Sleep Disorders Flashcards
Insomnia Types
Acute - stress or travel, self-resolves
Chronic - does not self-resolve
Causes of chronic insomnia
Mood disorders (depression most common) Anxiety disorders Psychotic disorders Substance use (including some antidepressants and cholesterols meds) Medical cause (GERD, dysuria, TBI, CVA, pain) Obstructive apnea Restless leg Nightmare disorders Result of acute insomnia patterns
Psychophysiologic Insomnia
a conditioned arousal in response to efforts to sleep and negative expectations regarding the ability to sleep. Individuals with PPI may be able to sleep better when they are not trying to fall asleep or in settings other than their own bedroom. Symptoms may include difficulty getting to sleep as well as trouble returning to sleep after awakening.
Diagnosis of Insomnia
Sleep history
Have patient take a sleep log
Description of sleep hygiene habits
Morning symptoms like headache, EDS, napping patterns
Polysomnograhy in a overnight sleep lab is not used often
Insomnia treatment
CBT
Sleep hygiene training
Melatonin may not be useful
Zolpidem and Zaleplon may be useful for short use
Obstructive Sleep Apnea
OSA is characterized by repetitive episodes of complete upper airway occlusions (known as apneas) or partial upper airway occlusions (known as hypopneas) during sleep. These partial or complete airway closures lead to increased efforts to breathe, finally terminating in a brief central nervous system (CNS) arousal from sleep to reestablish patency of the upper airway
Central Sleep Apnea
with CSA, the primary derangement is altered CNS respiratory drive, such that the patient does not receive the usual metabolic feedback to the CNS during sleep to drive the breathing in its normal pattern. This leads to repetitive cycles characterized by cessation of airflow because of lack of respiratory effort, which terminates once the metabolic trigger to breathe
OSA Presentation
History of snoring and daytime sleepiness / fatigue
May not know they have snoring or episodes of waking
Partner input on their sleep pattern
OSA / CSA Diagnosis
Risk factors - obesity, crowded oropharynx present with history suggestive of OSA
Rule out other causes of fatigue (cardiac, anemia)
Overnight sleep testing in a sleep lap is required for full diagnosis
OSA Management
Weight loss
CPAP (most effective)
Mouth inserts to keep airway open
CSA Management
CPAP may help
Taper medications that may cause it
Cardiovascular causes treatment
Hypersomnia
Narcolepsy
Idiopathic hypersomnia
post-tramatic hypersomnia
Hypersomnia presentation
EDS
Cataplexy (narcolepsy)
Reduced hypocretin
EDS Treatment
Stimulants - dextroamphetamine and methylphenidate
Waking agents - Modafinil
Educate not to drive, etc.
Sleep-related movement disorders
Sleep-related movement disorders are conditions in which patients have simple stereotyped movements or other sleep-related monophasic movements that disturb or prevent sleep. Sleep-related leg cramps, sleep-related rhythmic movement disorder, PLMD, and sleep-related bruxism are disorders that fall into this category.
