14. Sleep Disorders Flashcards
Adequate sleep is essential to normal functioning; deprivation can lead to what? (2)
cognitive impairment and increased mortality
True or False
Circadian rhythms help regulate mood and cognitive performance
True
Neurotransmitters commonly implicated in psychiatric illnesses also regulate sleep. Name them (2)
- acetylcholine activity and decreased activity of monoamine neurotransmitters is associated with greater REM sleep
- decreased adrenergic and cholinergic activity are associated with NREM sleep
Associate sleep and depression (3)
depression is associated with
- decreased ∆ (deep, slow-wave) sleep
- decreased REM latency
- and increased REM density
Name criteria of sleep disorders (2)
- must cause significant distress or impairment in normal functioning
- not due to a GMC or medications/drugs (unless specified)
Describe management: Sleep Disorders (3)
- pharmacological treatments are illness-specific
- non-benzodiazepines preferable (i.e. trazodone, zoplicone, quetiapine), but benzodiazepines a short term option
- medication should not be prescribed without having first made a diagnosis and considering major psychiatric illnesses (major depression and alcohol use disorders are common etiologies)
- sleep hygiene is a simple, effective, but often underutilized method for addressing sleep disturbances
- Cognitive Behavioural Therapy for insomnia (CBTi)
Name sleep hygiene recommendations (7)
- waking up and going to bed at same time every day, including on weekends
- avoiding long periods of wakefulness in bed
- not using bed for non-sleep activities (reading, TV, work)
- avoiding screens, especially smartphones and ipads in the hour before bed
- avoiding napping
- discontinuing or reducing consumption of alcohol, caffeine, drugs
- exercising at least 3-4x per week (but not in the evening, if this interferes with sleep)
Name: Major DSM-5 Sleep-Wake Disorders (12)
- (Uncategorized)
- Insomnia disorder
- Hypersomnolence disorder
- Narcolepsy
- Circadian rhythm sleep-wake disorders
- Restless legs syndrome
- Substance/medication-induced sleep disorder
- Breathing-Related Sleep Disorders
- Obstructive sleep apnea hypopnea
- Central sleep apnea
- Sleep-related hypoventilation
- Parasomnias
- Non-rapid eye movement sleep arousal disorders
- Nightmare disorder
- Rapid eye movement sleep behaviour disorder
Define: Insomnia disorder (1)
Difficulty sleeping
Define: Hypersomnolence disorder (1)
Feeling sleepy throughout the day
Define: Narcolepsy (1)
Recurrent attacks of irrepressible need to sleep
Define: Circadian rhythm sleep-wake disorders (1)
Insomnia or excessive sleepiness due to misalignment or alteration in endogenous circadian rhythm
Define: Restless legs syndrome (1)
Uncomfortable, frequent urge to move legs at night
Define: Substance/medication-induced sleep disorder (1)
Disturbance in sleep (insomnia or daytime sleepiness) caused by substance/medication intoxication or withdrawal
Name: Breathing-Related Sleep Disorders (3)
- Obstructive sleep apnea hypopnea
- Central sleep apnea
- Sleep-related hypoventilation
Define: Obstructive sleep apnea hypopnea (1)
Breathing issues due to obstruction
Define: Central sleep apnea (1)
Breathing issues due to aberrant brain signaling
Define: Sleep-related hypoventilation (1)
Breathing issues due to decreased responsiveness to carbon dioxide levels
Name: Parasomnias (3)
- Non-rapid eye movement sleep arousal disorders
- Nightmare disorder
- Rapid eye movement sleep behaviour disorder
Define: Non-rapid eye movement sleep arousal disorders (2)
- Incomplete awakening from sleep, complex motor behaviour without conscious awareness; amnesia regarding episodes; includes symptoms of:
- Sleepwalking
- Sleep terrors
- Specifiers: sleep-related sexual behaviour (sexsomnia) and sleep-related eating
Define: Sleepwalking (1)
rising from bed and walking about, blank face, unresponsive, awakened with difficulty
Define: Sleep terrors (2)
- recurrent episodes of abrupt terror arousals from sleep
- usually beginning with a panicky scream, intense fear and autonomic arousal, relative unresponsiveness to comfort during episodes
Define: Nightmare disorder (2)
- Repeated extended, extremely dysphoric, often very vivid, well-remembered dreams that usually involve significant threats
- rapid orientation and alertness on awakening with autonomic arousal
Define: Rapid eye movement sleep behaviour disorder (4)
- Arousal during sleep
- associated with vocalization and/or complex motor behaviours
- can cause violent injuries
- rapid orientation and alertness on awakening
