Sleep and Eating Disorders Flashcards
What is insomnia?
difficulty initiating or maintaining sleep or non-restorative sleep despite adequate opportunity and circumstances for sleep
What are the 3 phases of insomnia?
Transient (<1)
Acute or short-term or episodic (1-3 mo)
Chronic or persistent (>3mo)
What causes insomnia?
no single cause
What is the most common form of insomnia?
acute insomnia
What is insomnia associated with?
daytime impairment
How is insomnia diagnosed most of the time?
patient will tell you
What diagnostic test for insomnia are needed?
None
What are 3 diagnostic test that can be used for insomnia?
Polysomnography (sleep study)
Thyroid stimulating hormone
Urine toxicology
What is the txt for insomnia?
Counsel patient, practice consistent sleep hygiene
What is insomnia best treated without of?
medication
What med has no abuse and can be used for insomnia?
Ramelteon (Rozerem)- melatonin receptor agonist
What is more effective than meds for insomnia?
exercise (avoid 4 hrs prior to sleep)
What is narcolepsy?
INCURABLE rapid eye movement (REM) sleep disorder mainly characterized by excessive daytime sleepiness
What are the two types of narcolepsy?
Type 1 ( w/ cataplexy) Type 2 (w/o cataplexy)
What is the cure for narcolepsy?
NONE
Which ways can symptoms be improved for narcolepsy?
sleep hygiene, brief 15 min naps during the day, and drug therapy
What is the bimodal distribution for narcolepsy?
peak at 15 yrs
and again @ 35yrs
Which is more prevalent type 1 or type 2?
Type 1
Where is narcolepsy highest and lowest?
Highest in Japan
Lowest in Israel
What is narcolepsy associated with?
Obstructive sleep apnea
What is the classic tetrad of EDS?
cataplexy, sleep paralysis, and hypnagogic hallucinations
What are cardinal symptoms
EDS and sleep attacks
What are the 1st symptoms of EDS?
sleep attacks
What is cataplexy?
sudden episode of total or partial loss of motor tone, triggered by strong emotions
What is not impaired in cataplexy?
consciousness and memory
What two muscles are spared in cataplexy?
diaphragm and extraocular
What is sleep paralysis?
transient inability to move or speak either while failing asleep or on awakening
Occurs in 50% of people with type 1 narcolepsy?
sleep paralysis
What are hypnagogic or hypnopompic hallucinations?
vivid dreamlike experience that occur during awakening or at sleep onset
Hallucinations of being attacked by animals or feeling that someone else is in the room
hypnagogic
What test is used for narcolepsy?
Multiple sleep latency Test
If narcolepsy is suspected what should be done?
Referral to a sleep specialist
What is the treatment for narcolepsy?
proper sleep hygiene and regular sleep schedule
What should be avoided in narcolepsy?
stimulus- alcohol, heavy meals, caffeine, nicotine
Who is a 10 fold increase for driving accidents?
narcolepsy
Only medication approved effective and FDA approved for EDS and cataplexy?
Sodium oxybate (Xyrem)
Second line txt for nacroplesy?
amphetamines
What is parasomnias?
abnormal behavioral occurring in associated with sleep, sleep stages, or sleep-wake transitions
What is the most common type of parasomnia?
Non-Rapid eye movement (NREM)
What is not a global whole-brain phenomenon?
sleep and wakefulness
Sleepwalking occurs more frequently among who?
children
When does sleep walking occur during sleep?
1st third of the night
What are the two specialized forms of sleepwalking?
sleep related eating behavior and sleep related sexual behavior
What is sleep terror disorder?
repeated occurence of preciptious awakenings from sleep, usually beginning with a panicky scream or cry
What are sleep terrors also called?
night terrors or pavor nocturnus
Sleep terrors are most prevalent at what age?
18 months
What is the diagnostic study for parasomnias?
polysomnography w/ audiovisual monitoring
In order to make the diagnosis for parasomnias what must be met?
the person or household must be in distress or impairment due to it
What medication is used to treat parasomnias?
Clonazepam
Malnutrition can lead to?
multiorgan damage
Reports feeling fat even when emacitated, restriction of calories, history of fractures?
Anorexia Nervosa
What screening tool is used for eating disorders?
SCOFF or Eating Disorder Screen for Primary Care
What is considered a positive SCOFF?
two or more yes answers
What are some abnormal vital signs for anorexia nervosa?
hypothermia, bradycardia, orthostatic, hypotension
What is considered extreme BMI for anorexia nervosa?
<15
What is considered mild BMI for anorexia nervosa?
> 17
What are the 3 essential features of anorexia nervosa?
- persistent energy intake restriction
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
- disturbance in self perceived weight or shape
How should most patients with anorexia nervosa be treated?
outpatients
What is the initial txt goal for anorexia nervosa?
weight restoration
What is the treatment for anorexia nervosa?
CBT
What meds should be started low for anorexia nervosa?
SSRI
What med is associated with a higher incidence of seizures in anorexia nervosa?
Bupropion
What is bulimia nervosa?
binge eating (2hr period) along with lack of control over eating, followed by compensatory behaviors
What is time period for bulimia nervosa?
once per week for 3 months
Vomiting, binge eating, aerobic exercise, laxatives, cheilosis
Bulimia nervosa
What is the treatment for bulimia nervosa?
CBT
What medication is effective in treating bulimia nervosa?
Fluoxetine (Prozac)
What is the difference between bulimia and anorexia?
weight
What is binge eating?
eating a lot of food in a short period of time
What criteria must be met for binge eating?
occur at least once per week for 3 months
What is avoidant/restrictive food intake disorder?
avoidant of food due to its consequences
What is the difference between avoidant and anorexia?
in anorexia your concerned about body weight and shape
