12-4 Flashcards
Diagnostic tool to differentiate Sleep-Wake Disorders
An interview is conducted and often followed by polysomnography
Measuring a variety of physiological parameters including brain waves, muscle contractions, breathing, etc. during sleep
Polysomnography
Difficulty initiating or maintaining sleep for >3 mos
Insomnia Disorder
Using bed only to sleep improves what?
Sleep hygiene
Treatment for Insomnia Disorder that induces sleep and increases sleep duration but only for short-term use
Sedatives (Benzodiazepines like diazepam)
What are the long-term side effects of sedatives to treat Insomnia?
Poor sleep quality; decrease slow wave (N3) and REM
Tolerance and withdrawal
Benzodiazepine-like drug(s) with fewer side effects used to treat Insomnia
Ex: Zolpidem
Excessive sleepiness despite sufficient sleep (7+ hrs) for >3mos
Hypersomnolence Disorder
What is the neuropathology of Hypersomnolence Disorder?
Unknown etiology (idiopathic form)
Exclude other causes (ex: narcolepsy)
What treatment method is used for Hypersomnolence Disorder?
Stimulants that promote wakefulness (ex: Modafinil)
Recurrent irresistible sleep occurring within the same day, several times per week for >3mos
Narcolepsy
A form of narcolepsy that causes sudden loss of muscle tone while awake, an aberrant manifestation of REM sleep
Cataplexy
Autoimmune-related hypothalamic neuropeptide deficiency (Narcolepsy)
Hypocretin (Orexin) deficiency
Short REM-sleep latency (sleep onset REM) during Narcolepsy
Nocturnal PSG
Short REM-sleep latency AND short sleep-onset latency during Narcolepsy
Daytime PSG (Multiple Sleep Latency Test)
Stimulants for somnolence
Antidepressants for cataplexy
Narcoleptic Polytherapy Treatment
Treats cataplexy AND somnolence (ex: Xyrem AKA GHB)
Narcoleptic Monotherapy Treatment
Episodes of breathing cessation/reduction due to upper airway obstruction
Obstructive Sleep Apnea Hypopnea
Why do apnea’s/hypopneas cause sleepiness?
Rise in CO2 during apnea’s cause temp arousal (not awaken) bumping from deep to light stage of sleep
Duration adequate but sleep unrefreshing
Device that maintains an open airway by delivering compressed air at specific air pressure to the mask’s nasal pillow
Continuous positive airway pressure
Multiple episodes of cessation of breathing per night caused by CNS dysregulation of breathing
Central Sleep Apnea
How does PSG distinguish OSA and CSA?
Whether thoracic movements occur at the start of apneic episodes
OSA (thoracic efforts)
CSA (no thoracic efforts)
What is the treatment for CSA?
Varies depending on cause (ex: respiratory stimulants acetazolamide, nocturnal oxygen)
Excessive sleepiness or insomnia resulting from mismatch b/n person’s circadian sleep-wake pattern and environmental sleep-wake schedule
Circadian Rhythm Sleep-Wake Disorder
Delayed sleep onset and awakening times, with the inability to fall asleep and awaken at a desired earlier time
CRSWD, Delayed sleep phase type
Phototherapy at strategic times during day to adjust timing of sleep-wake cycle
CRSWD treatment
Disorders characterized by abnormal behaviors associated with slee
Parasomnias
Repeated episodes of incomplete awakening from sleep with sleep walking OR sleep terrors
Non-REM sleep arousal disorder
Abrupt terror arousals with panicky scream, intense fear and autonomic arousal, unresponsive to comforting
Sleep terrors
Rising from bed and walking about with a blank and staring face, relative unresponsive, and difficulty awakening
Sleep walking AKA somnambulism
Characterized by:
Episodes occuring within first ⅓ of sleep (slow wave sleep)
No (or little) dream imagery
Amnesia during episodes
Non-REM Sleep Arousal Disorder
What is the treatment for Non-REM sleep arousal disorder?
Benzodiazepines to decrease slow wave sleep
Extremely dysphoric dreams that typically involve threats to survival, security or physical integrity
Nightmare Disorder
Characterized by:
Awakening during REM
Rapid alertness upon awakening
Dream content remembered
Good recall of awakening the next morning
Nightmare Disorder
What is treatment for Nightmare Disorder?
Antidepressants to decrease REM
Vocalization and/or complex motor movements during REM
Action-filled violent dreams
Immediately awake, oriented and alert with detailed dream recall
REM Sleep Behavior Disorder
Loss of motor inhibition during REM is associated with what diseases?
Neurodegenerative (ex: Parkinson’s, Levy body dementia)
Treatment for REM Sleep Behavior Disorder
Clonazepam (benzodiazepine)
Modification of sleep environment
Urge to move legs in response to uncomfortable sensations that occurs/worsens during inactivity, nocturnal worsening of symptoms, and temporary relief from discomfort by moving
Aware of symptoms and complains of insomnia
Restless Legs Syndrome
Treatment for Restless Legs Syndrome
Anti-Parkinson’s drugs to increase dopamine (ex: benzo’s, anticonvulsants)
Repetitive muscle contractions during sleep, usually lower limb
Multiple sleep stage arousals
Complains of daytime sleepiness but unaware of movements
Periodic Limb Movements
Treatment for Periodic Limb Movements
Anti-Parkinson’s drug to increase dopamine (ex: benzo’s, anticonvulsant)
