13. Sleep disorders Flashcards
Dyssomnias vs. Parasomnias?
Dyssomnias = insufficient, excessive, altered timing of sleep Parasomnias = unusual sleep-related behaviors
What are the most common hypersomnias? (2)
- Obstructive sleep apnea
- Central sleep apnea
What type of primary insomnias are there?
- sleep-onset insomnia
- middle-of the night/sleep-maintenance insomnia
- late night/sleep-offset insomnia (early morning awakenings)
- nonrestorative sleep
What is the DSM criteria to meet primary insomnia in terms of the length of symptoms?
1 month
What is the first line therapy for chronic insomnia?
CBT
What pharmacotherapy (classes) is indicated for insomnia? (3)
- Benzodiazepines (short-term tx)
- Non-benzodiazepine hypnotics (short-term)
- Antidepressants
Which anti-depressants are used for insomnia? (3)
- Trazodone (SARI)
- Amitriptyline (TCA)
- Doxepin (TCA)
What is the most prescribed sedating antidepressant for pts with chronic insomnia and depressive symptoms?
Trazodone
Risk factor for obstructive sleep apnea?
- obesity –> increased neck circumference –> airway narrowing
Tx for obstructive sleep apnea? (3)
- positive airway pressure (CPAP or BiPAP)
- weight loss + exercise
- surgery
What is the classic tetrad of narcolepsy?
- excessive daytime sleepiness (“sleep attacks”)
- REM-related sleep phenomena - inability to move during transition from sleep to wakefulness
- hypnagogic or hypnopompic hallucinations
- Cataplexy = sudden loss of muscle tone evoked by strong emotions w/o loss of consciousness
Hypnagogic vs. hypnopompic hallucinations?
Hypnagogic = when transitioning TO sleep Hypnopompic = when transitioning FROM sleep
Pathophysiology of narcolepsy
- linked to loss of hypothalamic neurons that contain hypocretin
- may have autoimmune component
Pharmacotherapy for excessive daytime sleepiness? (4)
- amphetamines (dextroamphetamine, methamphetamine)
- methylphenidate (Ritalin)
- modafinil (provigil)
- sodium oxybate
Drug of choice for tx of cataplexy?
Sodium oxybate
Treatment of narcolepsy (non-pharm) (3)
- schedule daytime naps
- maintain regular sleep schedule at night
- avoidance of shift work
What is idiopathic hypersomnia? (IH) (3)
Rare disorder characterized by excessive daytime sleepiness, prolonged nocturnal sleep episodes, and frequent irresistible urges to nap
What is Kleine-Levin syndrome? (4)
Rare d/o characterized by:
- recurrent hypersomnia w/ episodes of daytime sleepiness
- w/ hyperphagia
- hypersexuality
- aggression
Subtypes of circadian rhythm sleep disorders (4)?
- Delayed sleep phase disorder
- Advanced sleep phase disorder
- Shift-work disorder
- Jet lag disorder
Which part of the sleep cycle does sleepwalking occur?
Slow-wave sleep
Epidemiology of sleepwalking (adults and children)
1-4% in adults
10-20% in children and adolescents
Risk factors for sleepwalking?
- obstructive sleep apnea
- sleep deprivation
- irregular sleep schedule
- stress
- hyperthyroidism
- magnesium deficiency
- seizures, migraines
Tx for refractory sleepwalking?
Clonazepam (Klonopin)
Which part of the sleep cycle does sleep terror occur? How about nightmare disorder?
- sleep terror = slow wave sleep
- nightmare = REM sleep
What is the treatment used for treating recurrent nightmares in pts w/ PTSD?
Imagery rehearsal therapy
What is REM sleep behavior disorder?
- characterized by muscle atonia during REM sleep and dream enactment (ex. sleep talking, limb jerking, punching)
Tx for REM sleep behavior disorder?
Clonazepam (efficacious in 90% of pts)
