Sleep disorders Flashcards
insomnia
difficulty initiating sleep, maintaining sleep or early morning awakenings occur at least three times per week for a minimum duration of at least 3 months
-freq triggered by stress and resolves when the stress resolves
causes of insomnia
- med conditions (pain, thyroid abnormalities, asthma, GERD)
- meds (SSRIs, steroids, stimulants, diuretics, b-agonists)
narcolepsy
less prevalent than insomnia
-onset: in childhood and adolescens
restless legs syndrome (RLS)
5-15% w/ 2.5% needing medical tx
-increases w/ age and various med conditions such as end-stage renal disease, pregnancy, and iron deficiency
-more common in W than M
-genetic
obstructive sleep apnea (OSA)
-common in M (4:1 ratio to W)
-link to obesity
parasomnias
sleep talking, bruxism (teeth grinding), sleepwalking, sleep terrors, and enuresis occur more frequently in childhood than in adulthood
neurotransmitters controling NREM sleep
serotonin
neurotransmitters controling REM sleep
cholinergic and adrenergic transmitters
neurotransmitters playing a role in wakefulness
dopamine, norepinephrine, hypocretin, substance P, and histamine
RLS patho
reduced serum ferritin levels and dopamine
OSA associated with
hypertension, arrhythmias, heart failure, stroke, and ischemic heart disease
PSG
overnight polysomnography or sleep study
-gold standard for dx and identifying sleep-disordered breathing, parasomnias, and nocturnal sleep irregularities r/t narcolepsy
first-line therapy for insomnia
non-pharmacological: cognitive-behavioral therapy for insomnia (CBT-I); sleep hygiene, behavioral, cognitive, and stimulus-control interventions
second-line intervention
pharmacologic tx
intermediate-acting NBRAs: eszopiclone or zolpidem
or
benzodiazepine: temazepam
patients w/ sleep onset difficulty
zaleplon (limit to 30 days), ramelteon (6mo), or triazolam (6mo)
patients difficulty maintaining sleep
doxepin or suvorexant
BZD carry a black box warning regarding concomitant use with
opioids (greater level of sedation, respiratory depression, coma, and death)
ramelteon
a melatonin receptor agonist; for difficulty w/ sleep onset
suvorexant and lemborexant
oxerin receptor antagonist: 1st meds to turn off wakefulness mechanism instead of stimulating pathways that induce sleepiness
for difficulty initiating and maitaning sleep, like BZD and NBRA classified as Schedule IV controlled substances
OTC agents
first-generation antihistamines: diphenhydramine and doxylamine
-produce undesirable anticholingeric effets and carryover sedation esp in elderly
-limit to 10 days
sleep latency
time it takes for person to fall asleep after turning the lights out
RLS tx
dopamine agonists (DAs) levodopa-carbidopa (longer half-lives to cover overnight symptoms)
-check iron levels and replete if nec
-switch to gabapentin (ropinirole, pramipexole,(1st line) and rotigotine)
gabapentin dose
600mg taken w/ food at dinnertime
clonazepam
reduces the amt of sleep time spent in stage 3 of NREM sleep when most NREM parasomnias occur
0.5-2mg at bedtime or melatonin 3-12 mg at bedrime