sleep

Question 1

what is non REM sleep?

Answer 1

more at start of the night
synchronised, rhythmic EEG activity
partial relaxation of the muscles
reduced cerebral blood flow

reduced HR, BP + tidal volumes
some narrative images

Question 2

REM sleep

Answer 2

most at emd of night
EEG - fast activity, fMRI - fast brain activity
similar to wakefulness
atonic muscles - except diaphragm + extraocular muscles

cerebral blood flow increases, impaired thermal regulation
narrative dreaming

Question 3

when is REM sleep mainly important?

Answer 3

early brain development - replaces wakefulness

Question 4

how long is normal circadian rhythm?

Answer 4

25hrs

Question 5

what are parasomnias?

Answer 5

undesirable disorders of behaviour or experience that occur during sleep or its stages, or during sleep-wake transitions

Question 6

presentation of non-REM parasomnias

Answer 6

non-dreaming:
- confusion arousals
- sleep walking
- sleep terrors
- paralysis

-> kids or stressed adults

Question 7

presentation of REM parasomnias

Answer 7

enactment of the experience of dreams during REM sleep
- kicking
- punching
- talking
- sitting up

-> men in 60s/70s, assoc with neurodegenerative disorders

Question 8

management of non-REM parasomnias

Answer 8

reassurance
- kids usually grow out of it before adolescence

Question 9

management of REM parasomnias

Answer 9

depends on underlying cause

• if no cause symptoms are responsive to meds

Question 10

narcolepsy

Answer 10

chronic neurological condition producing disruption to normal sleep pattern, which produces excessive sleepiness

may occur with or without cataplexy

Question 11

cataplexy

Answer 11

sudden loss of muscle tone + power in response to strong emotion

** it always and ONLY occurs as part of narcolepsy

Question 12

typical age of onset of narcolepsy

Answer 12

adolescence

Question 13

pathophysio of narcolepsy

Answer 13

caused by abnormalities of the brain neurotransmitter hypocretin (orexin)
–> which is a regulator of sleep

Question 14

clinical presentation of narcolepsy

Answer 14

daytime sleepiness
- involuntary sleep during eating/talking
cataplexy - loss of muscle tone, triggered by emotion

hypanagogic hallucinations - hallucinations occuring at sleep onset
sleep paralysis - unable to move upon falling asleep or awakening with retained consciousness

REM sleep behaviour disorder

Question 15

investigations of narcolepsy

Answer 15

overnight polysomnography
multiple sleep latency test

Question 16

management of narcolepsy

Answer 16

stop driving + inform DVLA
strategic daytime naps, regular exercise, education

drugs:
- daytime sleepiness - modafinil dexamfetamine, methylphenidate
- cataplexy - tricyclic antidepressants (clomipramine) or SSRIs

Question 17

insomnia

Answer 17

unsatisfactory sleep, either in terms of sleep onset, sleep maintenance or early waking

usually secondary to stress, substance misuse
-> can become habit, anticipates insomnia

Question 18

initial insomnia? common in which group?

Answer 18

initial insomnia = trouble going off to sleep

mania
anxiety
depressive disorders
substance misuse

Question 19

middle insomnia? common in which group?

Answer 19

waking up in the middle of the night

sleep apnoea
prostatism

Question 20

late insomnia? common in which group?

Answer 20

early morning wakening

depressive illness
malnutrition - anorexia

Question 21

management of insomnia

Answer 21

hypnotic drugs - 2 weeks max, lowest dose, avoid in elderly

manage underlying cause

30% improve with advice alone - limit caffiene, avoid napping, looking at screens