazepam, Clonazepam, ZOpiclone, ZOlpidem, Lemborexant
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Sleep Medicine Referal
Symptoms of OSA, Restless legs syndrome
Nocturnal Injuries
Sleep walking, REM behaviour disorder, nocturnal epilepsy
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Gaba Receptor
Produce inhibition via influx of cholride ions, prevent suizures
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Action of Agonists
Allosteric sites are where benzodiazepines, barbiturates, ehtanol all act
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Diagnosis
DSM 5 Criteria
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Difficulty initiating, maintaining, returning to sleep
Specifiers
Non-sleep disorder mental comorbidity, other medical comorbidity, other sleep disroder
Episodic (last at least 1 monht, but less than 3 months), Persistent (last 3+ months), Recurrent (2+ episodes in 1 year)
Pathophysiology
The result of multiple neurotransmitters, leading to excessive arousal
Assessment of Insomnia
Amount of insomnia, When did it begin, Shift work, napping in daytime, what part of night, associated with physical/enviornmental causes, alcohol consumption