Layer 1

The facts about sleep disorders

The facts about sleep disorders
Clinical quiz Separate the facts from fiction with our quiz on sleep disorders
Main Image: 

Test your knowledge of sleep disorders and separate the facts from the fiction


QUESTIONS

1. Taking regular exercise during the day will help you sleep better.

True or false?


2. Melatonin can be used to treat insomnia. Because it is a naturally occurring hormone in the body it has no side effects and does not interact with any drugs.

True or false?


3. Increasing your consumption of caffeine during the day will help in managing narcolepsy.

True or false?


4. There is no specific Nice guidance for the management of insomnia.

True or false?


5. Over-the-counter (OTC) medicines should be tried first before going to the GP for help with insomnia.

True or false?


6. Shift working can cause issues with tiredness and normal sleep disruption, which can result in a decreased performance at work. Caffeine has been shown to be effective in increasing cognitive performance in shift workers.

True or false?


7. Before prescribing sodium oxybate (Xyrem) for narcolepsy, doctors must evaluate the patient for a history of or susceptibility to drug abuse.

True or false?


8. Methylphenidate may be used for narcolepsy.

True or false?


DISCUSSION

1. True: Exercise will make you feel tired and relaxed, which will encourage you to go to bed. Exercise should not be done late in the evening as this can make you more alert and more hungry and thirsty, which if not sated will keep you awake. Conversely, if you eat too much then you will feel bloated and this will interfere with sleeping.


2. False: Melatonin side effects are uncommon but can include a range of symptoms that are detailed in the summary of product characteristics (SPC) for the branded melatonin product Circadin. Similarly, many drugs can interfere with the metabolism of melatonin due to their action on certain cytochrome P450 enzymes, which can cause an increase in melatonin plasma levels. Again, refer to the SPC for Circadin.


3. False: Caffeine is a stimulant that makes you more alert. Although caffeine supplements are used widely as a stimulant, eg drinks such as Red Bull and tablets such as Pro-Plus, these are not medicines and not licensed for use to treat any health condition. Narcolepsy is a specific medical condition with licensed pharmacological medicines such as modafinil (Provigil) and sodium oxybate (Xyrem).


4. True: There is Nice TA77 guidance (April 2004) on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia. More current information on insomnia may be obtained from the following BMJ article: The assessment and management of insomnia in primary care. C+D Update module 1699, published on April 24, 2014, also looks at sleep disorders.


5. False: Non-pharmacological methods should always be tried first. OTC products are for short-term use only. If it is a long-term problem the GP should be seen to rule out any underlying physical and psychiatric conditions that could be causing it.


6. True: A Cochrane systematic review Caffeine for preventing injuries and errors in shift workers 2010 concluded that caffeine may be an effective intervention for improving cognitive performance in shift workers.


7. True: Sodium oxybate is a sodium salt of GHB (gamma-hydroxybutyrate) which is used as a recreational drug due to its euphoric effects. Therefore patients should be monitored for the risk of diversion, misuse and abuse of sodium oxybate.


8. True: Methylphenidate may be used at doses of 10 to 60mg (usually 20 to 30mg) daily in divided doses before meals. However, this is an unlicensed indication.


More like this    
Update: Sleep disorders  

Update: Generalised anxiety disorder    
Staff training: Insomnia    
 

References and sources

Cochrane Summaries. 2010. Caffeine for preventing injuries and errors in shift workers. [Accessed April 16, 2014].

Royal College of Psychiatrists. 2014. Sleep and tiredness: key facts. [Accessed April 16, 2014].

emc. 2011. Xyrem 500mg/ml oral solution. [Accessed April 16, 2014].

emc. 2013. Circadin. [Accessed April 16, 2014].


Samir Vohra BPharm, MRPharmS, FHEA is a lecturer in clinical pharmacy at the School of Pharmacy, University of Central Lancashire

Login or register to post comments

Job of the week

Pharmacist Manager
Midlands, Cheshire & Dorset
Salary dependent upon experience