Sept 24 - Sleep and Human Sexuality Flashcards
List some common chief complaints associated with sleep disorders
Feeling tired, unable to fall asleep, waking during the night, irritability
What are some important questions to ask when obtaining an HPI for a suspected sleep disorder?
Problems falling or staying asleep? How many hours of sleep per night? Are you waking to use the bathroom? Any nightmares? Is pain causing you to not be able to sleep? Timing of caffeine use? Use of electronics in bed or close to bedtime? Do you nap during the day? What medications do you take?
What medication, when taken at the wrong time, can cause sleep disturbance?
Wellbutrin - should be taken in the AM. If taken too close to bedtime, can affect sleep.
Describe some physical exam findings consistent with sleep disorders.
Obesity, blindness, edema/orthopnea, large neck circ (men > 17”, women > 15”), enlarged tonsils, high and arched hard palate, allergies, stroke
What is required to diagnose insomnia disorder?
At least 2 of following 3 nights/week for 3+ months - difficulty falling asleep, difficulty staying asleep, awakening early and not able to fall back asleep
What is required to diagnose hypersomnolence disorder?
Sleepiness after 7+ hours of sleep for 3 nights/week for 3+ months and one of - recurrent periods of sleeping w/in same day, 9+ hours of sleep that is nonrestorative, difficulty achieving full awakeness
What is required to diagnose narcolepsy?
Recurrent need for sleep 3 x per week for 3+ months plus one of - episodes fo cataplexy, hypocretin deficiency, REM sleep latency < 15 minutes
Define cataplexy.
sudden, brief loss of muscle tone
List some potential sequelae to sleep apnea.
asthma, a-fib, behavioral disorders, learning disabilities, CA, CVD, gestational DM
What is required to diagnose obstructive sleep apnea?
- 15+ apneas or hypopneas per hour –OR–
2. 5+ apneas/hypopneas per hour and nocturnal breathing disturbances or daytime sleepiness
What is required to diagnose central sleep apnea?
5+ central sleep apneas per hour
Define sleep related hypoventilation.
dec respiration with inc CO2
Describe circadian rhythm sleep-wake disorders.
Mismatch of circadian system with the sleep-wake cycle causing excessive sleepiness and/or insomnia
List 5 types of circadian rhythm sleep-wake disorders.
- Delayed sleep phase type
- Advanced sleep phase type
- Irregular sleep-wake type
- Non 24 hour sleep-wake type
- Shift work type
Describe Non-REM sleep arousal disorders.
Incomplete awakening plus sleep walking or sleep terrors with little dream recall and episode amnesia.
Describe nightmare disorder.
Extended, dysphoric, well remembered dreams that involve threats to survival, security, or physical integrity. Pt becomes A&O quickly after wakening.
Describe REM sleep behavior disorder.
Arousal during sleep with speech and/or complex motor activity that occurs during REM. Pt A&O quickly after awakening.
Which 2 components of REM Sleep Behavior Disorder may be present (1 required for Dx)?
- REM sleep w/o atonia (paralysis)
2. REM sleep behavior + synucleinopathy (proteins in neurons)
Describe restless leg syndrome.
Urge to move legs 3+ nights/week for 3+ months
What diagnostic tool is most useful in sleep disorders?
Sleep studies
List 5 non-pharmacological treatments for sleep disorders.
- CBT-I –> control (-) thoughts that prevent sleep
- Sleep hygiene and sleep education
- Relaxation therapy
- Exercise
- Tai Chi
List and describe 7 pharmacotherapy options to treat sleep disorders.
Benzos (temazepam)
Non benzo C drugs (Eszopiclone, Zaleplon, Zolpidem)
Melatonin
Mirtazapine: weight gain is a side effect
Trazodone: low dose = sleep, high dose = depression
Hydroxyzine: also used for anxiety and allergies
Prazosin: reduces nightmares, causes dec BP
What is the caution when prescribing trazadone?
Can cause serotonin syndrome when prescribed with SSRIs - especially zoloft
What is the caution when prescribing prazosin?
Potentiates effects of phosphodiesterase inhibitors
Differentiate a nightmare from a sleep terror.
Nightmare: Pt is startled fully awake and usually occurs late in sleep.
Terror: Pt not fully awake and usually occurs early in sleep
Describe four aspects of the onset of sexual dysfunction that can help make the diagnosis.
Lifelong dysfunction
Acquired - onset follows period of healthy sex
Generalized - occurs regardless of stimulation, situation, and partners
Situational - occurs only with certain stimulation, situation, and partners
What is typically the general root cause of a sexual dysfunction disorder?
Psychological rather than physical or medical
What are some important items to note in the HPI for a sexual dysfunction disorder?
Partner, relationship (strong or weak), vulnerability (body image), anxiety/depression, outside stressors (job loss, death in family), cultural/religious attitudes toward sex, medical causes
What are some potential medical causes of sexual dysfunction disorder? (8 items)
Disruption of nerve supply to genitals, MS, diabetic or alcoholic neuropathy, smoking, obesity, HTN, dyslipidemia
What frequency is most commonly required to diagnose a sexualy dysfunction disorder?
75%+ of sexual encounters for 6+ months
Describe delayed ejaculation and erectile dysfunction.
delayed: ejaculation takes longer than expected
erectile: difficulty achieving/maintaining erection
Describe female orgasmic disorder.
Delay, infrequency, or absence of orgasm
Describe female sexual interest/arousal disorder.
3 of 6 S/S: dec interest in sex, dec thoughts/fantasies, dec initiation, dec excitement/pleasure during sex, dec arousal in response to cues, dec genital or non-genital sensations during encounters.
What is a common cause of female sexual interest/arousal disorder?
Previous rape or sexual assault
Describe genito-pelvic pain/penetration disorder.
1 of 3 S/S: marked pain during penetration, marked fear/anxiety of penetration related to pain, marked tensing of pelvic floor muscles during penetration
Describe male hypoactive sexual desire disorder.
Dec thoughts, fantasies, or desire for sex
Define premature ejaculation.
Ejaculation within one minute of penetration
What class of medications is known to cause delayed ejaculation and also is a frontline treatment for premature ejaculation? What other class of meds are also known to cause sexual dysfunction?
Anti-depressants, especially SSRIs (Zoloft)
Anti-hypertensives also cause sexual dysfunction
What must be true of a disorder for it to be defined as substance or medication induced?
- Symptoms not present before med started
2. Symptoms do not persist > 1 month after med stopped
List three goals in the treatment of males with sexual dysfunction disorder.
- achieve and maintain erection
- treatment of premature ejaculation
- psychotherapy
List three goals in the treatment of females with sexual dysfunction disorder.
- vaginal lubricants
- reduction of stress
- quality time with partner
- improve body image
- psychotherapy –> couples therapy and sex therapy
- pelvic physical therapy
