11. Sleep Disorders

Question 1

Dyssomnia includes

Answer 1

Disorder of the quantity and/or quality of sleep
Insomnia, hypersomnia, narcolepsy, breathing-related sleep disorder, Kleine-Levin Syndrome, circadian rhythm sleep disorder

Question 2

DSM 5 diagnostic criteria for insomnia

Answer 2

Sleep difficulties for at least 3 nights per week for the past 3 months:
1. Difficulties with initiation of sleep
2. Difficulties with maintenance of sleep
3. Early morning awakening and inability to return back to sleep

+ occurred despite adequate opportunities for rest

Question 3

Non-pharmacological management for insomnia

Answer 3

• Sleep education
• Sleep hygiene
• Stimulus control
• Sleep restriction

Question 4

Pharmacological management for insomnia

Answer 4

*attempt non-pharm measures first
*work up underlying cause

1st line:
- Antihistamines: Hydroxyzine (s/e: drowsiness in the morning)
- NaSSA: Mirtazepine (s/e: weight gain, sedation)
- Melatonin antiD targeting melatonin receptors: Agomelatine (s/e: giddiness)

Consider: BZD

Question 5

REM sleep triggers increase in ___ activity while NREM sleep triggers increase in ___ activity

Answer 5

sympathetic; parasympathetic

Question 6

REM sleep-related disorders

Answer 6

Nightmares: wake from REM sleep to full consciousness with detailed dream recall ability
Narcolepsy
Pickwickian syndrome
Sleep apnea
Sleep paralysis
Depressive disorders
- decrease REM latency
- increased density of REM sleep
- increased REM duration
Alcohol misuse
Seizure

Question 7

NREM sleep-related disorders aka slow wave sleep disorder

Answer 7

Night terrors
Somnambulism (sleep-walking)
Sleep talking
Sleep drunkenness
Bedwetting
Nocturnal leg cramps
Depression
Old age
Increased daytime napping

Question 8

Circadian rhythm sleep disorder is characterised by

Answer 8

1. Advanced sleep phase syndrome
   - “sleep early wake up early”
2. Delayed sleep phase syndrome
   - “sleep late wake up late”