Lecture 6+7+DLA Flashcards
diagnostic tools for SWD’s
must have an interview with the patient
then a polysomnography (PSG) is usually conducted to measure physiological changes during sleep
insomnia disorder
difficulty going to sleep or maintaining sleep for more than 3 months
etiology of insomnia
Insomnia is a learned arousal response to bedtime and other cues associated with the sleep environment.
usually due to poor sleep hygiene
insomnia treatment
improve sleep hygiene by changing sleep behaviors
(using bed for mainly sleeping and not wakeful activities)
have a constant sleep schedule
avoid caffeine after noon
physical activity no more than 2 hours before bed
hot bath within 2 hours before bed
medicine:
can use sedatives: diazepam (can only use for short time)
Nonbenzodiazepine Hypnotics (zolpidem)
Hypersomnolence Disorder
excessive sleepiness despite sufficient sleep (at least 7 hours for 3 months)
sleeping 9.5 hours on average
unrefreshing naps
normal PSG
etiology and treatment for hypersomnolence disorder
etiology: idiopathic
treatment:
stimulants: methylphenidate
stimulant-like drugs: modafinil
promote wakefulness
Narcolepsy
Recurrent irresistible sleep occurring within the same day, several times per week, for >3 mos
one of the following:
cataplexy (loss of muscle tone when awake usually due to strong emotion)
hypocretin deficiency (hypothalamic peptide)
PSG abnormalities
narcolepsy treatment
polytherapy:
simulants (wakefulness)
antidepressants (for cataplexy)
monotherapy: sodium oxybate (GHB) - for cataplexy and somnolence restricted distribution complex dosing (bed time - then 4 hours later)
Breathing-Related Sleep Disorder
Excessive sleepiness or insomnia that is due to a sleep-related breathing condition
obstructive sleep apnea hypopnea
central sleep apnea
Obstructive Sleep Apnea Hypopnea (OSAH)
Multiple episodes of breathing cessation/reduction occur per night due to an upper airway obstruction
soft tissue in the back of the throat will collapse leading to obstruction
The rise in CO2 will lead to deep sleep back into light sleep, thus sleep is not refreshing
classic:
Middle-aged, overweight male who snores loudly and intermittently
Treatment for OSAH
CPAP - A device that maintains an open airway by delivering compressed air at a specific air pressure to the mask’s nasal pillow
also: weight loss no back sleeping surgery orthodontic devices
Central sleep apnea (CSA)
Multiple episodes of cessation of breathing per night caused by CNS dysregulation of breathing
cause:
idiopathic
opioid use
diagnoses and treatment for CSA
A PSG distinguishes OSAH from CSA based on whether thoracic movements occur at the start of apneic episode:
– OSAH (thoracic effort occurs)
– CSA (no thoracic effort occurs)
treatment:
respiratory stimulants such as acetazolamide or nocturnal oxygen
Circadian Rhythm Sleep-Wake Disorder (CRSWD)
Excessive sleepiness or insomnia resulting from a mismatch between a person’s circadian sleep-wake pattern and the sleepwake schedule required by the environment
for example: delayed sleep onset and awake times
treatment for CRSWD
Phototherapy at strategic times during the day to adjust the timing of the sleep-wake cycle
resetting the internal clock:
Light → SCN → inhibits pineal gland → decreases melatonin → alert
No light → SCN → activates pineal gland →
increases melatonin → drowsy
Parasomnias
Disorders characterized by abnormal behaviors associated with sleep
Non -REM Sleep Arousal Disorder (N -RSAD)
Repeated episodes of incomplete awakening from sleep
sleep walking
sleep terrors
usually within first 1/3 of sleep
little to no dreaming
do not remember episodes
treatment:
benzodiazepines to ↓ SWS
Nightmare Disorder
Extremely dysphoric dreams that typically involve
threats to survival, security or physical integrity
will awaken second half of sleep
rapid alertness when awakening
dream content is well remembered
will remember waking up
treatment: if needed
antidepressants can be used to decrease REM
REM Sleep Behavior Disorder (RSBD)
Vocalizations and/or complex motor movements
occur during REM sleep
usually action-filled and violent dreams
Immediate awakening, orientation, and alertness with detailed dream recall
REM sleep with no atonia (PSG can confirm) (act out)
treatment for RSBD
Clonazepam (a benzodiazepine)
modification of sleep environment
can be associated with neurodegenerative disease later in life
Restless Legs Syndrome (RLS)
Urge to move legs in response to uncomfortable
sensations
occurs during inactivity or made worse
worse at night
movement helps
patient knows of the symptoms can complain of sleeplessness
treatment for RLS
Parkinson’s drugs
Periodic Limb Movements (PLMs)
Repetitive muscle contractions during sleep, usually of the lower limb
they complain of daytime sleepiness; they are not aware of these movements at night
PSG will confirm
treat using similar drugs as RLS
