Questions and Answers
What are lifestyle adjustments?
Lifestyle adjustments are often crucial for successful treatment and prevention of insomnia.
What is sleep hygiene?
Sleep hygiene is generally considered a good adjunctive addition to sleep restriction, stimulus control, relaxation therapy, and cognitive behavioral therapy (CBT), but has not been proven to be efficacious as a stand-alone treatment.
Exercising too close to sleep initiation can contribute to arousal that interferes with sleep.
True
What are considered examples of behavioral therapy?
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How is Cognitive Behavioral Therapy (CBT) for insomnia usually structured?
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What is the basis of stimulus control in treating insomnia?
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What are the most common stimulus control instructions?
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What is sleep restriction?
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What is the theory behind sleep compression?
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What does relaxation therapy focus on?
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What is progressive muscle relaxation (PMR)?
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What does the cognitive model of insomnia propose?
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What are the steps involved in cognitive therapy for insomnia?
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What is pharmacotherapy in the context of treating insomnia?
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What are the three main classes of medications currently used to treat insomnia?
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What are benzodiazepine receptor agonists commonly used for?
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What is Gamma-aminobutyric acid (GABA)?
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Which receptors have been the primary target in insomnia and why?
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What are the effects of BzRAs?
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BzRAs can lead to tolerance and withdrawal symptoms.
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What are non-benzodiazepine hypnotics and their characteristics?
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What have been some negative side effects of non-benzodiazepine hypnotics?
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What is zolpidem used for?
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What is the effect of zaleplon?
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How does eszopiclone aid sleep?
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What are melatonin receptor agonists?
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What does ramelteon do?
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What role does melatonin play in sleep?
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What are antidepressants used for?
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What are tricyclic antidepressants (TCAs) commonly used for?
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Nonprescription treatments are recommended for insomnia.
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What are some emerging treatments for insomnia?
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What is orexin?
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What does suvorexant do?
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What is tasimelteon used for?
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Study Notes
Treating Insomnia
- Lifestyle adjustments are essential for effective treatment and prevention of insomnia.
- Sleep hygiene complements treatments like sleep restriction, stimulus control, relaxation therapy, and Cognitive Behavioral Therapy (CBT), but lacks standalone efficacy.
- Exercising close to bedtime can hinder sleep, while earlier workouts may promote better rest.
- Behavioral Therapy includes empirically validated techniques based on the behavioral model of insomnia.
- Examples of behavioral therapy methods: stimulus control therapy, sleep restriction, and progressive muscle relaxation.
- CBT for insomnia combines behavioral therapy with sleep education and cognitive strategies for a comprehensive approach.
- Behavioral Therapy (BT), alone or combined with Cognitive Therapy (CT) and Sleep Hygiene (SH), effectively addresses both primary insomnia and insomnia linked to other disorders.
- Stimulus Control aims to break the association between the bedroom and poor sleep, minimizing distractions and anxieties.
- Key stimulus control instructions emphasize using the bed only for sleep, limits on time spent in bed, and actions to take when unable to sleep.
- Sleep restriction reduces time in bed to match actual sleep duration, addressing the tendency to prolong time awake in bed.
- Sleep compression gradually reduces time in bed, helping to alleviate sleep anxiety.
- Relaxation therapy teaches self-guided practices like imagery, meditation, and biofeedback to combat elevated arousal levels.
- Progressive muscle relaxation (PMR) involves sequential muscle tensing and relaxation to promote physical ease.
- The cognitive model of insomnia suggests that patients often fixate on sleep and hold distorted sleep-related beliefs negatively affecting daytime performance.
- Cognitive Therapy involves identifying negative sleep thoughts, challenging their validity, and substituting them with sleep-promoting thoughts.
- Cognitive therapy is typically integrated with other validated treatments as its standalone efficacy is not yet supported.
- Pharmacotherapy remains the most frequently used treatment for insomnia.
- Medication should be paired with behavioral and cognitive therapies to reduce dependence risks and daytime impairments.
- Main medication classes for insomnia include: benzodiazepine receptor agonists (BzRAs), non-benzodiazepine hypnotics, and antidepressants.
- BzRAs are commonly prescribed when first-line CBT interventions are ineffective.
- Gamma-aminobutyric acid (GABA) is a key inhibitory neurotransmitter affecting sleep regulation.
- GABA*A receptors are primarily targeted in insomnia treatment due to their role in sedation and muscle relaxation.
- BzRAs reduce sleep latency and increase total sleep time while being considered less lethal than barbiturates in overdose situations.
- However, BzRAs can lead to tolerance, rebound insomnia upon withdrawal, and daytime residual effects.
- Non-benzodiazepine hypnotics are newer drugs that act more selectively on GABA receptors, with a lower side effect profile but still a potential for dependence.
- Negative side effects of non-benzodiazepine hypnotics may include rebound insomnia and other cognitive issues.
- Zolpidem is effective for sleep latency and total sleep time; Zaleplon is notable for sleep latency but not overall sleep time; Eszopiclone improves both sleep onset and wake time.
- Melatonin receptor agonists, like Ramelteon, help regulate the circadian clock by mimicking natural melatonin secretion during darkness.
- Antidepressants, particularly tricyclics (TCAs), are often utilized off-label for insomnia with variable effects on sleep.
- Nonprescription treatments such as antihistamines can lead to rapid tolerance and are not recommended for insomnia management.
- Emerging treatments include Suvorexant and Tasimelteon, targeting orexin regulation and melatonin receptor activation, respectively.
- Orexin promotes wakefulness through several neurotransmitter systems, and is affected by sleep deprivation.
- Suvorexant, a dual orexin receptor antagonist, improves sleep efficiency by decreasing wakefulness.
- Tasimelteon shows promise for enhancing sleep efficiency and reducing disturbances, particularly in circadian rhythm-related disorders.
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Description
Test your knowledge on key concepts from Chapter 4 of the Handbook of Insomnia. This quiz focuses on essential terms like lifestyle adjustments and sleep hygiene that are crucial for managing and preventing insomnia. Perfect for students or anyone interested in improving their understanding of sleep health.