Chapter_15_Sleep_Wake_Disorders_Flashcards_
What are the two main categories of sleep disorders?
- Dyssomnias – insufficient, excessive, or misaligned sleep (e.g., insomnia, hypersomnia, narcolepsy).
- Parasomnias – abnormal behaviors during sleep (e.g., sleepwalking, REM behavior disorder)
Name physiologic changes in sleep with aging.
↑ Sleep latency, ↓ REM sleep, ↑ Sleep fragmentation
DSM-5 criteria for Insomnia Disorder?
Difficulty initiating/maintaining sleep or early awakening, ≥3 nights/week for ≥3 months, despite adequate opportunity, causes distress/impairment, not due to another disorder/substance
First-line treatment for chronic insomnia?
Cognitive Behavioral Therapy (CBT). Other: sleep hygiene, melatonin, trazodone, short-term hypnotics (e.g., zolpidem)
What is Hypersomnolence Disorder?
Excessive sleepiness despite ≥7h sleep, ≥3x/week for ≥3 months, not explained by another disorder/substance, often reports >9h nonrestorative sleep or difficulty waking
Common treatments for Hypersomnolence Disorder?
Modafinil (first-line), stimulants like methylphenidate; treat underlying cause
Most common hypersomnia?
Obstructive Sleep Apnea (OSA): snoring, apneas, choking, unrefreshing sleep, morning headaches. Risk: Obesity. Tx: CPAP, weight loss, surgery
Key feature distinguishing Central Sleep Apnea from OSA?
CSA has absent respiratory effort (vs. obstructed airflow in OSA). Often due to heart failure, stroke, or opioids. Tx: CPAP/BiPAP, acetazolamide
DSM-5 criteria for Narcolepsy?
Recurrent sleep need ≥3x/week for ≥3 months with ≥1 of: cataplexy, hypocretin deficiency in CSF, REM sleep latency <15 min
Narcolepsy treatment?
Modafinil (first-line for daytime sleepiness), sodium oxybate (for cataplexy), scheduled naps, TCAs/SSRIs/SNRIs for cataplexy
Key subtypes of circadian rhythm sleep-wake disorders?
Delayed sleep phase, Advanced sleep phase, Shift work, Non-24-hour sleep-wake, Jet lag
Treatments for circadian rhythm disorders?
Bright light therapy, Melatonin, Sleep hygiene, Modafinil (for shift work disorder)
Differences between NREM vs REM Parasomnias?
NREM: 1st third of night, amnesia, confusion. REM: last third of night, vivid dream recall, alert
What is REM Sleep Behavior Disorder?
Dream-enacting behavior with loss of REM atonia. Linked with Parkinson/Lewy body dementia. Tx: clonazepam, melatonin, safety precautions
Nightmare Disorder vs Night Terrors?
Nightmares: REM, vivid recall, alert. Terrors: NREM, no recall, autonomic arousal, common in children
Restless Legs Syndrome (RLS) features and treatment?
Urge to move legs with unpleasant sensations, worse at night, relieved by movement. Tx: pramipexole, gabapentin, iron replacement
How is Substance/Medication-Induced Sleep Disorder diagnosed and treated?
Sleep disorder related to use/intoxication/withdrawal of substance. Resolves within 1 month of stopping the substance. Tx: Remove offending agent
Which EEG waveforms are associated with each sleep stage?
Awake (eyes open): Beta
Awake (eyes closed): Alpha
N1 (light sleep): Theta
N2: Sleep spindles + K-complexes
N3 (deep sleep): Delta (slow waves)
REM: Beta (similar to awake), muscle atonia, dreaming
Which medications can worsen insomnia?
Caffeine, SSRIs, bupropion, steroids, stimulants, decongestants (pseudoephedrine)
Which antidepressants are most sedating and can help sleep?
Trazodone, mirtazapine, doxepin (FDA-approved for insomnia at low dose)
What’s the key difference between REM Behavior Disorder and Night Terrors?
REM Behavior Disorder: Adults, vivid dream enactment, dream recall, neurodegenerative association
Night Terrors: Children, no recall, NREM sleep, autonomic arousal
What sleep changes are commonly seen in depression?
↓ REM latency, ↑ REM density, ↓ Slow-wave sleep (N3), early morning awakening
What sleep changes are seen in aging vs depression?
Aging: ↓ REM and N3, ↑ awakenings
Depression: ↓ REM latency, ↑ REM time/density
