NB12-4 - Sleep Wake Disorders Flashcards
List the sleep-wake disorders (SWDs) we need to know.
- Insomnia disorder
- Hypersomnolence Disorder
- Breathing-Related Sleep Disorders
- Obstructive Sleep Apnea
- Central Sleep Apnea
- Narcolepsy
- Circadian Rhythm Sleep-Wake Disorder
- Parasomnias
What are the most commonly used diagnostic tools for diagnosing SWDs
- An interview
- Having them fill out an epworth sleepiness scale
- Polysomnography (PSG)
What are the diagnostic criteria for Insomnia Disorder? What is its etiology?
Difficulty initiating or maintaining sleep for at least 3 months
Insomnia is a learned arousal response to bedtime and other cues associated with the sleep environment
What is the treatment plan for insomnia disorder?
- First, work on sleep hygiene:
- Use bed only for sleep. Only get in bed when tired and, if not asleep in 10 min, depart bed. If you awaken early, get out of bed until tired
- Maintain constant sleep schedule
- Avoid caffeine after noon
- Exercise, but more than 2 hrs before going to bed
- Take hot bath within 2 hrs of bedtime
- Sedatives, but usually only if really needed and only for short term use
List the types of sedatives used to treat Insomnia. Include side effects and contraindications.
- Benzodiazepines (diazepam) are effective at inducing sleep and increasing sleep duration but are only recommended to be used for 2-4 wks due to long term side effects:
- Decreased N3 and REM sleep time (poor quality sleep)
- Tolerance and withdrawl symptoms
- Benzodiazepine-like drugs (zolpidem) aren’t as effective but have fewer side effects
What are the diagnostic criteria for hypersomnolence disorder? What is its etiology and how is it treated?
Excessive sleepiness despite sufficient sleep, and a normal PSG, for at least 3 months. Etiology unknown
Treated with stimulants like moafinil/provigil to promote wakefulness
What are the diagnostic criteria for narcolepsy?
- Recurrent irresistible sleep occurring within the same day, several times per week for at least 3 months
AND
- At least one of the following:
- Cataplexy - sudden loss of muscle tone while awake, typically precipitated by emotion. Considered to be an aberrant manifestation of REM sleep while awake.
- Hypocretin (orexin) deficiency in CSF
- Nocturnal PSG shows short REM-sleep latency (sleep-onset REM)
- Daytime PSG (multiple sleep latency test) shows short REM-sleep latency and short sleep-onset latency
What is the treatment plan for narcolepsy?
- Polytherapy
- Stimulants for somnolence (modanifil)
- Antidepressants for cataplexy
- Monotherapy
- Xyrem (GHB) which will treat cataplexy and somnolence but is only available through a restricted distribution system
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What is and what causes obstructive sleep apnea hypoapnea (OSAH)? What population is most susceptible to this? Why is this detrimental to sleep?
OSAH is multiple episodes of breathing cessation/reduction occurring during sleep due to an upper airway obstruction, usually from soft tissue in the back of the throat collapsing during sleep. The population most affected is middle-age, overweight males who snore loudly and intermittently.
During apnea, plasma [CO2] rises and causes temporary arousal from sleep which bumps the person from N3/4 or REM into N2, causing unrefreshing sleep.
What are the treatment options for OSAH?
- Continuous positive airway pressure (CPAP)
- Weight loss
- Avoid black sleeping
- Orthodontic devices
- Surgery
What is and what causes central sleep apneia (CSA)? How can a CSA be distinguished from OSAH? How is CSA treated?
CSA is multiple episodes of apnea per night caused by CNS dysregulation of breathing. CSA can be caused by opioid overuse but generally the cause is unknown. During a PSG, thoracic movements are observed to distinguish between CSA and OSAH. There will be no movements with CSA until the apnea is broken.
Treatment varies depending upon the cause but usually some kind of respiratory stimulant is used
What is and what causes circadian rhythm sleep-wake disorder (CRSWD)? How is it treated?
CRSWD is excessive sleepiness or insomnia resulting from a mismatch between a person’t circadian sleep-wake pattern and the sleep-wake schedule required by the environment.
Treatment usually involves phototherapy at strategic times during the day to adjust the circadian rhythm.
List the parasomnias we need to know and what they all have in common.
- Non-REM Sleep Arousal Disorder
- Nightmare Disorder
- REM Sleep Behavior Disorder
- Restless Leg Syndrome
- Periodic Limb Movements
All involve some type of abnormal behavior associated with sleep
What is the diagnostic criteria for non-REM sleep arousal disorder (N-RSAD)?
Repeated episodes of incomplete awakening from sleep with either of the following:
- Sleep Walking (somnambulism)
- Sleep Terrors - abrupt terror arousals (usually with a panicky scream), autonomic arousal, and unresponsiveness to comforting by others
Usually occurs in children, during the first third of sleep (SWS), and there is usually no memory of the episodes. Typically kids will grow out of this but if treatment is needed, benzodiazepines are used to decrease SWS
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