Sleep Disorder Flashcards
Sleep
Sleep is an active, multiphase process that provides restorative functions and promotes memory consolidation.
Stages of Sleep
- Awake
- Non-Rapid Eye Movement-N1(NREM): Lightest sleep
- Non-Rapid Eye Movement-N2: Light sleep
4.Non-Rapid Eye Movement-N3: Deep sleep - Rapid-Eye Movement (REM): Time of most movement
New Cycle, beginning with N2 follows each REM stage
Dyssomnias
Disorders of initiating and maintaining sleep and disorders of excessive sleepiness
Insomnias
Inability to fall or stay asleep.
-Primary (Treatable): Related to travel across time zones or caused by acute stress
-Secondary (Caused by other conditions): Related to drugs or alcohol abuse, chronic pain, depression, obesity, aging, etc.
Insomnia Epidemiology
-33% prevalence
-Female
-Older population
-Unemployment
-Marital status (separated/widowed)
-Lower socioeconomic status
-Poor sleep hygiene
Insomnia Etiology (SLEEP GAP)
-Snoring (Respiratory issues)
-Lamenting (mood disorders)
-Endocrine (Hypothyroidism)
-Excruciating (chronic pain)
-Pregnancy
-Gastroesophageal (GERD)
-Arrythmia, Anxiety, and Abuse
-Parkinson’s (Neurologic conditions)
What are the Clinical manifestation of insomnia?
Acute or short-term and Chronic
Insomnia Pathophysiology
High level of Cortisol which is responsible of activating the arousal system.
Insomnia Diagnostic
-≥ 1 of the following symptoms:
-Difficulty initiating sleep
-Difficulty maintaining
sleep, characterized by
frequent awakenings or
problems returning to
sleep afterward.
-Early-morning
awakening with inability
to return to sleep.
-The sleep difficulty occurs at least 3 nights per week.
-Episodic
-The sleep difficulty is present for at least 3 months.
-Chronic (Persistent ≥ 3
months, Recurrent ≥ 2
episodes within a year)
Obstructive Sleep Apnea Syndrome (OSAS)
Characterized by repetitive episodes of cessation of breathing during sleep
-Followed by blood
oxygen desaturation and
brief arousal from sleep
to restart breathing
OSAS Risk Factors
-Male
-Older Population
-Large Neck circumference
-Obesity
-Afro desendientes o hispanos
-Excessive use of alcohol and sedative
OSAS Clinical Presentation
-Symptoms
-Snoring
-Sleep Interruption
-Excessive daytime
sleepiness
-Obstructive Sleep Apnea
-Central Sleep Apnea
OSAS Diagnostic
-Evidence by polysomnography of at least 5 obstructive apneas or hypopneas
-15 or more obstructive apneas and/or hypopneas per hour of sleep
Restless Leg Syndrome (RLS)
Sensorimotor disorder that is associated with unpleasant sensations usually in the calf muscle and compelling urge to move the legs for relief.
RLS Risk Factors
-Female
-Older Population
-Northern Europeans
-5-15% prevalence
RLS Clinical Presentation
-Unpleasant sensation in lower limbs
-Symptoms lead to insomnia and affect quality of life
-Aches, itching, pulling, crawling, tingling, tightness
RLS Pathophysiology
Nigrostriatal Pathway
-Deficiency of
dopaminergic activity in
the striatum and
substantia nigra
Iron Deficiency
-Low iron stores in the
striatum, thalamus, and
red nucleus
-Iron is a co-factor in
dopamine production
RLS Diagnostic
An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs.
-Three time a week for
three months
-Not attributed for SUD
or medication
Narcolepsy
Characterized by excessive daytime sleepiness with loss of muscle tone (cataplexy) and sleep paralysis.
Narcolepsy Risk Factors
-Male
-0.06% prevalence
-10% of patients have a close relative with similar symptoms
-Prevalencia en hombres y afecta a los 20 o 30 años
Narcolepsy Clinical Presentation
Narcolepsy Type 2
-EDS (Hypersomnia)
-Hallucinations
-Sleep Paralysis
Narcolepsy Type 1
-Cataplexy
-Type 1 presents all of
the symptoms of type 2
in addition to cataplexy
Narcolepsy Pathophysiology
Type 1
-Hypocretin (orexin)
deficiency
-Believed to be and
immune-mediated
destruction of
hypocretin-producing
neurons in the
hypothalamus
-A strong association
exists between
narcolepsy and HLA-
DQB1*06:02
Type 2
-Normal levels of
hypocretin
-Pathophysiology poorly
understood
Narcolepsy Diagnostic
At least 3 times/week ≥ 3 months.
One of the following:
-Cataplexy
-Hypocretin deficiency, as
measured using
cerebrospinal fluid (CSF)
hypocretin-1
immunoreactivity values
(≤ to 110 pg/mL).
Normal CSF Hypocretin-1: > 200 pg/ml
Circadian Rhythm Sleep Disorders (CRSD)
-A common disorder where a desynchronization between an individual’s biological clock and external demands on the sleep cycle occurs.
-Typically symptoms include insomnia and hypersomnia
CRSD Clinical Presentation
Shift-Work Type - Overnight workers
-Directly related to
working night shifts or
outside the conventional
9 a.m.–5 p.m. window.
Jet Lag
-Results from traveling
across multiple time
zones, causing temporary
misalignment of the
internal clock.
CRSD Severity
-Episodic: Symptoms last at least 1 month but less than 3 months.
-Persistent: Symptoms last 3 months or longer.
-Recurrent: Two or more episodes occur within the space of 1 year.
