Sleep Disorders Flashcards
Why is sleep important?
Tissue recovery
Resting of the cerebral cortex
What does sleep deprivation cause?
Impaired alertness
Irritability
Concentration lapses
Reduced ability to think or react in potentially dangerous situations
What is non-REM sleep?
Most abundant type
Light and deep states
Deep state is associated with rest and recovery
What are the characteristics of non-REM sleep?
Rhythmic EEG activity
Partial muscle relaxation
Non narrative dreams
Decreased HR, BP, tidal volume and cerebral perfusion
What are the characteristics of REM sleep?
The state in-between non-REM sleep and wakefulness
What are the characteristics of REM sleep?
Increased EEG activity
Loss of all muscle tone except in the diaphragm and extra-ocular
Narrative dreams
Increased cerebral blood flow
What is the sleep cycle?
Standard sleep moves from light non-REM to deep non-REM, to light non-REM then REM sleep
Multiple cycles happen in one night
What are non-REM parasomnias?
A group of non-dreaming sleep disorders
How are sleep disorders diagnosed?
History and overnight sleep studies
Who are non-REM parasomnias more common in?
Children and younger adults
What are the risk factors and triggers for non-REM parasomnias?
Stress
Exercise
Alcohol
Emotional upset
What are examples of non-REM parasomnias?
Bruxism Confusional arousals Somnambulism Sleep terrors Restless sleep Sleep talking Sleep sex
What is bruxism?
Teeth grinding
What are confusional arousals?
Confusion upon waking for seconds to minutes
What is somnambulism?
Sleep walking
Patient is unaware of that they are going and wont remember it after they wake up
What are sleep terrors?
Usually occur within the first hours of going to sleep
Can involve paralysis, sitting up screaming or lashing out and then falling back to sleep
What are REM parasomnias?
Dreaming sleep disorders
Who are REM parasomnias more common in?
Men over 50
What are REM parasomnias associated with?
Alcohol
Parkinson’s
Lewy body dementia
Drugs such as antidepressants
What is the most common REM parasomnia?
REM sleep behaviour disorder
What is REM sleep behaviour disorder associated with?
Lack of atonia
Acting out dreams, with this involving motor activity, violence and vocalisation
Generally more simple behaviours than seen in non-REM disorders
What is narcolepsy?
Disorder where the patient experiences uncontrollable and unresistable daytime somnolence
Who are more likely to present with narcolepsy?
Peaks of onset: age 15, age 36
What is the aetiology of narcolepsy?
Unknown - thought to be linked to low levels of hypocretin
What are the clinical features of narcolepsy?
Daytime somnolence
Cataplexy
Hypnagogic hallucinations at the onset of sleep
Sleep paralysis on falling or waking form sleep
What is daytime somnolence?
Uncontrollable and un-resistible desire to fall asleep, at any time even while talking or eating
What is cataplexy?
Complete loss of muscle tone in response to extremes of emotion such as fear or surprise
How is narcolepsy diagnosed?
Overnight sleep studies
Multiple sleep latency tests - will fall asleep quickly and progress quickly to REM sleep
LP - low hypocretin
What is the management for narcolepsy?
Stimulants - modafinil (reduce daytime somnolence) Sodium oxybate (reduces cataplexy and ability to sleep at night)
What is insomnia?
Sleep disorder in which there is difficulty in being able to sleep and resultantly too little sleep
Usually psychogenic in nature (anxiety, stress)
What is the management for insomnia?
Treat underlying cause
Promote good sleep
Hypnotic drugs - zopiclone (short term only)
