Lecture 7 Flashcards
1
Q
How are sleep disorders assessed?
A
- primary care physician, send to sleep clinic
and/or - sleep lab, polysomnography w/ multiple physiological measurements
- patient histories, diagnostic info
- signs (observable) & symptoms (reported)
- sleep amount, quality, timing & daytime
- technicians, researchers, clinicians, psychologists & physician specialists
- meet regularly, review & discuss patients: share knowledge & for treatment
- case studies/“grand rounds”: multiple doctors visiting patient
- International Classification of Sleep Disorders
2
Q
What are the symptoms of sleep disorders? (UEDUSMM)
A
how persistent/frequent:
- unrefreshed sleep
- excessive daytime fatigue/sleepiness
- difficulty staying/falling asleep
- unusual/violent behaviour during sleep
- snoring, breathing irregularities
- motor restlessness in the evening/previous to sleep
- mood changes/issues
3
Q
What is insomnia?
A
cannot obtain enough time asleep, quality sleep despite adequate opportunity to do so
4
Q
What is sleep onset insomnia?
A
difficulty initiating sleep
5
Q
What is sleep maintenance insomnia?
A
difficulty maintaining sleep thruout the night
6
Q
What is early awakening insomnia?
A
rapid sleep onset, good sleep continuity, but awakening much earlier than desired, inadequate total amount
7
Q
What is sleep dissatisfaction?
A
not feeling refreshed after a night of seemingly sufficient sleep
8
Q
What is idiopathic insomnia?
A
no found cause (15% of cases, childhood onset, life-long condition w/o treatment)
9
Q
What is psychophysiological insomnia?
A
chronically hyper-aroused; greater arousal at night + day restless, overactive, nervous, apprehensive; intense and persistent physiological arousal
10
Q
What is paradoxical insomnia?
A
“sleep state misperception”
- no daytime impairment
- normal sleep length & profile, but report no sleep
- highly attentive, “thinking all night”
11
Q
What are the causes of insomnia? (GCCD)
A
- genetic component (7 genes contribute)
- cause for initial sleep disruption should be found, but not as relevant as perpetuating circumstance
- Co-morbid insomnia
- decongestants, caffeine
12
Q
What are the causes of insomnia? (ATTPU)
A
- alcohol:
- increase sleep time, less N3 & REM
- alcoholism: permanent irreversible reduction of N3 & REM
- time zone, schedule changes
- temperature regulation
- pregnancy, menopause
- unique sleeping environments
13
Q
What are the causes of insomnia? (MMGTW)
A
- mild to severe psychological issues
- marital, job stress
- grief
- trauma
- war, PTSD
14
Q
What is co-morbid insomnia?
A
insomnia caused by other disorders, medication, illicit drug use, pain/discomfort, environmental factors
15
Q
What are the sleep specific cognitive issues for the causes of insomnia?
A
- exaggerated concerns about “not enough sleep”
- self-blame/guilt of lack of sleep
- dread sleep time, pressure to sleep leading to hyper-vigilance about sleep
- if try to self-treat, cannot sleep b/c monitoring sleep treatment to evaluate its effectiveness
- mental listing/persistent problem solving
16
Q
What is the impact of insomnia? (PIFBUP)
A
- physical & psychological issues of sleep deprivation
- impact on work performance, communication, relationships
- family/sleep partner: sleep separate, need quiet, sleep envy/resentment
- bargaining with partner/children
- unpredictable in planning, choices of activities, lifestyle
- purchasing/relying on “aids”
17
Q
What are the physical and psychological issues of sleep deprivation? (CIJDIC)
A
- concentration
- irritability
- jitters
- diminished well being
- inappropriate sleeping locations/episodes
- clumsiness to severe accidents
18
Q
What are facts about insomnia? (36V1)
A
- 30-50% of Western pop. report occasional/temporary insomnia
- 6-10% report serious problem, persistent
- v. rare in children 8-10 but 25-35% of retirees/post middle-aged
- 1.5x more prevalent in women than men
19
Q
What are facts about insomnia? (MSSB)
A
- more prevalent in those w/ depression, anxiety, substance abuse, disordered breathing & recurrent health issues
- sleep onset insomnia: more common in younger adults
- sleep maintenance insomnia: more common in older adults
- BUT types can change w/ physical + psychological circumstances & aging
20
Q
What are treatments for insomnia? (S)
A
sleeping pills:
- over-the-counter (OTC), non-prescription: ineffective/questionable effectiveness
- antihistamine, acetaminophen
- magnets, herbal treatments
21
Q
What are treatments for insomnia? (P)
A
prescription: effective temporarily
- hypnotics, benzodiazepines: work on GABA receptors to promote sleep, relax muscles & reduce anxiety
- “psychological dependency”
- amnesia, risk of falls, serious accidents
- people tend to overdose on non-prescription, thinking they are “safer” or combine w/ other substances which can be disastrous or lethal
22
Q
What is CBT for insomnia (CBT-i)? (CEFES)
A
- change thoughts, emotions, beh., “relearn to sleep”
- effective, long-lasting
- few sessions to several weeks, practitioner, resources provided
- examine: what contributing to issues, tracking/log
- several components sequentially, individually introduced, monitor motivation/compliance & progress; enough in place, good sleep will result
23
Q
What are the components introduced in CBT-i?
