CT 12 - Sleep Disorders

Question 1

How can sleep disorders be characterised

Answer 1

Dyssomnias (issue with the quantity, timing or sometimes quality of sleep)

Parasomnias (issue with what happens during sleep) eg bad dreams

Sleep disorders secondary to medical or psychiatric disorders

Question 2

What is primary insomnia

Answer 2

Too little sleep (difficulty in initiating or maintaining sleep)
Must have occurred for longer than a month

Question 3

List some causes of primary insomnia

Answer 3

Major depressive disorder
Manic episode
Anxiety disorder
Misuse of substances
Breathing related problems

Or cause unknown

Question 4

What are the treatments of insomnia

Answer 4

Daytime exercise
Metronome
Relaxation exercises
Ear plugs or calm reading
Reduce caffeine
CBT

Question 5

How should ST insomnia be treated pharmacologically (<4wks)

Answer 5

Hypnotics only there is severe daytime impairment

No longer than 2 weeks and if they don’t work don’t just simply prescribe another hypnotic

Low dose

Question 6

What are the classifications of hypnotics

Answer 6

Short acting benzodiazepines - temazepam, loprazolam , lormetazepam (*diazepam not recommended)
Non acting benzodiazepines Z drugs (zopiclone, zolpidem and zaleplon

Question 7

How should LT insomnia be treated

Answer 7

CBT

Drugs not recommend for LT therapy but for those with severe symptoms or acute exacerbation consider hypnotic

For people over 55 consider an initial 3 week treatment of modified release melatonin

Question 8

What is primary hypersomnia

Answer 8

Sleeping too much or being drowsy at times when you should be alert
Should be present for 1 month or longer

Question 9

What are some causes of hypersomnia

Answer 9

Major depressive episode
Dysthymic disorder with atypical features

Overdose on sleeping pills

Question 10

What is the treatment of hypersomnia

Answer 10

Exercise when becoming sleepy

Question 11

What is narcolepsy

Answer 11

Sleeping at the wrong time

Sleep is brief but refreshing

May also have sleep paralysis, sudden loss of strength and hallucinations

Question 12

Treatment of narcolepsy

Answer 12

Stimulants

Sometimes antidepressants but less successful

Question 13

What is breathing related sleep disorder

Answer 13

Sleep disruption (excessive sleeping or insomnia).
Eg obstructive sleep apnoea syndrome

Treatment - weight loss, sleeping on side, avoid hypnotics and alcohol
Severe= machine that provides continuous positive airway pressure CPAP

Surgery

Question 14

What is circadian rhythm sleep disorder

Answer 14

Persistent pattern of sleep disruption (can be either insomnia or hypersomnia)
Maybe caused by delayed sleep phase, jet lag, shift work and unspecified type

Question 15

What is the treatment for circadian rhythm disorders

Answer 15

Darken bedroom and soundproofing
Limit caffeine and hard to digest food
To help jet lag sun exposure helps

Question 16

Examples of parasomnias

Answer 16

1) nightmares. Occur in early morning during REM sleep. Stress may induce 60% of nightmares. Dreams are clearly remembered. Sudden withdrawal of rem-suppressing medications and drugs can cause rem rebound

2) sleep terrors

3) sleepwalking

Question 17

What are night terrors

Answer 17

Abrupt awakening from sleep, confused sweating, immense fear + screaming. Unresponsive to comfort. No detail of what happened

Usually in children and earlier evening as occur during nonrem sleep

Question 18

Background info about sleepwalking

Answer 18

In children is normal

Runs in families

Begins between ages 6 and 12 and may be stress related

Question 19

What is the treatment for sleepwalking

Answer 19

Relaxation techniques

Biofeedback training

Hypnosis

May need to sleep on floor, doors securely locked and car keys unavailable

Question 20

Other parasomnias

Answer 20

Sleep talking (can occur during rem sleep or delta sleep. During rem words are understandable)

Sleep paralysis (inability to perform voluntary movements in the transition from asleep to awake)

Rem sleep behaviour disorder (agitated and violent behaviour. Physically and vocally act out vivid or unpleasant dreams)

Question 21

What is sleep hygiene

Answer 21

Variety of practices and habits that are necessary to have good sleep and full day time alertnes

Eg

Limiting day time naps

No strenuous exercise near bedtime

Avoid stimulants and heavy foods before bedtime

Adequate exposure to daylight during day is helpful

Establishing a regular relaxing bedtime routine

Comfortable environment (bed/pillows, temperature)