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Psych > 13. Sleep disorders > Flashcards

13. Sleep disorders Flashcards

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1
Q

Dyssomnias vs. Parasomnias?

A 
Dyssomnias = insufficient, excessive, altered timing of sleep 
Parasomnias = unusual sleep-related behaviors
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2
Q

What are the most common hypersomnias? (2)

A
  • Obstructive sleep apnea

- Central sleep apnea

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3
Q

What type of primary insomnias are there?

A
  • sleep-onset insomnia
  • middle-of the night/sleep-maintenance insomnia
  • late night/sleep-offset insomnia (early morning awakenings)
  • nonrestorative sleep
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4
Q

What is the DSM criteria to meet primary insomnia in terms of the length of symptoms?

A

1 month

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5
Q

What is the first line therapy for chronic insomnia?

A

CBT

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6
Q

What pharmacotherapy (classes) is indicated for insomnia? (3)

A
  • Benzodiazepines (short-term tx)
  • Non-benzodiazepine hypnotics (short-term)
  • Antidepressants
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7
Q

Which anti-depressants are used for insomnia? (3)

A
  1. Trazodone (SARI)
  2. Amitriptyline (TCA)
  3. Doxepin (TCA)
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8
Q

What is the most prescribed sedating antidepressant for pts with chronic insomnia and depressive symptoms?

A

Trazodone

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9
Q

Risk factor for obstructive sleep apnea?

A
  • obesity –> increased neck circumference –> airway narrowing
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10
Q

Tx for obstructive sleep apnea? (3)

A
  • positive airway pressure (CPAP or BiPAP)
  • weight loss + exercise
  • surgery
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11
Q

What is the classic tetrad of narcolepsy?

A
  1. excessive daytime sleepiness (“sleep attacks”)
    - REM-related sleep phenomena
  2. inability to move during transition from sleep to wakefulness
  3. hypnagogic or hypnopompic hallucinations
  4. Cataplexy = sudden loss of muscle tone evoked by strong emotions w/o loss of consciousness
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12
Q

Hypnagogic vs. hypnopompic hallucinations?

A 
Hypnagogic = when transitioning TO sleep 
Hypnopompic = when transitioning FROM sleep
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13
Q

Pathophysiology of narcolepsy

A
  • linked to loss of hypothalamic neurons that contain hypocretin
  • may have autoimmune component
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14
Q

Pharmacotherapy for excessive daytime sleepiness? (4)

A
  • amphetamines (dextroamphetamine, methamphetamine)
  • methylphenidate (Ritalin)
  • modafinil (provigil)
  • sodium oxybate
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15
Q

Drug of choice for tx of cataplexy?

A

Sodium oxybate

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16
Q

Treatment of narcolepsy (non-pharm) (3)

A
  • schedule daytime naps
  • maintain regular sleep schedule at night
  • avoidance of shift work
17
Q

What is idiopathic hypersomnia? (IH) (3)

A

Rare disorder characterized by excessive daytime sleepiness, prolonged nocturnal sleep episodes, and frequent irresistible urges to nap

18
Q

What is Kleine-Levin syndrome? (4)

A

Rare d/o characterized by:

  • recurrent hypersomnia w/ episodes of daytime sleepiness
  • w/ hyperphagia
  • hypersexuality
  • aggression
19
Q

Subtypes of circadian rhythm sleep disorders (4)?

A
  1. Delayed sleep phase disorder
  2. Advanced sleep phase disorder
  3. Shift-work disorder
  4. Jet lag disorder
20
Q

Which part of the sleep cycle does sleepwalking occur?

A

Slow-wave sleep

21
Q

Epidemiology of sleepwalking (adults and children)

A

1-4% in adults

10-20% in children and adolescents

22
Q

Risk factors for sleepwalking?

A
  • obstructive sleep apnea
  • sleep deprivation
  • irregular sleep schedule
  • stress
  • hyperthyroidism
  • magnesium deficiency
  • seizures, migraines
23
Q

Tx for refractory sleepwalking?

A

Clonazepam (Klonopin)

24
Q

Which part of the sleep cycle does sleep terror occur? How about nightmare disorder?

A
  • sleep terror = slow wave sleep

- nightmare = REM sleep

25
Q

What is the treatment used for treating recurrent nightmares in pts w/ PTSD?

A

Imagery rehearsal therapy

26
Q

What is REM sleep behavior disorder?

A
  • characterized by muscle atonia during REM sleep and dream enactment (ex. sleep talking, limb jerking, punching)
27
Q

Tx for REM sleep behavior disorder?

A

Clonazepam (efficacious in 90% of pts)

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