# Insomnia and Sedatives. Learning Platform Series. Presenter S.Hong Chairpersons: Dr Claire and Mable. --- ### Why is Sleep Important? - Restorative function - Clearance function - Brain Plasticity and Learning - Relation to mental illness - Insomnia is risk factor for depression, and risk for suicide for those with depression. *- -- That's why we want to monitor sleep in [[HOPES Project Index]]* ### DSM Diagnosis of Insomnia Disorder - 307.42 - DSM Diagnostic Criteria. ### Sleep Architecture - Various parts of sleep. - Average around 7.5 hours - each NREM + REM is about 1.5 hour - NREM is 75% of sleep - increase parasympathetic activity - abolition of tendon reflexes - REM 25% of sleep - This gets longer after every cycle. - High level of brain and physiological activity - Increased sympathetic activity - Muscle paralysis - Vivid recall of dreams if awaken (nightmares) - NREM - N1: 5% of sleep![[Pasted image 20220930121114.png]] - ![[Pasted image 20220930121213.png]] ### Causes of Insomnia There are many causes for Insomnia. ![[Pasted image 20220930121313.png]] Important to consider the past mental history of patient to understand WHY they are having sleep issues. ### History Taking ![[Pasted image 20220930121534.png]] ![[Pasted image 20220930121730.png]] ### Therapy for Chronic Insomnia ![[Pasted image 20220930122048.png]] ### Medications - Antihistamines - Benzodiazepines - Z-drugs - Melatonin - Mirtazapine, Trazadone - Others ![[Pasted image 20220930122232.png]] ![[Pasted image 20220930122504.png]] - Reduce anxiety - Later part of the sleep is more restorative, benzodiazepines reduces that. ![[Pasted image 20220930122814.png]] ![[Pasted image 20220930123005.png]] ![[Pasted image 20220930123147.png]] ![[Pasted image 20220930123258.png]] - Medication comes with side effects. We need to explore reasons for sleep disturbances before using medication. ![[Pasted image 20220930123433.png]] ## Discussions, Questions and Answers - Am I accurate to say that, sleep issues is important to monitor because the reduce sleep can potentially bring about relapse, OR reduce sleep as relapse sign. ? Thanks YES - Can share more about bipolar cases why sleep is so impt? is it poor sleep > affect mood > mood swings > possible relapse? - Could be either way. - Mood affect sleep. or Sleep affect mood ---- Related notes - [[202108311024 Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis]] ### Social Rhythm Therapy - How social relationships affect your life. Have a fixed routine, because it affect your sleep/mood. - [[Theoretical Foundation of IPSRT]] - [[Interpersonal and Social Rhythm Therapy]]