A
- sleep restricted to bedroom
- progressive muscle relaxation, bath/shower, reading
- scheduled worry, thinking and resting time
- write lists of tasks and worry targets
- change expectations about sleep
24
Q
What is sleep compression, restriction?
A
- no daytime napping
- change sleep onset time: 5 hours at a certain time, increase in 10-15 min intervals
- start sleep prep later, even if fatigued
- sleep drive will increase, less time awake
25
What is narcolepsy?
- appears in teens, early 20’s can appear in adulthood, both genders
- complain of excessive, perpetual sleepiness
- intractable sleep attack, w/o warning, even in stimulating situations
- can have narcolepsy w/o cataplexy
- hallucinations paired with sleep paralysis: reported in half of sufferers
- blackouts
26
What are hallucinations paired with sleep paralysis like?
- vivid, dream-like occurrence
- visual, auditory, tactile or involve movement
- hypnagogic: entry to sleep
- hypnopompic: from sleep
27
What are blackouts?
typical wakefulness behaviour w/ no memory of events, behaviours
28
What is cataplexy?
weakness in limbs, face, speech muscles; mild to complete wilting collapse
- triggered by emotions/stress response
- blurred vision, irregular respiration, slurred speech
- if minutes, consciousness remains, but over 2min, REM sleep triggered
- less than 1x/week to several per day
29
What are the causes for narcolepsy? (GCAAI)
- genetic predisposition
- catalyst: brain damage, infection/other medical conditions
- autoimmune disorder: body attacking own tissue in lateral hypothalamus
- abnormally low/absent hypocretin in cerebral spinal fluid
- increased activity of acetylcholine & decreased activation of locus coeruleus
30
What are the impacts of narcolepsy? (WSPAF)
- work: fall asleep on the job (fired)
- social: dating, outings, events
- personal: safety driving
- appear dull, emotionally flat, unmotivated, withdrawn, aggressive, lazy or bored
- feel guarded, anxious, frustrated: depression can result
31
What are treatments for narcolepsy?
- no cure
- behavioural + pharmacological treatments necessary
- naps: can be refreshing, although inconvenient
- good sleep hygiene
- medication:
- stimulant for daytime activities, side effects
- noradrenergic reuptake blocking, SSRI or gamma-hydroxybutyrate for cataplexy
- psychological support (learn to anticipate attacks, support groups)
- family, peer education & therapy
32
What are new possibilities of treatment for narcolepsy?
- stem cell transplant to regenerate hypocretin producing cells
- gene replacement therapy: use virus to insert hypocretin procurer genes in cells to encourage hypocretin production
33
What is restless leg syndrome (RLS)? (UUWRPMD)
- unpleasant sensation at legs, tingling to painful
- urge to move legs
- when stationary, seated or lying, or at rest esp. at night
- relieved w/ continuous movement
- physical exam, lab tests = no issues
- misdiagnosed as cramps, vericose veins, "nerve problems"
- daytime: report fatigue, sleepiness
34
What are facts about RLS?
- 5-15% of pop. report it; 2x often in females
- onset at any age, can be misdiagnosed as growing pains/hyperactivity disorder
- highest incident in middle-age to elderly
- family history, genetic component
- 1/3 of cases due to iron deficiency
- 15-40% of people on dialysis complain of RLS
- 20% of pregnant women (temporary)
35
What are the causes of RLS? (CDDIBI)
- caffeine, warm rooms & exposure to cold intensifies symptoms
- disappears w/ fever
- depletion of dopamine & blood loss worsens symptoms
- iron: deficiency, transferrin malfunction
- iron therapy may improve symptoms
36
What are treatments for RLS? (IAIASM)
- improved sleep hygiene
- awareness of & control for worsening circumstances + substances
- iron supplementation
- aware of blood loss
- stretching, relaxation massage
- medication:
- dopamine agonists; issues with impulse control behaviours, increased dosing causes worsening symptoms
- oxicodon hydrocodone, issues with dependency
37
What is periodic limb movement (PLM's)?
- jerking of arms/legs during sleep
- short duration (0.5-10 secs) at regular intervals
- clusters (every 5 secs-90 secs) lasting several minutes to hours
- more likely during first half of night
- no awareness of movements, aware of multiple awakenings
- accompany OSA, narcolepsy, REM beh. disorder
- treatment similar to RLS
38
What is bruxism?
- teeth clenching, grinding, crunching, scraping
- damage to teeth, jaw, muscle injury
- due to stress, pre-existing mandibular/maxillary condition
- during N2 sleep & REM; accompanied by partial arousal but no awareness
- higher HR/other body movements accompany
39
What is the goal of CBT-i?
- alleviate perceived, actual nighttime sleep issues
- eliminate self-blame & analysis
- relief from consequences of poor/lack of sleep
40
What is treatment for bruxism?
- dental exam & correction of anatomic abnormalities
- soft/hard guard over teeth
- check for sleep apnea
41
What is periodic limb movement disorder (PLMD)?
periodic limb movement + insomnia/excessive daytime sleepiness
