INSOMNIA Pearl Card Sleep Hygiene

The Schedule

Differential Diagnosis
1. Follow a regular schedule
Psychiatric syndromes Primary sleep disorders
(go to sleep and arise at same time each day)
Depression Restless leg 2. Sleep only what you need
Anxiety Sleep apneas1 (Avoid naps during the day)
3. Exercise at regular times each day.
Dementia PLMS
Best → moderate exercise (avoid 4 hours before bedtime.)
Grief (Periodic Limb Movements of Sleep) 4. Develop bedtime routines that signal your body to sleep.
Medical (Warm milk, read, warm bath, etc.)
Pain Pulmonary dz. 5. Adjust your internal “sleep clock” by exposure to natural
light in the afternoon each day.
Peri-menopausal Thyroid dz. 6. Empty your bladder before bedtime.
CHF GERD 7. Stop smoking entirely.
Medications (Initially sleep will worsen then it will improve)
Glucocorticoids Theophylline
The Diet
Activating antidepressents2 Amphetamines
ACE Inhib. (cough) Diuretics (diuresis)
1. Avoid stimulants late in day:
Lipophilic beta blockers Methyldopa e.g. caffeine, MSG, nicotine, chocolate, tea.
Resperine Cimetidine 2. Don’t use alcohol or cigarettes to make you sleep.
MAO Inhib Cholinergic agents3 (Avoid alcohol for > 4 hours before bedtime)
3. Don’t’ go to bed hungry but avoid heavy meals at bedtime.
L-Dopa Digoxin 4. Ask your doctor to review your medications
Diet Alcohol Nicotine Caffeine for possible stimulants.
5. Avoid over the counter sleep medications
Environment avoid the following:
Noise, Light (excess) Temperature (Unregulated)
The Environment
Treatment:
1St choice: 1. Create a safe/comfortable sleep environment:
Non-pharmacologic (see reverse side card) -locks on doors as needed
-smoke alarms on each floor
2nd choice:
-easy to use lamp and telephone at bedside
Treat sx’s that awaken: (pain?, urination?, anxiety?) -room should be dark, quite and well-ventilated
3RD choice -room temperature adjusted to your preference
2. Use your bedroom for sleeping only, ie.
Pharmacologic
(After turning off your lights allow 15 minutes to fall asleep.
Trazodone 25-50 mg q hs If you are still awake get up and go to another room until
Zolpidem (Ambien)/Zaleplon 5-10 mg q hs you feel sleepy again.)
(Sonata) 3. If pain is bothering sleep, ask your doctor for help.
Eszopiclone (Lunesta) 1-2 mg q hs 4. Wear comfortable bed clothes

Ramelteon (Rozerem) 8 mg q hs For more explanation see: website: geriatrics.unmc.edu

Lorazepam (for < 2 wks) 0.25 - 1 mg q hs & visit Geri Pearls evv7/22/06

1
Sleep apnea = apnea > 10 secs. and > 5x per hour
Indications for sleep studies: I SNORED (mnemonic)

I nsomnia

S noring

N octurnal awakenings/N ot breathing

O besity

R estorative sleep? or do you feel Refreshed in the AM ?

E xcessive daytime somnolence

D riving difficulties due to sleepiness

2
Activating antidepressants: Bupropion, Methylphenidate

3
Donepezil (Aricept), Rivastigmine, Galantamine