9. Sleep Medicine Flashcards
1
Q
sleep disorders
A
American academy of sleep medicine (1997)
common
- 1/3 more sleepy in the day than they would like
- 4-19% chronic insomnia
- 2-4% obstructive sleep apnoea (OSA; middle aged adults)
serious
- mortality (e.g. accidents) more likely = 1/6 sleep influenced (George, 1996)
- 100’000 crashed per anum
- 1500 fatalities per anum
- also links to obesity, depression, poor performance and relationships
2
Q
George (1996)
A
- driving drunk is less likely to cause an accident compared to having OSA
- more people drive tired too
3
Q
problem sleepiness
A
- Selby train crash = 10 fatalities
- Bhopal chemical disaster = >10’000 fatalities and 1/2 million exposed to chemicals
- Chernobyl nuclear disaster = 125’000 deaths worldwide
- Exxon oil spill = > 1000 sea otters, 300 harbour seals and 250’000 sea birds died costing $2.5 billion
4
Q
what is normal sleep
A
depends on the individual
- we need to get a proper evaluation
- its about how people feel
5
Q
Sleep disorders are under-diagnosed
A
- 95% remain unidentified and undiagnosed
- few health care professionals ask about sleep as they aren’t trained
- medical students have approximately 5 minutes talking about sleep in 5 years of lectures
- yet sleep disturbances are linked to the top 10 most diagnosed conditions
- yearly cost of sleep deprivation is $16 billion direct and $50-100 billion indirect
6
Q
sleep disorders
A
- insomnia (cant sleep)
- hypersomnia (sleeps too much)
- circadian rhythm disorders
- parasomnias (sleep walking/talking)
- movement disorders of sleep
7
Q
insomnia
A
- 30-80% prevelance rate - Ohayon (2002)
- evolutionarily we have evolved to have 7-9 hours sleep (seen in 1910) but nowadays we have on average 6.9h (2000)
- treating insomnia also enhances the treatment of depression (Fava et al., 2007)
- if you improve the sleep of individuals with mental disorders you also signficiantly improve their mental health as well (Morin et al., 1994 also below)
- CBT is an influential therapy for insomnia
- 30% of individuals improved just from talking about CBT
8
Q
CBT in insomnia sufferers
A
- told if they wake up and cant sleep for 15-30 mins just to get up to reduce the fear of trying to sleep
- slowly consolidating into a block of sleep
what time they need to wake up - how much sleep they need = bed time
- extend this by 15 minutes each week but cant move on until they have mastered each block
- reducing sleep onset latency
- reducing wake after onset
- 70-80% benefit
9
Q
sleep questionnaires and rating scales
A
- Epworth sleepiness scale (0-3, how likely are you to fall asleep in these situations)
- Restless leg rating scale (asks about how sleep disturbances are related to restless leg syndrome)
- Parkinson’s disease sleep scale (how would you rate the following based on your experiences the previous week)
- all based on subjective measures
10
Q
objective measures
A
- multiple sleep latency test (MSLT)
- maintenance of wakefulness test
- vigilance test (Osler test)
- outpatient neurophysiology studies = pulse oximetry, respiratory monitoring, ambulatory EEG (epilepsy)
- can identify how successful therapies are through these sleep recording methods
- can then have a sleep diary (subjective) to compare to
- inpatient telemetry studies = polysomnography (EEG, respiratory monitoring, movement detection)
11
Q
hypersomnolance/excessive daytime somnolance
A
- differential diagnosis - sleep disordered breathing hypersomnia of central origin, insufficient sleep syndrome, depression and anxiety syndromes
12
Q
sleep disordered breathing
A
increased thoracic and abdominal effort when airways are blocked (Vuzir et al., 2005)
- measures of severity = Apnoea-hypoapnoea index (AHI) looks at the number of episodes each hour
- children = 2-3%
- middle age = 5-7%
- CPAT treatment helps keep airways open throughout the night by forcing air through the airway
- CPAT improves feelings of sleepiness, cognition, health status and blood pressure
- controlled trial evidence that mandibular (jaw bone) advancement devices (MAD) and mandibular repositioning splints (MRS) (Mehta et al., 2001) but not as much as CPAP
- mild evidence for surgery too
13
Q
narcolepsy features
A
- Narcolepsy features = normal sleep quality is poor (lots of dreams, nighttime waking), hypnagogic (sleep onset) hallucinations, hypnopompic (awakening) hallucinations, sleep paralysis
- 25-50 per 100’000 people (Billiard et al., 2003)
- more common in younger and middle adolescents
- diagnosis = 6 months duration without obvious cause, exclusions of other abnormalities, genetic associations (HLA on chromosome 6)
14
Q
cataplexy features
A
- features = loss of muscle tone is triggered by emotions (mainly laughter), which worsens with poor sleep and fatigue
- consciousness is retained
15
Q
narcolepsy/cataplexy physiology
A
- pathophysiology (disease that impacts physiological processes)
- intrusions of REM into wakefulness
- diss-regulation of normal sleeping from an imbalance in adrenergic (decrease), serotonergic (decrease), hypocretin (decrease - mutation in gene coding) and Ach (increase)
