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Psych Block 2 > Parainsomnias > Flashcards

Parainsomnias Flashcards

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1
Q

How is daytime sleepiness assessed?

A

Sleepiness vs. fatigue
Self-Report Measures
- Epworth Sleepiness Scale
Objective Measures
- Multiple Sleep Latency Test (MSLT) => 4-5 nap opportunities during 2 hours
- Maintenance of Wakefulness Test (MWT) => stay awake for 40 minutes

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2
Q

What are causes for excessive sleepiness?

A
  • Sleep quantity
  • Sleep quality
  • Substances/medication lists
  • Sleep wake schedule disorder
  • +/- Psychiatric disorder (bipolar/atypical depression)
  • Medical illness
  • Primary hypersomnolence
    • Narcolepsy/idiopathic hypersomnolence
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3
Q

Define narcolepsy.

A

Narcolepsy: A disorder of sleep-wake regulation involving inappropriate manifestations of REM sleep
- Prevalence: ~1/5000

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4
Q

What are the primary symptoms of narcolepsy?

A
  • Excessive sleepiness (restorative naps)
  • Cataplexy
    • Sudden loss of muscle tone associated with emotion
    • Manifestation / triggers
  • Sleep paralysis
  • Hypnagogic/hypnapompic hallucinations
  • Disturbed nocturnal sleep
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5
Q

What is the problem with cataplexy?

A

Inappropriate intrusion of REM atonia into waking

- makes it difficult to enter REM at night when it is appropriate

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6
Q

What is the diagnostic sign for narcolepsy?

A
  • Cataplexy

- Although sleep studies done to confirm

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7
Q

What is the average age of onset of narcolepsy?

A
  • 20-30s

- sometimes seen in teens

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8
Q

What are the complications associated with narcolepsy?

A

Occupational limitations
Social limitations
Mood disorder
Quality of life

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9
Q

What are the possible causes of narcolepsy?

A
  • HLA antigen => autoimmune phenomenon

- Human narcolepsy results from destruction of hypocretin neurons

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10
Q

How is sleepiness in narcolepsy treated?

A
  • Stimulant medication:
    • Amphetamine (dexedrine) – release of norepinephrine / dopamine / serotonin/ Methylphenidate (Ritalin) – dopamine uptake blockade
    • Modafinil (Provigil)/Armodafinil (Nuvigil) – Alpha1 adrenergic receptor agonist; hypocretin activation (?)
  • Gammahydroxybutyrate (GHB)
  • Naps
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11
Q

How is cataplexy in narcolepsy treated?

A

Cataplexy / Sleep paralysis / Hallucinations

  • REM suppressant medication: tricyclic / SSRI/SNRI
    • Noradrenergic/serotonergic activation / anti-cholinergic activity
  • GHB (gammahydroxybutyrate)- sedation
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12
Q

What are the criteria for idiopathic hyper somnolence?

A 
Chronic drowsiness
Non-restorative naps
Long / deep nocturnal sleep
Sleep drunkenness
Possible autonomic disturbance
Hypotension / migraine / Raynaud’s
Relationship to long sleep / chronic fatigue
Poor treatment response
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13
Q

Define parasomnia.

A

Abnormal events or behaviors which arise from sleep or sleep-wake transition

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14
Q

What types of disorders are non-REM/Disorders of arousal?

A

Sleepwalking
Night terrors
Confusional arousals

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15
Q

Name 3 types of REM parasomnias.

A

Nightmares
REM Behavior disorder
Sleep paralysis

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16
Q

What are other types of parasomnias?

A

Enuresis (bedwetting)
Rhythmic movement disorder
Bruxism (teeth-grinding)
Sleeptalking

17
Q

What are the characteristics of disorders of arousal?

A
  • Arise from Stage 3/4 sleep
  • Partial arousal pattern
  • Incomplete activation preceded by synchronous, high amplitude delta waves
  • First third of the night
  • Amnesia / partial recall
  • Associated mentation
18
Q

What is the average age of onset for disorders of arousal?

A

Predominantly childhood

- can persist into adulthood

19
Q

What are characteristics of sleep walking?

A

Complex automatic motor activity from deep sleep
Confusion / incoherence / lack of recognition
Wide range of behaviors
Dangerousness / forensic issues

20
Q

What are characteristics of night terrors?

A 
“Pavor nocturnus” / incubus
Sudden arousals from deep sleep
Scream / terror / confusion
Extreme autonomic arousal
Variable motor activity
   - Includes extreme agitation / escape behavior
   - Dangerousness
21
Q

How are disorders of arousal managed?

A
  • Ensure safety

- Medication: benzodiazepines

22
Q

What are characteristics of REM behavior disorder?

A 
Dream / nightmare-related
Wide range of behaviors
   - Verbalizations
   - Walking / running
   - Violent / agitated behaviors
Duration seconds to minutes
Frequency of occurrence variable
23
Q

What is the patient profile of REM behavior disorder?

A 
Predominantly male (3-10:1)
Mostly elderly
45-50% with neuropathology (i.e. dementia)
Remainder “idiopathic” 
   -medication induced
24
Q

What neuropathologies are associated with REM behavior disorder?

A

Parkinson’s disease
Dementia with Lewy bodies
Multi-system atrophy

25
Q

What are the pharmacologic treatments for REM behavior disorder?

A
  • Melatonin

- Clonezepam

Psych Block 2 (22 decks)

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