Sleep Disorders

Question 1

Why is sleep important?

Answer 1

Tissue recovery

Resting of the cerebral cortex

Question 2

What does sleep deprivation cause?

Answer 2

Impaired alertness
Irritability
Concentration lapses
Reduced ability to think or react in potentially dangerous situations

Question 3

What is non-REM sleep?

Answer 3

Most abundant type
Light and deep states
Deep state is associated with rest and recovery

Question 4

What are the characteristics of non-REM sleep?

Answer 4

Rhythmic EEG activity
Partial muscle relaxation
Non narrative dreams
Decreased HR, BP, tidal volume and cerebral perfusion

Question 5

What are the characteristics of REM sleep?

Answer 5

The state in-between non-REM sleep and wakefulness

Question 6

What are the characteristics of REM sleep?

Answer 6

Increased EEG activity
Loss of all muscle tone except in the diaphragm and extra-ocular
Narrative dreams
Increased cerebral blood flow

Question 7

What is the sleep cycle?

Answer 7

Standard sleep moves from light non-REM to deep non-REM, to light non-REM then REM sleep
Multiple cycles happen in one night

Question 8

What are non-REM parasomnias?

Answer 8

A group of non-dreaming sleep disorders

Question 9

How are sleep disorders diagnosed?

Answer 9

History and overnight sleep studies

Question 10

Who are non-REM parasomnias more common in?

Answer 10

Children and younger adults

Question 11

What are the risk factors and triggers for non-REM parasomnias?

Answer 11

Stress
Exercise
Alcohol
Emotional upset

Question 12

What are examples of non-REM parasomnias?

Answer 12

Bruxism
Confusional arousals
Somnambulism
Sleep terrors
Restless sleep
Sleep talking
Sleep sex

Question 13

What is bruxism?

Answer 13

Teeth grinding

Question 14

What are confusional arousals?

Answer 14

Confusion upon waking for seconds to minutes

Question 15

What is somnambulism?

Answer 15

Sleep walking

Patient is unaware of that they are going and wont remember it after they wake up

Question 16

What are sleep terrors?

Answer 16

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

Question 17

What are REM parasomnias?

Answer 17

Dreaming sleep disorders

Question 18

Who are REM parasomnias more common in?

Answer 18

Men over 50

Question 19

What are REM parasomnias associated with?

Answer 19

Alcohol
Parkinson’s
Lewy body dementia
Drugs such as antidepressants

Question 20

What is the most common REM parasomnia?

Answer 20

REM sleep behaviour disorder

Question 21

What is REM sleep behaviour disorder associated with?

Answer 21

Lack of atonia
Acting out dreams, with this involving motor activity, violence and vocalisation
Generally more simple behaviours than seen in non-REM disorders

Question 22

What is narcolepsy?

Answer 22

Disorder where the patient experiences uncontrollable and unresistable daytime somnolence

Question 23

Who are more likely to present with narcolepsy?

Answer 23

Peaks of onset: age 15, age 36

Question 24

What is the aetiology of narcolepsy?

Answer 24

Unknown - thought to be linked to low levels of hypocretin

Question 25

What are the clinical features of narcolepsy?

Answer 25

Daytime somnolence Cataplexy Hypnagogic hallucinations at the onset of sleep Sleep paralysis on falling or waking form sleep

Question 26

What is daytime somnolence?

Answer 26

Uncontrollable and un-resistible desire to fall asleep, at any time even while talking or eating

Question 27

What is cataplexy?

Answer 27

Complete loss of muscle tone in response to extremes of emotion such as fear or surprise

Question 28

How is narcolepsy diagnosed?

Answer 28

Overnight sleep studies Multiple sleep latency tests - will fall asleep quickly and progress quickly to REM sleep LP - low hypocretin

Question 29

What is the management for narcolepsy?

Answer 29

``` Stimulants - modafinil (reduce daytime somnolence) Sodium oxybate (reduces cataplexy and ability to sleep at night) ```

Question 30

What is insomnia?

Answer 30

Sleep disorder in which there is difficulty in being able to sleep and resultantly too little sleep Usually psychogenic in nature (anxiety, stress)

Question 31

What is the management for insomnia?

Answer 31

Treat underlying cause Promote good sleep Hypnotic drugs - zopiclone (short term only)