Sleep 2: Others Flashcards
How to treat nocturnal leg cramps?
- Stretch
- Heat
- Rx
What are the Rx for nocturnal leg cramps?
- Vitamin B complex
- Diltiazem
- Gabapentin
- Quinine - effective but considering side effects
What defines RLS?
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
Again, what are the associated symptoms of RLS
- Parethesais/Dysesthesia
- Motor restlessness
- Vague discomfort
- Sx relieve by movement
Managment for RLS
- Sleep hygiene
- avoid EtOH/caffeine/nicotine
- rubs, hot bath
- Rx
What are the Rx for RLS?
- Trial of Fe
- Dopamine agonist: 1st line
- daily sx: gabapentin
- intermittent sx: carbidopa-levodopa
Which drugs to avoid for RLS?
- SSRI
- TCAs
- Lithium
- Dopamine antagonist
Again, which substance to avoid for RLS?
- EtOH, Caffeine, and Nicotine
What defines periodic limb movement disorder?
- insomnia or excessive sleepiness
- repetitive/highly stereotyped limb muscle movements
- occurs during non-REM
- a/w arousal or awakenings sleep
What does polysomnographic monitoring show for periodic limb movement disorder?
> 15 episodes of muscle contraction per hour
What’s the Rx for PLMD?
Same as RLS
What’s the Rx for PLMD?
- Trial of Iron
- 1st line: Dopamine agonist
- daily sx: gabapentin
- intermittent sx: carbidopa-levodopa
What are examples of dopamine agonist?
Requip (Ropinirole) and Mirapex (Pramipexole)
What are examples of dopamine antagonist?
- Atypical AP: paliperidone, clozapine, risperidone, olanzapine, quetiapine, and ziprasidone
- Antiemetics: metoclopramide, droperidol, domperidone
- TCAs: amoxapine, clomipramine, trimipramine
- Even melatonin: suppress dopamine activity
Which 2 drugs are FDA approved for treating RLS?
Requip (Ropinirole) and Mirapex (Pramipexole)
- both are dopamine agonist
What are REM sleep behavior disorder?
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)
Again, what are the sx of REM sleep behavior disorder?
- loss of atonia
- nightmares
- sleep paralysis
Patients with REM sleep behavior disorder are at increasing risk for?
- Parkinson’s disease
- MSA
- Lewy body dementia
Rx for REM sleep behavior disorder?
Clonazapam, Melatonin
Classification of Sleep Disorder
- 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
T or F: Insomnia include both difficulty initiating sleep and maintaining sleep
T
Hypersomnea of central origin
Narcolepsy
Parasomnia
Disorder of arousal, partial arousal, sleep stage transition
