Mehl. sleep disorders 03-14 (1) Flashcards
Narcolepsy. definition?
Chronic sleep disorder affecting the brain’s ability to regulate sleep-wake cycles normally.
Chronic sleep disorder affecting the brain’s ability to regulate sleep-wake cycles normally.?
Narcolepsy.
Narcolepsy. CP?
Characterized by excessive daytime sleepiness, sudden episodes of muscle weakness (cataplexy), sleep paralysis, and hallucinations. The latter tend to occur prior to sleep (hypnagogic) or upon waking up (hypnopompic).
Narcolepsy. what neurotrasmitter responsible?
Thought to be due to deficiency of a neurotransmitter called orexin (aka hypocretin), which normally promotes wakefulness.
Narcolepsy. Tx?
Treatment is modafinil (dopamine reuptake inhibitor + promotes release of orexin from hypothalamus).
Sleep apnea. types? 2
Can be obstructive (i.e., usually from obesity) or central (i.e., brain- related).
Sleep apnea. mechanism?
Chronic fatigue and poor oxygenation can lead to dysthymia / depression.
Sleep apnea. The answer on NBME is “mood disorder due to a medical condition.”
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Sleep apnea. how to Dx?
Polysomnography (sleep study) is what USMLE wants to diagnose.
Sleep apnea.
When obstructive sleep apnea progresses to the point that the patient is a chronic CO2 retainer with pulmonary hypertension and/or cor pulmonale, we call it obesity hypoventilation syndrome (Pickwickian syndrome). If you’re confused about the cardio, go to the HY Cardio PDF.
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Restless leg syndrome. definition?
Idiopathic, irresistible urge to move legs while in bed/sleeping.
Restless leg syndrome. MCC?
Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.
Restless leg syndrome. if suspect, first thing to do?
Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.
Restless leg syndrome. if iron normal –> how to Tx?
If iron studies are normal, gabapentin and D2 agonists (ropinirole, pramipexole) can be used.
Restless leg syndrome. incr risk for what disease?
USMLE wants you to know that patients with RLS have increased risk of developing Parkinson disease, which makes sense since D2 agonists help, indicating a potential problem with dopamine signaling or production in some patients.
Peds. Circadian rhythm sleep-wake disorder. definition?
Misalignment between the individual’s sleep pattern and the societal norm or natural environment.
Misalignment between the individual’s sleep pattern and the societal norm or natural environment.?
Peds. Circadian rhythm sleep-wake disorder.
Peds. Circadian rhythm sleep-wake disorder.
Common types include delayed sleep phase disorder (going to bed / waking up later than desired), advanced sleep phase disorder (going to bed / waking up earlier than desired), and shift work disorder (struggle with sleep due to abnormal work hours).
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Peds. Somnambulism. definition?
Sleep walking.
Peds. Somnambulism. occurs during what stage?
Occurs during Stage 3 (deep) sleep.
Peds. Nightmare disorder. during what sleep phase?
Occurs during REM sleep.
Peds. Nightmare disorder. Cp?
Dreams often involve threats to survival or self-esteem, leading to awakenings and distress.
Dreams often involve threats to survival or self-esteem, leading to awakenings and distress.?
Peds. Nightmare disorder.
Peds. Nightmare disorder. why episodes can be remembered?
Episodes can be remembered by the patient after awakening since they occur during REM sleep.
Peds. Sleep terror disorder. mistaken for what? in what sex?
Often mistaken for nightmares; more common in male children and abates by pre-adolescence
Peds. Sleep terror disorder. in what sleep stage?
Occur in Stage 3 (delta wave) sleep.
Peds. Sleep terror disorder.
CP?
Episodes where the patient somnambulates and can wake up at different location, often in a panic; can demonstrate violent behavior, such as pulling on the mother’s arm to go outside, followed by awakening from the episode with no memory of what happened.
Peds. Sleep terror disorder. vs nightmare disorder.?
This is in contrast to nightmare disorder, where the patient remembers a dream + cannot somnambulate due to muscle paralysis during REM.
Peds. Insomnia. definition?
Inability to obtain adequate sleep, either due to difficulty falling asleep, staying asleep, or waking up too early, leading to impaired daytime functioning.
Inability to obtain adequate sleep, either due to difficulty falling asleep, staying asleep, or waking up too early, leading to impaired daytime functioning. Dx?
Peds. Insomnia.
Peds. Insomnia. usme want what Tx?
USMLE wants benzo (usually clonazepam) for acute insomnia.
Peds. Insomnia. terminal insomnia can occur in ….?
Terminal insomnia can occur in depression (waking up too early).
