Lecture 12: Sleep Flashcards
What happens during sleep that makes it important
Synaptic shrinkage: loss of unnecessary/insignificant memories to make room for new connections the following day.
How does sleep vary across life stages
Infants get between 16-12 hours of sleep
Children get 11-9 hrs. Adults get 8-6 hours (50 yrs+)
What factors do you need to take into account for a sleep history
Need to make specific diagnosis to avoid giving wrong med
- Sleep onset/latency
- Total sleep time
- Quality of sleep (interruptions)
- Long term sleep pattern
- Sleepiness during the day
- Parasomnias
What are the 5 different types of insomnias
- Primary- may be linked to rumination - first 2 questions of sleep questionaire yes, all others no
- Secondary due to substances, psychiatric, medical/neurological condition: breathing, bladder, pain
- Circadian rhythm problems (delayed sleeping phase)
- Jet lag,
- Shift work sleep disorder
What is excessive daytime sleepiness
Difficulty in maintaining desired wakefulness/ falling asleep at inappropriate times/ excessive amount of sleep.
What are Parasomnias
- Sleep walking, talking, eating, screaming.
- REM behaviour disorders, periodic limb movements, restless legs, bruxism
Define Insomnia
Trouble with sleeping on at least 3 nights per week such that it interferes with activities the following day, lasting for more than one month
Other definitions include taking 2hrs to fall asleep
What are the major causes of insomnia
- Depression, anxiety,
- General health- Sleep apnea
- Parasomnias
- Alcohol or other substance problem
- Primary insomnia
- Delayed sleep phase disorder
What are some characteristics of a patient with obstructive sleep apnoea
- BMI 30+
- Very tired in daytime- Epworth sleepiness score 15+
- Stops breathing at night for up to 15s and gasping episodes
Other criteria: snoring loudly, waking up with dry mouth, morning headache
How is obstructive sleep apnoea assessed (1) and treated (2)
- Assessment for CPAP (continuous positive airways pressure), Pulse oximetry at night, Polysomnography (sleep lab)
- CPAP which blows air in through a mask, weight loss, mandibular advancement splints or surgery to stop tongue from blocking airway
What is the requirements for sleep hygiene -first line treatment for insomnias
- Bed only for sleep or intimacy - no screen/blue light in bed
- avoid stimulants before bed time
- Get up if not asleep within 20 min
- Naps are between 12-3pm and 30min max.
- More exercise during the day- not just before bed
- Keep a sleep routine
- Make sure environment is quiet, correct temperature, comfortable
What is sleep restriction treatment - good for primary insomnia
1stly current amount of time in bed assessed by sleep diary
- Spend ~5-6 hrs for adults. Use reading, light housework to keep occupied
- If drowsy the next day increase by 15-30 min.
- Changes need 1 week to set. Can use compression (8>7->6 hours) to help compliance
What are 5 meds can you consider for treatment
- Melatonin (for some)
Depression and anxiety meds- make sure to stop ssris, snri, buproprion
- Tricyclics in low doses (10mg)
- Mirtazapine 15 mg (antid)
- quetiapine
- All else fails low dose hypnotic which is short term bc long term = addiction
What are some supplemented treatments
- CBT
- Accupressures, tai chi, yoga,
- 500 mg magnesium in elderly
- Mindfulness. L trytophan ??~~
How is delayed sleep phase disorder treated
Try to get circadian rhythm to match societal norms using melatonin at night and light box in morning. Long term may use night jobs
