Disturbios do sono Flashcards
O que perguntas na história de um disturbio do sono?
Patients may seek help from a physician because of one of (I) several symptoms: (1) an acute or chronic inability to initiate or maintain sleep adequately at night (insomnia); (2) chronic fatigue, sleepiness, or tiredness during the day; or (3) a behavioral manifestation associated with sleep itself. The specific approach to an insomnia complaint will depend on the nature of (II) comorbid medical or psychiatric disease, if present. In general, however, the insomnia complaint should be specifically addressed as soon as it is recognized.
(III) Information from a friend or family member can be invaluable; some patients may be unaware of, or will underreport, such potentially embarrassing symptoms as heavy snoring or falling asleep while driving.
(IV) Completion by the patient of a day-by-day sleepwork-drug log for at least 2 weeks can help the physician better understand the nature of the complaint. Work times and sleep times (including daytime naps and nocturnal awakenings) as well as drug and alcohol use, including caffeine and hypnotics, should be noted each day.
Qual o tratamento da narcolepsia?
(1) Somnolence is treated with wake-promoting therapeutics. Modafinil is now the drug of choice, principally because it is associated with fewer side effects than older stimulants and has a long half-life; 200–400 mg is given as a single daily dose. Older drugs such as methylphenidate (10 mg bid to 20 mg qid) or dextroamphetamine (10 mg bid) are still used as alternatives, particularly in refractory patients.
(2) eatment of the REM-related phenomena of cataplexy, hypnagogic hallucinations, and sleep paralysis requires the potent REM sleep suppression produced by antidepressant medications. The tricyclic antidepressants (e.g., protriptyline [10–40 mg/d] and clomipramine [25–50 mg/d]) and the selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine [10–20 mg/d]) are commonly used for this purpose. Efficacy of the antidepressants is limited largely by anticholinergic side effects (tricyclics) and by sleep disturbance and sexual dysfunction (SSRIs). Alternately, gamma hydroxybutyrate (GHB), given at bedtime, and 4 h later, is effective in reducing daytime cataplectic episodes.
(3) Adequate nocturnal sleep time and planned daytime naps (when possible) are important preventive measures.
Como tratar a “shift-work disorder”?
(A) Caffeine is frequently used to promote wakefulness. However, it cannot forestall sleep indefinitely, and it does not shield users from sleep-related performance lapses. Modafinil (200 mg, taken 30–60 min before the start of each night shift) is approved by the U.S. Food and Drug Administration as a treatment for the excessive sleepiness during night work in patients with SWD. Although treatment with modafinil significantly increases sleep latency and reduces the risk of lapses of attention during night work, SWD patients remain excessively sleepy at night, even while being treated with modafinil.
(B) Postural changes, exercise, and strategic placement of nap opportunities can sometimes temporarily reduce the risk of fatigue-related performance lapses. Properly timed exposure to bright light can facilitate rapid adaptation to night-shift work.
(C) Work schedules should be designed to minimize (1) exposure to night work, (2) the frequency of shift rotation so that shifts do not rotate more than once every 2–3 weeks, (3) the number of consecutive night shifts, and (4) the duration of night shifts. Shift durations of >16 h should be universally recognized as increasing the risk of sleeprelated errors and performance lapses to a level that is unacceptable in nonemergency circumstances. At least 11 h off duty should be provided between work shifts, with at least 1 day off every week and 2 consecutive days off every month.
Quais os tipos de sono vistos pela polissonografia?
Polysomnographic profiles define two states of sleep: (1) rapid-eye-movement (REM) sleep and (2) nonrapid-eye-movement (NREM) sleep. NREM sleep is further subdivided into three stages, characterized by increasing arousal threshold and slowing of the cortical EEG. REM sleep is characterized by a low-amplitude, mixed-frequency EEG similar to that of NREM stage N1 sleep. The EOG shows bursts of REM similar to those seen during eyes-open wakefulness. Chin EMG activity is absent, refl ecting the brainstem-mediated muscle atonia that is characteristic of that state.
Quais os sintomas associados a sonolência diurna na narcolepsia?
(1) sudden weakness or loss of muscle tone without loss of consciousness, often elicited by emotion (cataplexy); (2) hallucinations at sleep onset (hypnagogic hallucinations) or upon awakening (hypnopompic hallucinations); and (3) muscle paralysis upon awakening (sleep paralysis).
Quais as características da disordem da fase de sono atrasada?
Delayed sleep phase disorder is characterized by (1) reported sleep onset and wake times intractably later than desired, (2) actual sleep times at nearly the same clock hours daily, and (3) essentially normal all-night polysomnography except for delayed sleep onset.
