Insomnia Treatment ABIM Board Review

>> YOUR LINK HERE: ___ http://youtube.com/watch?v=qHxkkXhl-KA

This is a snippet from Dr. Leonard A. Mankin’s General Internal Medicine lecture in MedStudy’s 2023-2024 Internal Medicine Video Board Review. https://medstudy.com/products/interna... • Insomnia review from the syllabus: • • A very common and vexing issue in older adults • • Look for conditions that could be responsible (pain, nocturia, restless legs, dyspnea, OSA, anxiety) • • SSRIs/SNRIs may cause insomnia in up to 20% of patients • • Stimulants, corticosteroids, diuretics should be administered early in the day • • Counsel on avoidance of caffeine, alcohol, and nicotine • Insomnia — Treatment • • CBT for insomnia (CBT-I) is 1st line therapy — safer than medication with superior outcomes, but limited availability • • Ideally, medications should be used only to supplement CBT-I • • Benzodiazepines and non-BZD “Z drugs” effective, but associated with falls, amnesia, somnambulism, dementia, and habituation • • Low-dose trazodone or gabapentin are reasonable alternatives to habit-forming drugs (off-label) • • Anticholinergics (antihistamines, tricyclics, neuroleptics), including OTC sleep aids, have many adverse effects • • Ramelteon (melatonin agonist) seems safe and may be helpful; melatonin untested but might be worth a try • • α-Blockers useful for PTSD with nightmares • Continue your review: https://medstudy.com/products/interna... • Join our community of 30,000+ #physicians who get regular study tips, board prep advice, and special offers on MedStudy learning tools: https://explore.medstudy.com/join-our... • Subscribe to our YouTube channel: / @medstudycom • Follow us on: • Instagram: / medstudystrong • Facebook: / medstudy • Twitter: / medstudy • TikTok: / medstudystrong • #insomnia #internist #internalmedicine #boardexam #boardprep

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