First Aid CH15 Sleep-Wake Disorders

Question 1

what is vital to ask about when pts are dealing with psych issues?

Answer 1

how’s their sleep? because psych issues and poor sleep have a positive feeedback on one another

Question 2

what changes occur during sleep cycles?

Answer 2

brain wave activity, eye movements, motor activity

Question 3

what often occurs with REM wakening?

Answer 3

vivid dream recall

Question 4

in REM sleep, what’s sig about the brain patterns?

Answer 4

resemble EEG of aroused person

Question 5

define dyssomnias

Answer 5

insufficient (insomnia), excessive (hypersomnia), or altered timing of sleep

Question 6

define parasomnias

Answer 6

unusual sleep-related behaviors

Question 7

what type of disorders are the MC hypersomnias?

Answer 7

breathing disorders

• obstructive sleep apnea
• central sleep apnea

Question 8

define insomnia disorder

Answer 8

difficulty falling asleep, staying asleep, and early awakenings, sleep is not refreshing, acute (less than 3 months, stress or schedule changes) or chronic (greater than 3 months, red QoL)

Question 9

how prevalent is insomnia?

Answer 9

~10% of folks (also for hypersomnolence)

Question 10

first-line tx for insomnia?

Answer 10

CBT

- also considered: benzos (MC indication for benzos now), zolpidem, eszopiclone, zaleplon

Question 11

sxs of hypersomnolence disorder

Answer 11

escessive but nonrestorative sleep, routine behaviors performed with little to no recall, difficulties waking up

Question 12

etiology of hypersomnolence disorder

Answer 12

infections (HIV, mono, Guillain-Barre), head trauma

Question 13

tx for hypersomnolence disorder

Answer 13

life-long, modafinil or stimulants, scheduled napping

- second line = atomoxetine

Question 14

define obstructive sleep apnea

Answer 14

continuous collapse of upper airway during sleep causes breathing issues which force pt to wake up at night gasping for air, sleep studies confirm, pt feels non-rested and may snore
- risk = obesity, inc neck circumference

Question 15

tx for obstructive sleep apnea

Answer 15

CPAP (continuous positive airway pressure) or BiPAP (bi-level), wt loss and exercise

Question 16

who might have central sleep apnea?

Answer 16

chronic opiod users, heart dx or stroke pts (Cheyne-Stokes breathing, crescendo-decrescendo in tidal volume), idiopathic

Question 17

tx for central sleep apnea?

Answer 17

tx underlying condition

Question 18

define narcolepsy

Answer 18

excessive daytime sleepiness and falling asleep at inappropriate times d/t loss of hypothalamic neurons that produce hypocretin, involves cataplexy (brief episodes of muscle tone loss d/t intense emotion), pt may hallucinate or experience sleep paralysis at the start or end of sleep cycles

Question 19

what is the pathophys of narcolepsy?

Answer 19

loss of hypothalamic neurons that produce hypocretin, may be autoimmune response

Question 20

different types of hallucinations

Answer 20

hyponagogic: when going to sleep (mom NAGs to go to sleep)
hyponopomic: when waking up (nope, I don’t want to get up)

Question 21

hyponagogic

Answer 21

hallucinations when going to sleep

Question 22

hyponopomic

Answer 22

hallucinations when waking up

Question 23

is narcoleptic cataplexy the same as catatonic catalepsy?

Answer 23

no, narcoleptic can be provokes, catonic can’t

Question 24

tx for narcolepsy

Answer 24

sleep hygiene, scheduled naps, stimulants

- cataplexy: Sodium oxybate!

Question 25

what are the different circadian rhythm sleep wake disorders?

Answer 25

delayed sleep phase disorder
advanced sleep phase disorder
shift-work disorder
jet lag disorder (self-limited, 2-3 days)

tx: phototherapy, melatonin, modafinil

Question 26

what’s a medication used for narcolepsy, sleep apnea, and shift-work disorder (SWD)?

Answer 26

modafinil, a non-amphetamine

Question 27

what part of the brain coordinates the circadian rhythm?

Answer 27

suprachiasmic nucleus (SCN)

Question 28

examples of parasomnias? (behaviors, b is an upside down p parasomnia)

Answer 28

non-REM: sleepwalking, sleep terrors

Question 29

attributes of sleep walking

Answer 29

pt’s eyes are open, sitting up in bed, walking around, eating, going outside

• blank stare
• difficult to arouse during episodes
• amnesia of episode
• rarely is there violent behavior

Question 30

risk factors for sleep walking and night terrors

Answer 30

sleep deprivation, poor sleep hygiene, stress, obstructive sleep apnea, fever, medications, FH

Question 31

attributes of sleep terrors

Answer 31

sudden arousal with screaming and/or crying, tachy, diaphoresis, mydraisis (dilated pupil), difficult to wake from a sleep terror, pt may not wake at all and transition back to normal sleep

Question 32

comorbidities with sleep terrors

Answer 32

sleepwalking

Question 33

define nightmare disorder

Answer 33

recurrent frightening dreams that terminate in awakening, vivid recollection of dreams, cause sig distress

Question 34

tx of nightmare disorder

Answer 34

reassurance, IRT (desensitization/imagery rehersal therapy), Prazosin (PTSD)

Question 35

define REM sleep behavior disorder

Answer 35

arousal during REM sleep including vocalization and/or motor behaviors, dream enacting, lack of muscle atonia during REM

Question 36

risk factors for REM sleep behavior disorder

Answer 36

older age, psych med SE, narcolepsy, NCDs (Parkinson’s, Lewy body dx)

Question 37

tx for REM sleep behavior disorder

Answer 37

d/c causative meds, clonazepam and melatonin, ensure safe sleeping environment

Question 38

define restless leg syndrome

Answer 38

urge to move legs w/ unpleasant sensation in legs too with inactivity, movement is relieving

Question 39

risk factors for RLS

Answer 39

age, FH, iron deficiency, psych meds, cardiovascular dx,

Question 40

tx for RLS

Answer 40

remove offending agent, Fe replacement, dopamine agonist (pramipexole) or benzo