Sleep 2: Others

Question 1

How to treat nocturnal leg cramps?

Answer 1

• Stretch
• Heat
• Rx

Question 2

What are the Rx for nocturnal leg cramps?

Answer 2

• Vitamin B complex
• Diltiazem
• Gabapentin
• Quinine - effective but considering side effects

Question 3

What defines RLS?

Answer 3

Compelling urge to move the limbs, usually associated with paresthesias/dysesthesias, motor restlessness, vague discomfort usually in calves, symptoms occur while awake but worse at night and at rest, symptoms relieve by movement

Question 4

Again, what are the associated symptoms of RLS

Answer 4

• Parethesais/Dysesthesia
• Motor restlessness
• Vague discomfort
• Sx relieve by movement

Question 5

Managment for RLS

Answer 5

• Sleep hygiene
• avoid EtOH/caffeine/nicotine
• rubs, hot bath
• Rx

Question 6

What are the Rx for RLS?

Answer 6

• Trial of Fe
• Dopamine agonist: 1st line
• daily sx: gabapentin
• intermittent sx: carbidopa-levodopa

Question 7

Which drugs to avoid for RLS?

Answer 7

• SSRI
• TCAs
• Lithium
• Dopamine antagonist

Question 8

Again, which substance to avoid for RLS?

Answer 8

• EtOH, Caffeine, and Nicotine

Question 9

What defines periodic limb movement disorder?

Answer 9

• insomnia or excessive sleepiness
• repetitive/highly stereotyped limb muscle movements
• occurs during non-REM
• a/w arousal or awakenings sleep

Question 10

What does polysomnographic monitoring show for periodic limb movement disorder?

Answer 10

> 15 episodes of muscle contraction per hour

Question 11

What’s the Rx for PLMD?

Answer 11

Same as RLS

Question 12

What’s the Rx for PLMD?

Answer 12

• Trial of Iron
• 1st line: Dopamine agonist
• daily sx: gabapentin
• intermittent sx: carbidopa-levodopa

Question 13

What are examples of dopamine agonist?

Answer 13

Requip (Ropinirole) and Mirapex (Pramipexole)

Question 14

What are examples of dopamine antagonist?

Answer 14

• Atypical AP: paliperidone, clozapine, risperidone, olanzapine, quetiapine, and ziprasidone
• Antiemetics: metoclopramide, droperidol, domperidone
• TCAs: amoxapine, clomipramine, trimipramine
• Even melatonin: suppress dopamine activity

Question 15

Which 2 drugs are FDA approved for treating RLS?

Answer 15

Requip (Ropinirole) and Mirapex (Pramipexole)

- both are dopamine agonist

Question 16

What are REM sleep behavior disorder?

Answer 16

Loss of atonia during REM sleep (twitches to acting out dreams), exaggeration of features of REM sleep (nightmares), intrusion of aspect of REM into wakefulness (sleep paralysis)

Question 17

Again, what are the sx of REM sleep behavior disorder?

Answer 17

• loss of atonia
• nightmares
• sleep paralysis

Question 18

Patients with REM sleep behavior disorder are at increasing risk for?

Answer 18

• Parkinson’s disease
• MSA
• Lewy body dementia

Question 19

Rx for REM sleep behavior disorder?

Answer 19

Clonazapam, Melatonin

Question 20

Classification of Sleep Disorder

Answer 20

• Circadian rhythm, e.g. jet lag
• Insomnia - difficulty initiating or maintaining sleep or poor quality
• Parasomnia - disorder of arousal, partial arousal, sle tage transition
• hypersomnea of central origin = narcolepsy
• Sleep-related breathing disorders: sleep apnea
• Sleep-related movement disorders: restless legs, periodic limb movement

Question 21

T or F: Insomnia include both difficulty initiating sleep and maintaining sleep

Answer 21

T

Question 22

Hypersomnea of central origin

Answer 22

Narcolepsy

Question 23

Parasomnia

Answer 23

Disorder of arousal, partial arousal, sleep stage transition