psych sleep disorders Flashcards
how long is a cycle of sleep?
approx every 90 min, NREM sleep alernates with REM sleep;
progression through NREM
results in slower brain wave patterns and hgiher arousal thresholds
REM sleep brain wave pattern
resembles the EEG of an aroused person
vivid dream recall
assoc with awakening from REM sleep
dysomnias
insufficient, excessive, or altered timing of sleep
parasomnias
unusual sleep-related behaviors
primary insomnia
difficulty initiaing sleep (sleep onset insomnia), freq nocturnal awakenings (middle of the night or sleep maintenance insomnia)early morning awakenings (late night or sleep offset insomnia); waking up feeling fatigued (nonrestorative sleep)
acute insomnia
between 1 and 4 weeks; usually assoc with stress and resolves spontaneously
chronic insomnia
more than 4 weeks; assoc with reduced quality of life and increased risk of psych illness
dsm criteria for dyssomnias
difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 mo
treatment for dyssomnias
sleep hygiene measures; CBT; benzos, non-benzo sedatives, antidepressants
benzos used for dyssomnias
reduce sleep latency and nocturnal awakening; side effects incl development of tolerance, addiction, daytime sleepiness, and rebound insomnia
non-benzos used for dyssomnias
zolpidem (ambien), eszopiclone (Lunesta), and zaleplon (sonata); effective for short-term treatment; assoc with low incidence of daytime sleepiness or orthostatic hypotension
zolpidem in the elderly
increased risk of falls and may induce cognitive impairment
antidepressants used for dyssomnias
trazadone, amitrytpiline, and doxepin (off-label use)
most prescribed sedating antidepressant for patients with chronic insomnia and depressive sx
trazadone
morning headaches
can be a sign of OSA
narcolepsy tetrad
excessive daytime sleepiness or seep attacks plus REM-related sleep phenomena incl inability to move during transition from sleep to wake, hypnagogic or hypnopompic hallucinations; or a sudden loss of muscle tone evoked by strong emotion
cataplexy
sudden loss of muscle tone evoked by strong emotion without loss of consciousness
cataplexy occurs in what percent of people dx with narcalepsy
60-80 percent
treatment for narcolepsy
daytime naps; get at least 8 hrs of sleep; pharm treatment may incl stimulants and antidepressants
modafinil
stimulant effective in the treatment of narcolepsy
sodium oxybate
treats narcolepsy, and is particularly effective in the treatment of cataplexy
narcolepsy features
irresistible attacks of refreshing sleep that occur daily for at least 3 mos; cataplexy; hallucinations and/or sleep paralysis at the beginning or end of sleep episodes
pathophy of narcolepsy
loss of hypothalamic neurons that contain hypocretin; may have autoimmune component
treatment for narcolepsy
sleep hygiene; scheduled daytime naps; avoidance of shift work; amphetamines, other stimulants
treatments for cataplexy
sodium oxybate (drug of choice); TCAs; SSRIs, SSNRIs
idiopathic hypersomnia
excessive daytime sleepiness, prolonged nocturnal sleep episodes, and freq irresistible urges to nap; can be mild or as debilitating as narcolepsy
Kleine-Levin syndrome
rare disorder characterized by recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hypersexuality, and aggression
Circadian rhythm sleep disorders
caused by either intrinsic defects in the circadian pacemaker or imapired entrainment (absence of light)
subtypes of circadian rhythm sleep disorder
delayed sleep phase disorder, shift-work disorder, and jet lage disorder
parasomnias
abnormal behaviors or experiences that occur during sleep and are often assoc with sleep disruption; sx may include abnormal emotions, movements, dreams, and autonomic activity; common in childhood and adolescence
sleepwalking
simple to complex behaviors that are initiated in slow wave sleep and result in walking during sleep
what dose a sleepwalker look like?
eyes are open with a glassy look; difficulty arousing the sleepwalker during an episode; confusion on awakening, amnesia for episode; episodes usually end with patients returning to bed or awakening confused or disoriented
sleepwalking occurs more often in kids with wha?
obstructive sleep apnea
risk factors for sleep walking
sleep deprivation, irreg sleep schedules, stress, hyperthyroidism, OSA, seizures, migraines, meds, magnesium def
which meds can increase risk of sleep walking
sedatives/hypnotics, lithium, and anticholinergics
treatment for sleep walking
refractory cases may respond to clonazepam or other benzos or TCA
sleep terrors
episodes of sudden arousal with screaming from slow wave sleep; sympathetic hyperactivation; after episode, patient returns to sleep without awakening; usually amnestic about episode;
slow wave sleep
stages 3 and 4 on nonREM
risk factors for sleep terrors
fever, nocturnal asthma, GERD, sleep deprivation, CNS-stimulating medications; other sleep disorder such as sleep apnea
treatment for night terrors
reassurance that the condition is benign and self-limited; consider low dose short acting benzos in adults with refractory cases; sleep hygeine and psychotherapy
nightmare disorder
recurrent frightening dreams that tend to terminate in awakening with vivid recall; no confusion or disorientation upon awakening; can lead to signif stress and anxiety
treatment for nightmare diosorder
imagery rehearsal therapy (IRT) involves the use of mental imagery to modify the outcome of a recurrent nightmare; sever cases may benefit from antidepressants
REM sleep behavior disorder
muscle atonia during REM slep and complex motor activity assoc with dream mentation (dream enactment); presenting complaint is usually violent behaviors during sleep
risk factors for REM sleep behavior disorder
older age (between 60 and 70); psych meds like TCAs, SSRIs, and MAOIs; narcolepsy; brain stem lesions; dementis like olivopontocerbellar atrophy and diffuse lewy body disease
treatment for REM sleep behavior disorder
clonazepam is effective in most patients; other agents incl imipramine, carbamazepine, pramipexole, or levodopa
first line therapy from chronic insomnia
CBT
the best reason to put a patient on longterm benzos
insomnia
REM sleep autonomic
increae in bp, hr, and resp rate; this is counterintutive
hypnagogic hallucination
when transitioning to sleep
hypnopompic hallucination
when transitioning FROM sleep
what part of the brain coordinates the 24 hour or circadian rhythmicity
SCN in the hypothalamus
best treatment forrecurrent nightmares in PTSD
imagery rehearsal therapy
