12.3 (8.6) Sleep Disorders Flashcards
List two mechanisms that control sleep.
Identify which promotes sleep and which promotes wakefullness
Homestatic drive for sleep
Circadian system that regulates wakefullness
What are the two main types of sleep?
which is more prevalent over the night?
when in the night, typically, do each occur?
REM sleep
Non-REM sleep
Non-REM more prevalent (80%) and occurs more often in first half of night —> REM second half of night
Where is the central pacemaker for circadian cycles located?
what input helps to regulate this structure?
What hormone does it regulate?
Suprachiasmatic nucleus of hypothalamus
Retinal light input helps synchronize the pacemaker to the external light
Melatonin
What are four common complaints about sleep in palliative care?
difficulty initiating sleep difficulting maintaining sleep early waking non-restorative sleep poor quality sleep
What are two major categories of primary sleep disorders?
Provide an example of each
Dyssomnia:
- d/o that may disturb sleep quality, quantity, timing or cause excessive daytime sleepiness
Ex: narcolepsy, sleep apnea*, circadian rhythm d/o
Parasomnia:
- unusual exp/behaviours that occur during sleep
Ex: sleep terror disorder, sleep walking*, nightmare disorder, rem sleep behaviour disorder
List five consequences of insomnia
daytime tiredness* poor functioning* malaise disturbances in concentration and memory* low mood* impairment of QOL* tension HA GI symptoms
Given two examples of syndromes that can occur with circadian rhythm sleep disorders.
(Which is more common with medical illness)
complete disappearance of normal sleep pattern
delayed sleep phase syndrome
advanced sleep phase syndrome (most common with medical illness)
List 8 causes of secondary sleep disorders
Anxiety/depression
Chronic pain
Dementia
Advanced cancer - direct brain involvement, cancer treatment or pain/nausea
Respiratory disorder - COPD
Heart disease
HTN
Liver disease - HE, Hep C, Wilson’s
HIV - particularly HIV-dementia complex
Nutritional def
Environmental - restless bed partner
Periodic limb movement - see other flashcard!
Nocturia - prostatism
Delirium
WP: essentially everything
FS: VINDICATE NP
V - anemia, HTN
I - infection -> delirium, HIV
N - brain cancer
D - heart, lung, liver, kidney, prostate
I
C
A
T
E - thyroid, diabetes
N - dementia, Parkinson’s
P - depression, anxiety
List four causes of perioidic limb movement overnight
Benzo withdrawal*
TCA, haldol *
anemia*
uremia*
DM*
leukemia
peripheral neuropathy
Spinal cord tumor or injury
What is the gold standard sleep test? List three situations where it is indicated
Polysomnography
Suspected osa (dyssomnia)
Sleep related movement disorder (parasomnia)
Treatment resistant patient
List seven components of the Pittsburgh sleep quality index (psqi)*
Subjective sleep quality Sleep latency Sleep duration Habitual sleep efficiency Sleeo disturbances Sleep med use Daytime dysfunction
List four classes of medication used for sleep. Name one example from each class.
Alternatives (Ramelteon)
Anti-depressant (mirtazapine, trazodone)*
Anti-epileptic (pregabalin, gabapentin)
Anti-histamines (doxepin)
Anti-psychotics (quetiapine, olanzapine)*
Benzodiazepine (diazepam, clonazepam)*
Non-benzodiazepine (Zopiclone, zolpidem)*
Non-prescription meds (Melatonin, valerian)*
Table 12.3.1
List four non-pharm interventions for sleep
Sleep hygiene*
CBT-I (for insomnia!)*
Relaxation techniques*
Exercise*
Expressive therapy
Stimulus control
Complementary & alternative medicine
Name TWO ways to manage opioid-induced daytime somnolence
◆ opioid dose reduction
◆ opioid rotation
◆ psychostimulant
Name FOUR self-reported sleep questionaires *
◆ Pittsburgh Sleep Quality Index (PSQI)
◆ Global Sleep Quality Index (GSQI)
◆ Insominia Severity Index
◆ Epworth Sleepiness Scale (ESS)
◆ Medical Outcome Study Sleep Scale (MOS sleep scale)
