Assessment of Sleep Disorders

Question 1

Key things to consider

• difference between fatigue and sleepiness
• tool you can use to assess risk of sleeping
• other key questions to ask in a history

Answer 1

Tired is not the same as sleepiness

Fatigue - tired after physical/mental exertion
Sleepiness - if they could, would they fall asleep

What is their bedtime routine - is the problem behaviour induced?

Quality of sleep

Issue with initiation or maintenance of sleep

Any psychiatric diagnosis?
Medications?

Epworth Score (U10 is normal)

Question 2

Possible differentials for daytime sleepiness

-what are the most common ones

Answer 2

MOST COMMON
Obstructive sleep apnea
Behaviourally induced insufficient sleep syndrome

Restless leg syndrome, periodic leg movement disorder

Psychiatric problems
Medications

Central hypersomnia
Circadian rhythm disorder

Question 3

Presentation of restless legs and periodic leg movement disorder

Answer 3

Urge to move legs, with unpleasant sensations

• worse with inactivity at night
• relieved by movement

Can also affect arms, abdo, face

Associated with Fe deficiency, genetics, dopamine deficiency

Question 4

Narcolepsy

• pathophysiology
• presentation

Investigations
Management

Answer 4

Sudden transitions from wake => REM NREM sleep
-due to reduced hypocretin, this is needed to control transition between wake, NREM and REM (NT)

EDS
Symptoms associated with REM 
-10min visual/auditory hypogogic hallucinations
-Sleep paralysis
-Cataplexy - sudden loss of tone triggered by emotion
-retained awareness
-no deep tendon reflexes
-if generalised => falls

Multiple sleep latency EEG

Daytime stimulant - modafinil
Nighttime sodium oxybate

Question 5

Factors that affect circadian rhythms

Answer 5

Light
Melatonin
Genetics
Exercise
Temperature
Feeding behaviour
Age

Question 6

Examples of

• non REM parasomnias
• REM parasomnias

Answer 6

Sleeptalking, walking, terrors
Bruxism

RBD
Sleep paralysis

Question 7

Describe the normal sleep pattern

Answer 7

Cycle down and up all 4 NREM stages => REM

• period of REM increases
• period in NREM decreases

Sleep disorders are linked to nerve lesions

Question 8

Presentation of RBD

-pathophysiology

Answer 8

Associated with alphasynucleopathy
Loss of muscle atony
-eyes closed
-muttering, shouting
-thrashing, kicking

No recollection but has vivid dreams that relate to their violent actions

More common in males
Occurs several times a night

Question 9

Associations with RBD

Answer 9

Neurodegeneration
-precedes PD, DLB, MSA

Drugs
-antidepressants, antipsychotics

Sleep apnoea, narcolepsy