Insomnia

1. True or False Re: Insomnia
  1. Affects 1/3 or the population 
  2. Common in men
  3. Common in the elderly 
  4. Chronic insomnia rarely remits spontaneously 
  5. Insomnia >1 year is a risk factor for depression 
2. True or False Re: Tx of Insomnia
  1. Improving sleep hygiene is first line 
  2. Intermittent doses of BDZ is more detrimental than regular dosing 
  3. Short acting BDZ = patients having difficulty falling a sleep 
  4. Medium to long term BDZ = patients having difficulty maintaining sleep 
  5. Prescribing BDZ for sleep to the elderly is not justified
3. True or False
  1. Z drugs are better than BDZ 
  2. All Z drugs have similar efficacy
  3. Zopiclone impairs driving more than BDZ 
  4. Melatonin is an effective treatment
  5. Melatonin should not be used in the elderly 
4. True or False
  1. Ramelteon is effective in primary sleep disorders
  2. Melatonin in effective in primary and secondary sleep disorders
  3. Ramalteon is MT agonist 
  4. Zolpidem has the quickest onset action
  5. Zolpidem is long acting 
5. True or False
  1. CBT is effective for long term sleep disorders 
  2. Long term use of hypnotics can be justified in a group of individuals 

Answers                                                                                                        

1. True or False Re: Insomnia
  1. Affects 1/3 or the population - T
  2. Common in men - F, common in women
  3. Common in the elderly - T
  4. Chronic insomnia rarely remits spontaneously - T
  5. Insomnia >1 year is a risk factor for depression - T
2. True or False Re: Tx of Insomnia
  1. Improving sleep hygiene is first line - T
  2. Intermittent doses of BDZ is more detrimental than regular dosing - F, better at avoiding dependence and tolerance
  3. Short acting BDZ = patients having difficulty falling a sleep - T, but rebound more likely
  4. Medium to long term BDZ = patients having difficulty maintaining sleep - T, rebound less likely but sedation is a problem
  5. Prescribing BDZ for sleep to the elderly is not justified - T, NNT for sleep – 13 Number needed to harm is 6
3. True or False
  1. Z drugs are better than BDZ - F, Not much hard evidence, probably causes dependence, tolerance and rebound
  2. All Z drugs have similar efficacy - T, if one drug does not work so wouldn’t the others
  3. Zopiclone impairs driving more than BDZ - T
  4. Melatonin is an effective treatment - T, Many advantages – well tolerated, few side effects, no dependence, no tolerance, Few problems – may worsen epilepsy and asthma
  5. Melatonin should not be used in the elderly - F, licensed to be used in the elderly
4. True or False
  1. Ramelteon is effective in primary sleep disorders - T, quick onset of sleep, increases total sleep
  2. Melatonin in effective in primary and secondary sleep disorders - F, only in primary
  3. Ramalteon is MT agonist - T
  4. Zolpidem has the quickest onset action - T
  5. Zolpidem is long acting - F, none of the z drugs are long acting drugs, Nitraxepam is long acting drug
5. True or False
  1. CBT is effective for long term sleep disorders - T
  2. Long term use of hypnotics can be justified in a group of individuals - T

Source                                                                                                       

Maudsley Prescribing Guidelines – 10th edition – page 248-250

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