9 sleep disorders Flashcards
Prevalence of sleep disorders
American Academy Sleep medicine (1997)
- General sleepiness: 0.5-36^
- 4-9% insomnia
- 2-4% OSA
- 7% of adolescents delayed sleep phase syndrome
- 0.03-0.16% narcolepsy
- sleep walking 1-15% of adults
- sleep terrors 3% children
consequence of poor sleep- mortality
Car accidents: 1 in 6 crashes related to fatugue.
consequence of poor sleep - morbidity
- obesity
- metabollic syndrome : CPAP shown to educe the effects of this
- depression (Suicide)
consequence of poor sleep - performance
work - after 24 hours of sd performance equivalent to 10% blood ETOH concentration (George, 1996)
53% of people driven while feeling drowsy
19% dozed off
1% accident
consequence of poor sleep- relationships
less enjoyable.
treatments for sleep disorders
- pharmacotherapy
- behavioural therapy
- continous positive airway pressure (CPAP)
- surgical therapy.
Problem - diagnosis
sleep disorders are under diagnosed:
As manyy as 95% of people with a sleep problem remain unidentified and undiagnosed.
- few health care providers question sleep
problem - cost
possibly 100,000 motor vehicle accidents sleep related.
Annual cost of sleep related problem is 16 billion in direct costs. 50- 100 billion in indirect costs - accidents, litigation, property distructon, hospitalisation, death
sleep questionnaires
the epworth sleepiness scale,
Parkinsons disease sleep scale
objective measurement of sleep quality
pulse oximetry
ambulatory EEG
limited outpatient respiratory monitoring
actigraphy
- multiple sleep latency test
- maintenance of wakefulness test
- vigilance tests
: psychomotor vigilance test: PVT - osler test
insomnia in the population
- overall prevalence: 30-48%
- often or always: 16-21%
- moderate to extreme: 10-28%
insomnia diagnosis and treatment
Difficulty initiating and maintaining sleep. Waking early.
- CBT to treat. 70-80% benefit. Well sustained over time. (First choice treatment)
- CBT- sleep hygeine. (exercise afternoon, wind down in evening. usual routine, cut down stimulants)
Hypersomnia
- sleep disordered breathing
Excessive daytime somnolence
- OSA
-CSA
- OHS
Symptoms: unrefreshing sleep, memory problems, morning headache, depression, stomache ache.
Risk: Obese, age, male, alcohol, race, smoking.
Treatment: CPAP, surgery
hypersomnia
- hypersomnia of central origin
Narcolepsy/ cataplexy
(Cataplexy= a sudden drop in muscle tone, consciousness retained)- emotional triggers: laughter common
narcolepsy- pathophysiology
: Intrusion of REM into wakefulness
- disregulation of normal sleeping pattern
- imbalance between adrenergic (too low) serotonergic (too low) and acetylcholine (too high)
Hypocretin produced in the LH projects to RAS, cortex, thalamus and brainstem
a reduction in caraplexy.
