Clinical Sleep Disorders Flashcards
Sleep Stage 1
characteristics:
time spent in stage:
Sleep Stage 1
characteristics: light sleep- easily awakened. theta waves present
time spent in stage: 5% of total sleep time
Sleep Stage 2
characteristics:
Time spent in Stage:
Sleep Stage 2
People in sleep stage 2 are generally easy to arouse, but may require some shaking. The majority of our total sleep time is spent in this stage (45-55%). On a polysomomogram you will see Sleep Spindles andd K complexes
Sleep Stage 3/4
Deep sleep begins. A person in stage 3/4 is very hard to awaken and is unresponsive to external stimuli. Brain waves are slow delta waves. Time in stage 3/4 is aproximately 16-21% of total sleep time
REM Sleep
REM Sleep is also known as actie or paradoxical sleep. It is the stage of sleep where dreaming occurs due to an increase in cholernergic activity (Ach). REM sleep is concentrated in the second half of a night’s sleep
This stage of sleep makes up about 20-25% of total sleep time.
Skeletal muscle is inhibited
Possible consequences of sleep distrubances:
Consequenes of sleep disturbances include:
impaired mental functioning
emotional changes (irritability, anxiety, depression)
memory difficulties
impairment on complex motor tasks
decreased work efficiency/productivity
immune supression
reduced quality of life
weight gain
Insomnia:
definition
Insomnia is repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment
Insomnia:
Symptoms:
Characteristics:
Pathophysiology:
Treatment
Insomnia:
Symptoms: difficulty falling asleep, frequent awakenings with difficulty falling back to sleep, unrefreshing sleep, waking up too early, daytime sleepiness, difficulty concentrating, irritability
Characteristics:
Pathophysiology:
Treatment
Insomnia:
Characteristics:
Insomnia is the most common sleep disorder affecting 10-15% of the population.
Insomnia affects more women than men and its incidence increases with age
Pt. may say “I have a hard time unwinding at the end of my day” or may also have an inability to take naps
Insomnia:
Pathophysiology
The most common etiology for insomnia is psychophysiological.
It is a state of hyperarousal at bedtime leading to a conditioned difficulty falling asleep.
40% of patients with insomnia have comorbid psychiatric conditions such as anxiety or depression
Insomnia:
Treatment
Treatment for insomnia is to first identify the cause of the insomnia (period of adjustment- new job, starting med school, etc. usually lasts less than 3 months)
discuss sleep hygine: regular bed/wake time, caffine use, exercise timing, tobacco use, etc
Cognitive Behavioral Therapy
pharmacology (hypnotics, antidepressants, melatonin receptor agonists)
**successful treatment= improved sleep latency by 30 minutes (from the time you go to bed to the time you fall asleep. If this time goes from 2 hours to 90 minutes the treatment is considered a success)
Obstructive Sleep Apnea
Definition:
Obstructive Sleep Apnea (OSA) is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns.
Airflow stops but patient will have continued respiratory effort
Obstructive Sleep Apnea:
Symptoms
Symptoms of OSA include:
general symptoms of sleep disturbances (impaired mental function, memory difficulties, etc)
+
Erectile dysfunction
nocturnal gastroesophageal reflux disease (heartburn)
Obstructive Sleep Apnea
increases the risk for:
OSA is associated with an increase risk for:
Cardiovascular disease
arrhythmias (atrial fibrilation)
hypertension
Stroke (secondary to clots formed during atrial fibralation)
death (caused by stroke)
increased glucose levels
Obstructive Sleep Apnea
Pathophysiology:
Treatment:
OSA occurs when the tongue and jaw fall back and block the upper airway. It can be a partial collapse (hypopnea) or a complete collapse (apneas)
Treatment:
CPAP or BiPAP
Oral appliances (keep jaw and tongue from blocking airway)
weight reduction (usually very helpful)
Surgery
Narcolepsy:
Clinical Features:
Clinical Features of narcolepsy include
Excessive sleepiness (100% of patients. Sleepiness is not relieved by adequate sleep)
Disturbed Nocturnal Sleep: fragmented sleep, unexplained arousals
Sleep Paralysis: inability to move when first falling or waking up from sleep
Hypnogogic Hallucinations: very vivid dreams during the transition from wake to sleep
Cataplexy: inappropriate intrusion of REM atonia during wakefullness brought about by emotion (rag doll)
Narcolepsy:
Pathophysiology
Diagnosis
Narcolepsy
Narcolepsy is caused by a lack of hypocretin neurons of the lateral hypothalamus and low CSF hypocretin levels
Narcolepsy is diagnosed with evidence of:
shortened REM latency (the time it takes from falling asleep to entering REM <60 minutes) and fragmented sleep and
short mean sleep latency (<8 minutes) and REM present in at lease 2+ naps during a multiple sleep latency test.
Narcolepsy
pathophysiology:
Diagnosis:
Narcolepsy
Pathophysiology: lack of hypocretin neurons of the lateral hypothalamus or Low CSF hypocretin levels (possibly autoimmune disorder)
Diagnosis: All night polysomnogram with evidence of shortene REM Latency (time from going to sleep to entering REM sleep. <60 minutes)
Narcolepsy:
Treatment for:
excessive sleepiness:
cataplexy:
Treatment for narcolepsy includes frequent naps (every 4 hours), regular sleep-wake schedule, good sleep hygine, avoiding changes in time zones, career counseling (avoid night shift work), and discussion of driving restrictions- if applicable.
Excessive Sleepiness: CNS Stimulants (methylphenidate, amphetamine)
Cataplexy: tricyclic Antidepressants, SSRIs, Sodium Oxybate
Restless Leg Syndrome:
Periodic Limb Movements:
Treatment:
Restless Leg Syndrome: clinical diagnosis made primarily on subjective reports by the patient
Periodic Limb Movements: An objective polysomnographic finding. Repetitive, stereotyped dorsiflexion of the big toe with fanning of the other toes, flexion of the ankle, knee, and thigh. Movements are at pretty regullar intervals, seperatd by 5-90 seconds
Treatment: treathment for both RLS and PLM are dopamine agonists
Restless Leg Syndrome
Core Symptoms:
Supportive features
Restless Leg Syndrome
“URGE”- Urge to move limbs accompained by uncomfortable, unpleasant feeling in the limbs, Rest or inactivity precipitates symptoms, Getting up and moving improves them, Evening or nighttime is associated with worsening symptoms
Supportive features: family history (1st degree relatives), response to dopaminergic therapy
Restless Leg Syndrome:
Precipitating Factors:
Precipitating factors for RLS:
iron deficiency (low serum ferritin)
pregnancy
renal failure
peripheral neuropathy
Medication (antidepressants, antihistamines, antiemetics)
