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SLEEP and INSOMNIA Lynn N. Stewart, M.D. Travis County Wellness and Health Clinic Austin, TX
Objectives By the conclusion of this lecture, you will be able to: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why do we care about sleep? ,[object Object],[object Object],[object Object],[object Object]
Sleep Stages and their function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Cycle and Architecture ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep at different ages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
So what keeps us awake? ,[object Object],[object Object]
Types of Insomnia ,[object Object],[object Object],[object Object],[object Object]
Why Are We Talking About This? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Daytime Consequences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Real Consequences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Real Consequences ,[object Object],[object Object],[object Object]
Sleep Deprivation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hyper Arousal State from Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factors for Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stages of Insomnia ,[object Object],[object Object],[object Object],[object Object]
Psychiatric Causes of Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Causes of Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Causes of Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dyssomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrinsic Dyssomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Extrinsic Dyssomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Circadian Dyssomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parasomnias ,[object Object],[object Object],[object Object],[object Object],[object Object]
Parasomnias Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parasomnias Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Causes of Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Behavioral Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Interview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Interview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Habits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Habits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Habits (bad!) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Half-lives: why you can’t go to sleep at 10pm if your last coffee was at noon.
What’s New With You? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Exam ,[object Object],[object Object]
Sleep Diaries ,[object Object],[object Object],[object Object],[object Object]
Sleep Diaries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sample Sleep Diary
Example Sleep Patterns 6.0 hours Yes 2+ 45 Depression Or anxiety ~5.5 hours 7.5 hours Total Time Asleep Yes No Early Morning Awakenings 6 2 Awakenings 45 10 Sleep onset (minutes) Insomnia Normal
Treatment Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chronic Insomnia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene ,[object Object],[object Object]
Sleep Hygiene--Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene--Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene--Relaxation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene—Sleep Restriction ,[object Object],[object Object],[object Object]
Sleep Hygiene—Sleep Restriction ,[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene—Sleep Restriction ,[object Object],[object Object],[object Object],[object Object]
Sleep Hygiene—Cognitive Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Behavioral Therapies ,[object Object],[object Object],[object Object],[object Object]
Stimulus Control Therapy ,[object Object],[object Object],[object Object],[object Object]
Other Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What works best? ,[object Object],[object Object],[object Object],[object Object]
If you have to use drugs: Pharmacotherapy Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Drugs that make you sleep ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Over the Counter Medicines—FDA approved and regulated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OTC Medicines—FDA approved and regulated ,[object Object],[object Object],[object Object],[object Object]
OTC Medicines--herbals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OTC Medicines--herbals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepines ,[object Object],[object Object]
Prescription Medicines: Benzodiazepines ,[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepines ,[object Object],[object Object],[object Object],[object Object]
Presciption Medicines: Benzodiazepines—how they work ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepine Information ,[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepine Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepine-Like ,[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepine-Like ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Benzodiazepine-Like ,[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Melatonin-Receptor Agonist ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Other Drugs (antidepressants) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prescription Medicines: Other Drugs (antidepressants) ,[object Object],[object Object],[object Object],[object Object]
If all else fails ,[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Insomnia Presentation

  • 1. SLEEP and INSOMNIA Lynn N. Stewart, M.D. Travis County Wellness and Health Clinic Austin, TX
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  • 36. Half-lives: why you can’t go to sleep at 10pm if your last coffee was at noon.
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  • 42. Example Sleep Patterns 6.0 hours Yes 2+ 45 Depression Or anxiety ~5.5 hours 7.5 hours Total Time Asleep Yes No Early Morning Awakenings 6 2 Awakenings 45 10 Sleep onset (minutes) Insomnia Normal
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