Sleep 2- SG Flashcards
Central Disorders of Hypersomnolence
- Be sure to evaluate for ____ prior to dx
Sleep Deprivation
Which condition?
- Loss of hypothalamic neurons that produce orexin neuropeptides (hypocretins)
- May have autoimmune component
Central DIsorders of Hypersomnolence
Narcolepsy
People w/ narcolepsy have what 3 issues/
- Difficulty sustaining wakefulness
- Poor regulation of REM sleep (immediately enter REM sleep)
- Disturbed nocturnal sleep
Which type of narcolepsy?
- w/ cataplexy
- w/o cataplexy
- w/ : type 1
- w/o : type 2
Definition:
Sudden muscle weakness w/o LOC, usually triggered by strong emotions
Cataplexy
2 alternative presentations of narcolepsy besides with or without cataplexy
- Hypnagogic hallucinations (dream like hallucinations at sleep onset or upon awakening - hypnopompic)
- Sleep paralysis - muscle paralysis upon awakening or just before falling asleep
Narcolepsy
- Excessive daytime sleepiness (usually severe)
- Feel ____ upon awakening
- Have episodes of _____
- Epworth sleepiness scale score is typically > __
- Besides excessive daytime sleepiness, also associated w/ what 4 things?
- rested
- “sleep attacks”
- 15
- Fragmented sleep
- other sleep disorders
- psych comorbidities
- obesity
Dx of Narcolepsy
- Start w/ _____
- _____ to r/o other causes
- REM sleep within ___ mins of sleep onset at night
- H&P
- Polysomnogram
- 15 mins
Which test for narcolepsy?
- Sleep latency <8 mins
- REM episodes in at least 2 of the naps
Multiple Sleep Latency Test
Pts w/ Narcolepsy should avoid what 4 things?
- Benzos
- Opiates
- Antipsychotics
- Alcohol
(BOAA)
Pts w/ narcolepsy should get adequate sleep at night, along w/ what type of naps?
1 to 2 well timed 20 minute naps
Screen narcolepsy pts for what 3 things?
- depression
- anxiety
- CV risk
1st line pharm tx for narcolepsy?
- Wake promoting medication: Modafinil
Which drug for narcolepsy?
- CNS stimulant
- Potent wakefulness promoting drug
Methylphenidate
Which drug for narcolepsy?
- CNS stimulant
- MOST potent wakefulness promoting drug
Amphetamines
Which 2 medications should be prescribed for cataplexy?
- Antidepressants (increase noradrenergic / serotonergic tone)
- Sodium oxybate (CNS depressant)
What 3 medications are used in Narcolepsy which suppress REM sleep and Cataplexy?
- Venlafaxine
- Fluoxetine
- Tricyclics
Which condition?
- Chronic / recurrent pattern of sleep wake rhythm disruption caused by an alteration in endogenous circadian timing system & desired/required sleep wake schedule
- Sxs duration of at least 3 months
- “shift work disorder”
- Jet lag disorder
Circadian rhythm sleep-wake disorders
Which condition?
- Fragmented sleep
- Difficulty falling asleep
- Difficulty staying asleep
- Poor sleep quality
- Reduced sleep duration
Circadian Rhythm Sleep Wake Disorders
(shift work disorder)
2 types of therapies for Circadian Rhythm Sleep-Wake Disorders (shift work disorder)
- CBT
- Therapeutics such as: short acting hypnotic agent, exogenous melatonin, caffeine, wake promoting agents
Circadian rhythm sleep wake disorder (shift work disorder)
Prognosis
- RIsk of ____
- Negative impact on ___ resulting in what 4 things?
- ___ concerns
- insomnia
- work ->
- absenteeism
- reduced productivity
- increased injuries
- increased illnesses
- Safety
Which condition?
- Undesirable physical events (movements/behaviors)
- Undesirable experiences (emotions, perceptions, dreams)
- More common in _____
Parasomnias
- Children
4 NREM related disorders of arousal w/ Parasomnias?
- Confusional arousal
- Sleepwalking
- Sleep terrors
- Sleep-related eating disorder
(TWEC)
REM related Parasomnias involve intrusion of the features of REM sleep into wakefulness
- 3 disorders of this?
- What is NOT a parasomnia, but is mistaken as such?
- Sleep paralysis
- Exaggerated features of REM sleep (nightmare disorder)
- Aberrations of REM sleep physiology (lack of atonia) atonia = muscles completely relaxed during REM
- Sleep talking (NOT a parasomnia)
Which condition?
- Dysfunction in orchestration of neural pathways regulating wake, NREM, and REM –> leads to state dissociation
NREM related Parasomnias
NREM related parasomnias usually occur during which stage?
N3 in the first 1/3 of major sleep period
Criteria for what disorder?
- Recurrent episodes of incomplete awakening
- Absent / inappropriate responsiveness
- Limited or no cognition or dream report
- Partial or complete amnesia for event
NREM related parasomnias
Dx of NREM related parasomnias is made by what 2 things?
- History
- PSG (if comorbid sleep disorder is suspected) -Polysomnography
Precipitating factors of what?
- Sleep deprivation
- Emotional stress
- Fever, menses, environmental / internal stimuli
- Comorbid sleep disorders (OSA, periodic limb movement)
- Medications / substances
NREM related parasomnias
Which condition?
- Sudden arousal from sleep associated w/ sitting up in bed, intense fear, piercing scream
- Intense autonomic activation (tachycardia, tachypnea, diaphoresis, facial flushing, mydriasis)
- Appear frightened / confused / inconsolable
- Difficult to arouse
- Usually no recollection of events
- Lasts ____ mins
- Calmly, quietyly return to sleep (do not interfere / try to wake pt)
Sleep Terrors
(NREM related Parasomnia)
Which condition?
- Slow quiet ambulation w/ eye open
- Possible activities: such as what?
- How does the episode end?
- Appears confused
- _____ when aroused
- Self injury common or not common?
Sleep Walking (NREM parasomnia)
- preparing food, eating, cleaning, rearranging furniture, driving, inappropriate behavior (urinating in closet)
- Terminates spontaneously
- agitated/aggressive when aroused
- Self injury is NOT uncommon
Which condition?
- Variant of sleepwalking
- Involuntary eating associated w/ diminished LOC during an arousal from sleep
- NOT linked o daytime eating disturbances
Sleep related eating disorder (NREM parasomnias)
How do you manage a pt w/ NREM parasomnias?
- Avoid sleep deprivation
- Avoid ETOH
Avoid certain meds - Maintain consistent, regular sleep-wake cycles
- Safety interventions
- Bystanders should allow pt to move freely
- Bystanders should ensure safety w/o yelling, screaming, or arousing pt (gently coax pt back to bed)
- Anticipatory awakening (wake pt before sleep terror bc you shouldn’t wake pt during)
