Sleep

Question 1

DIMS

DOES

1950’s classifications of sleep disorders

Answer 1

Disorder of intiation or maintainance of sleep

Disorders of excess sleepiness

Parasomnias

Question 2

BEARS Questionaire for sleeping?

Answer 2

B - Bedtime problames
E - Excess daytime sleepiness
A - Awakening at night
R - Regularity and duration of sleep
S - Snoring and apnoea

Question 3

What changes in state exist in sleep?

Answer 3

Double upper airway resistance
Tidal volume halved in REM

Any impaired ventilation will be worse “Stress test”, except laryngomalacia - which is quieter due to less breathing

(Also reduction in BP and body temp)

Question 4

Effects sleep deprivation?

Answer 4

Damaged executive function - ala ADHD
Pro-inflammatory - e.g. TNF-alpha
Decreased hormone secretion
Obesity (consuming more calories when staying up AND fatigue to do less during day, modified ghrelin/leptin)
Mortality if <6/24 or >9/24

Question 5

Sleep Stages?

Answer 5

Awake - Eye movements and big chin tone (Big EMG Chin)
N1 Transition
N2 (Light) k complexes (Up and Down) and spindles (fuzzy caterpillar)
N3 (Deep) Big slow wave sleep, “choppy”
REM (Dream) - Eye movements Quiet EEG, Small EMG (chin lead), Paralysed muscles, airway obstruction, twitching, active, occurs during second half of the night

In Babies 50:50 Active (REM) and Quiet (N3)

Question 6

Requirement of duration of sleep

Answer 6

Adults 8-10 hours

Babies 12-16 hours

Question 7

What evidence based techniques are available for insomnia

Answer 7

After physiological exclusion (Restless legs, OSA, reflux, eczema)
Daytime limit setting
Sleep hygeine
Sleep association

• TO fix
  Controlled crying (sudden) or graduated, move chair every few days
  Or
  Fading with positive bedtime, shift bedtime 15/60 every 3 days

Question 8

Treatment for delayed sleep phase

Answer 8

Sleep Hygeine
Candle light throughout house from 1930
No stereo/texting/computer

Bright light at wake up time

Fading - 15/60 every 3 nights, in order to move ‘sleep-gates’ slowly
Melatonin as adjucant

Question 9

Regarding parasomnias

• What sorts?
• What treatments

Answer 9

Non-REM sleep, from deep to light (N3 to N2 or wake) at first “skip of REM phase” - part of sleep remains - completly back to sleep before termination.

Night Terror, can’t be comforted because still asleep, right back to sleep, nil memory.
Common, 40% of kids, 3% frequently
Can medicate with clonazepam/zopiclone

Vs.
Nightmare child is fully awake, wakes from REM - terrifying dream, hard to settle, can recall

Seizures - identical every time, stereotypical episodes, more likely to stand/pelvic, sudden offset, all stages of sleep

Sleepwalking - Occasional in 15%, frequent in 3-4%, redirect to bed, can wake early (first sleep cycle) or clonazepam

Question 10

Any treatment for restless leg syndrome/periodic limb movement

Answer 10

Partial iron deficiency
Treat to keep iron > 50 or > 75
Do ferriting first to screen for haemochromatosis first
Or melatonin for 4/24 of sleep
Don’t use anti-parkinsonism due to unwanted behaviours

Question 11

Why are we awake? do we sleep?

Answer 11

Awake due to lateral hypothalamus - orecxin, hypocretin-1 secreting neurotransmitters to remain awake
Damaged cells in narcolepsy, lack of neurotransmitter

Sleep is:
Process S - sleep pressure in hours awake
Process C - circadian rhythm - be awake when bright and active
Melatonin in response to darkness

Question 12

What is hypersomnia?

What tests can be done

What is cataplexy?

Answer 12

Different to tiredness/fatigue
Sleepiness - falling asleep in a situation where expected to be awake/alert
Constantly fighting sleep during the day

Most common cause is lack of sleep

Narcolepsy is auto-immune destruction of cells- HLA Typing

PERIODIC SLEEPINESS
Kleine-Levin syndrome
Menstrual related hypersomnia

Sleep Hx - habits/timing/duration
How long to sleep on weekend
Sleep diary/actigraphy
MSLT Multiple sleep latency test - 5x 20minute opportunities during day, REM sleep present
MWT - Maintenance of wakefulness - truck driver test, dark room not allowed to sleep

NARCOLEPSY have REM sleep
MRI if any neuro signs/symptoms

//
Treat it with <25/60 naps “Sleep inertia”
Methylphenidate or dexamphetamine, Modafinil is best but second line for funding
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Cataplexy is awake drop attacks- loss of muscle tone in response to stresses
Tricyclics, SSRI, Venlafaxine, GHB (Sodium Oxybate)