McNamara Ch 5 Flashcards
What are the two broad categories of sleep disorders?
parasomnias and dyssomnias
Explain the difference between hypersomnolensce and insomnia.
Hypersomnolesnce is sleeping too much, whereas insomnia is sleeping too little.
What are the two most common disorders?
daytime sleepiness and insomnia
List the dyssomnias mentioned in this chapter.
Primary and secondary insomnia, major depression, sleep apnea and narcolepsy.
Name the NREM parasomnias listed in this chapter.
Sleepwalking (somnambulism)
Sleep sex
night terrors
sleep talking
Name the REM parasomnias listed in this chapter.
nightmares
REM behavior disorder
Sleep paralysis
What is the definition of insomnia?
difficulty initiating sleep or staying asleep or both.
What percentage of the population will experience insomnia at least once in their lifetime?
95%
What percentage of the population has persistent insomnia?
10%
What is primary insomnia?
sleeplessness due to intrinsic sleep-related issues
What is secondary insomnia?
sleeplessness caused by non-sleep related issues such as anxiety or an illness or stress, etc.
What is the listed primary insomnia disease?
Fatal Familia Insomnia
What percentage of the population have sleep state misconception?
4%
Name the two types of sleep apnea.
Central sleep apnea and obstructive sleep apnea.
what is the cause of central sleep apnea?
the problem is located within the central nervous system such that the respiratory muscles do not respond normally.
what are the ranges of the apnea hypopnea index (AHI)?
How is it determined?
mild- 5-15 moderate 15-30 severe 30-45 extremely severe above 45. number of arousals divided by the total hours of sleep
What are the two hypersomnolence disorders mentioned?
Narcolepsy and Kleine-Levin Syndrome
what is idiopathic hypersomnia?
excessive daytime sleepiness of unknown origin.
What is Kleine-Levin Syndrome?
periodic hypersomnia characterized by recurrent episodes of prolonged sleeping or hypersomnia and other behavioral and cognitive symptoms.
What demographic does Kleine-Levin Syndrome mainly affect?
Teenage boys
What is the diagnostic criteria for KLS?
1) episodes of excessive sleepiness lasting more than two days and less than four weeks, occurring at least once a year.
2) episodes intermixed with long intervals of normal alertness, mood, cognition, and behavior lasting usually months to years.
3) episodes recurring at least every year interspersed with long periods of normal sleep
4) episodes not better explained by a sleep disorder, a neurological disorder a mental disorder or the use of drugs.
In addition to the four main diagnostic criteria, individuals should experience at least one of these…
hyperphagia, hypersexuality, odd behavior, or cognitive disturbance.
What are the characteristics of Narcolepsy?
1) excessive daytime sleepiness
2) hypnogogic hallucinations
3) “sleep attacks” or sudden paralysis following a strong emotional stimulus
4) sleep paralysis or paralysis during the transition from sleep to wake or from wake to sleep.
Narcoleptics sometimes exhibit reduced hypocretin in the cerebrospinal fluid and SOREM. why are these abnormal?
SOREM means you enter sleep through REM sleep instead of NREM first.
Hypocretin (orexin) is a neuromodulator that is a peptide manufactured in the hypothalamus. It is important for activation of the awakening circuit centered in the thalamus. These are partially destroyed in narcolepsy, and we don’t know why.
what is the difference between hypnogogic hallucinations and hypnopompic hallucinations?
hypnogogic are between wake and sleep onset.
hynopompic are between sleep and waking.
What is the treatment for narcolepsy?
modafinil or Ritalin to combat daytime sleepiness and clomipranmine and imipramine to treat cataplexy.
what is cataplexy?
When the brain is awake but the body is still paralyzed. Individuals will experience hypnopompic hallucinations and they tend to be frightening.
What are parasomnias?
disruptions in behavior or consciousness during sleep
When do parasomnias typically occur?
between sleep states
What is the most common NREM parasomnia?
Somnambulism (sleep walking)
When does somnambulism (sleep walking) typically occur?
between N3 SWS and N2 light NREM sleep
What percentage of children experience somnambulism or sleep walking?
20%
What percentage of adults occasionally sleepwalk?
4%
What does the EEG show for sleep walkers?
unstable delta activity and frequent arousals during the early part of the sleep period.
What treats somnambulism effectively?
clonazepam and alprazolam (Xanax).
Sleep sex disorder is most prevalent in…
men (80%)
many who exhibit symptoms of sleep sex disorder also show what?
sleepwalking
When do night terrors typically occur?
The same as sleep walking and sleep sex, when transitioning out of SWS.
Most cases of sleep-related binge eating are seen in…
girls or women (75%).
What is the prevalence of sleep talking?
50% in children and 4% in adults
What is “exploding head syndrome?”
the sensation of a flashbulb sound or explosion occurring inside your head.
how does the DSM-5 define Nightmare Disorder?
parasomnia involving repeated awakenings from extremely frightening dreams that do not occur in the context of some other mental disorder.
how does the ICD 10-CM define Nightmare Disorder?
a sleep disorder characterized by the repeated occurrence of frightening dreams which precipitate awakenings from sleep.
what is the prevalence of Nightmare Disorder?
4-6% of adults experience a nightmare at least once a week.
what is the prevalence of Nightmare Disorder in children?
between one half and two thirds of children experience recurring nightmares.
What therapy is being tested to help with Nightmare Disorder?
Imagery Rehearsal Therapy
What is REM behavior disorder (RBD)?
loss of the atonia normally associated with rapid eye movement sleep.
What behaviors are commonly displayed in RBD?
screaming, kicking, punching, jumping out of bed, trying to attack a foe.
isolated sleep paralysis is what?
paralysis upon “waking” involving a malevolent presence. (they are still dreaming.)
describe the significance of brain state transition failures in parasomnias.
because the mechanisms that control brains states are probabilistic, transitions between brain states can not be complete, and result in a hybrid state, creating the environment in which parasomnias thrive.
What might failures to transition from one brain state to another teach us about consciousness?
that consciousness requires participation of dorsolateral prefrontal cortex and its connections, as whenever that brain network is activated self-awareness and critical insight ensue.
What is the significance of abnormal N3 delta wave activity for NREM parasomnias?
It happens prior to arousal that accounts for the episodes viewed in individuals with parasomnias.
How does failure to transition out of REM explain sleep paralysis nightmares?
One theory is that we process fear during REM sleep. If we fail to transition fully out of REM, atonia can continue though we may be conscious, thus the amygdala can still activate as it would during REM, which is responsible for threat appraisal and fear response, leading to the experience of nightmares.
What are the major causes and consequences of insomnia?
they can be caused by sleep related issues or non-sleep related issues including other diseases or disorders, stress, illness, or anxiety. the major consequences of insomnia are daily fatigue and exhaustion that can interfere with all life activities leaving a person irritable, unhappy and vulnerable to all kinds of minor and major health complaints.