Pain, fatigue and sleep Flashcards
Most common circadian rhythm issue
Delayed sleep phase cycle
Features of narcolepsy
Sudden sleep attacks (narcolepsy)
Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnogogic hallucinations
CSF finding in narcolepsy
Low hypocretin-1
Medications used for narcolepsy
Methylphenidate
Modafinil
Percentage of men with obstructive sleep apnoea
4%
Percentage of women with obstructive sleep apnoea
2.5%
Stages of sleep where sleep walking occurs
3 and 4
Time of the night where night terrors occurs
First third of the night
Time of the night where REM sleep behavioural disorder occurs
Middle to last third
First line treatment for REM sleep behavioural disorder
Clonazepam
Features of restless leg syndrome
Akathisia, usually with parasthaesia
Motor restlessness
Symptoms worsen at rest
Symptoms worsen at night
Predisposing factors for restless leg syndrome
IDA
Peripheral neuropathy
Sedative antihistamines
Antipsychotics
Caffeine
Antidepressants
First licensed drug for restless leg syndrome
Ropinirole
Disorder characterised by period episodes of repetitive and stereotyped limb movements during sleep
Periodic limb movement disorder
Disorder characterised by grinding of the teeth during sleep or while awake
Sleep bruxism
Type of insomnia usually associated with anxiety
Initial insomnia
Type of insomnia usually associated with depression
Terminal insomnia/early morning wakening
Prevalence of CFS in the UK
2.6%
Prevalence of CFS in the UK once co morbid psychological diseases are ruled out
0.5%
Male:female ratio of CFS
1:3
Typical age of onset of CFS
29-35
Typical duration of illness of CFS
3-9 years
Features of CFS that predict a poor outcome
Claiming a disability related benefit
Low sense of self control
Strong focus on physical symptoms
Being passive with reduced activity
Membership of a self help group
Percentage of people with CFS who are unable to work
33%
Evidence based treatments for CFS
CBT
Graded exercise therapy
Percentage improvement rate in CFS after CBT treatment
70%
Percentage improvement rate in CFS after graded exercise therapy treatment
55%
Percentage of patients with CFS who have concurrent depression
23%
Percentage of patients with CFS who have a lifetime history of depression
50-75%
Efficacy of antidepressants in treating CFS
Not effective unless being added to ongoing CBT
New term for pain disorder in DSM V
Somatic symptom and related disorders
Percentage of depressed adult patients who report pain
43%
Sleep disorder with a female predominance
Nightmares
Length of time symptoms need to be present for a diagnosis of CFS
6 months
Diagnostic symptoms of CFS
Brain fog
Sore throat
Tender cervical or axillary nodes
Muscle pain
Multipoint pain without joint swelling
Headaches
Unrefreshing sleep
Post-exertional malaise lasting >24 hours
Average length of time of symptoms of night terrors
5-10 minutes
Muscle tone during night terrors
Increased
Usual recall of events of night terrors
None
ICD 11 diagnosis which has replaced ‘somatoform disorders’ diagnosis in ICD 10
Bodily distress disorder
Mechanism of action of modafinil, used to treat narcolepsy
Increases synaptic dopamine which
activates hypothalamic neurons which release orexin/hypocretin
Elimination half life of modafinil
10-12 hours
Most common side effect of modafinil
Headache
Psychiatric condition associated with ‘doctor shopping’
Somatisation disorder
Most common psychiatric diagnosis in patients with CFS
Depression
Percentage of patients with restless leg syndrome who experience periodic limb movements during sleep
80-90%
Supportive criteria for restless leg syndrome
Periodic limb movements in sleep
First degree relative with RLS
Symptom improvement with dopaminergic medication
Core criteria for restless leg syndrome
Urge to move the legs
Rest worsens urge
Moving improves urge
Symptoms worse at evening or night
Other disorders excluded
Area of the brain where lesions are found in REM sleep disorder
Brainstem
First line medication for restless leg syndrome
Dopamine agonists e.g. ropinirole
Gabapentin
Pregabalin
Symptom with the highest sensitivity for obstructive sleep apnoea
Snoring
Good prognostic factors in CFS
Not attributing symptoms to a physical cause
Lower severity of initial symptoms
Regular physical activity
High sense of control
Younger age
