Lecture 12: Sleep and clinical practice Flashcards
What is parainsomnia?
Sleep walk, talk, unusual things
What is insomnia?
Difficulty falling asleep, waking in night, poor quality sleep such that it affects you the next day
Why do we sleep?
Unknown, possibly;
- Cell machine repair
- energy replenishment
- predator avoidance
- thermoregulation
- memory consolidation
- resculpting synapse
- synaptic resetting
What is the most robust theory as to why we sleep?
Shrinkage
- Synaptic shrinkage during sleep to make room for new connections the following day
What happens to length of time spent sleeping over a lifetime?
Gradually the requirements get less and less
What is a polysomnogram
- EEG
- Eye and jaw muscles
- Leg movement
- Airflow
- Resp. effort
- ECG
- Oxygen saturation (sleep apnea)
What can cause excessive daytime sleepiness?
- Sleep apnoea (Weight)
- Idiopathic hypersomnia
- Substances
- Circadian rhythm disorder
- Sleep deprivation
- Narcolepsy/sleep attack
What are some examples of parasomnias?
- Sleep walking
- Sleep eating
- Sleep talking
- Sleep screaming
- REM behaviour disorders
- Periodic limb movements
- Restless legs
- Bruxism
How can sleep be enhanced?
- Address underlying medical and psychiatric condition
- Avoiding stimulating substances
- Minimising alcohol intake
- Physical aspects of sleeping
- Minimize stimulating activities at night
- Going to bed only when really sleepy
- Consistent time in getting out of bed
- Meditation, gratitude diary, relaxation techniques to calm the mind
What are the causes of insomnia?
- Depression
- Anxiety
- Sleep apnea
- Parainsomnia
- Alcohol problems
- Other substance
- Delayed sleep phase disorder
- Primary insomnia
REM disorder
What was a good method of treating sleeping disorder?
Time in bed restriction i.e dont lie on bed all day
Patient 1:
50 y/o
BMI 35
V tired, falls asleep at work
Wife notices he stops breathing for 15sec
- Snores loudly
- Wakes with dry mouth
- Morning headache
Treatment?
Meets criteria for sleep apneoa
i.e stops breathing and gasping
Needs:
- Assessment for CPAP
- Pulse oximetry at night
- Polysmonography
Treatment:
- CPAP
- Weight loss
- Mandibular advancement splints
- Surgery?
75 y/o
Goes to bed at 9 and wakes for couple hours and then wakes up at 6
Does not feel rested and when she wakes she is bored, cold and lonely
Check:
- Sleep hygiene
- Keep naps less than 30 mins between 12-3
- Exercise
- Time in bed restriction
- Medication
Write some notes on sleep hygiene:
- Bed only for sleep or intimacy
- No TV or screens
- If not asleep within 20 mins, get up
- Avoid caffeine before bed time
- Avoid energetic activity before bed time
- Avoid naps during the day or else before 3pm
- Make sure environment is comfortable, quite, correct temp, comfortable bed.
Whats some basic sleep advice?
- Slow down breathing
- Make your eyes half closed
- Sleep routine
