Sleep Disorders

Question 1

Sleep disorders include
Dyssominias
Parasomnias

Answer 1

Dyssominiasare disorders that cause difficulty in initiating sleep and maintaining sleep (insomnia) or excessive sleep(hypersomnia).
Parasomnias innclude unusual sleep related behaviors.

Question 2

Dyssominias include

Answer 2

Insomnia disorder
Hypersomnolence disorder
Obstructive sleep apnea hypopnoea
Central sleep apnea
Sleep related hypoventilation
Narcolepsy
Circadian rhythm sleep wake disorders

Question 3

Insomnia disorder
Symptoms that interfere with duration or quality of sleep.
Symptoms include
Initial onset sleep insomnia
Sleep maintainance sleep insomnia
Sleep offset insomnia
Non restorative sleep

Answer 3

Acute insomnia less than 3 months
Chronic insomnia more than 3 months.
Diagnosis is done by consensus sleep diary .
TTT
Sleep hygiene,CBT,chronic bright light therapy,BZD,non BZD, Antidepressants.

Question 4

Hypersomnolence disorder

Answer 4

Excessive sleep,reduced wakefulness and sleep drunkenness with non restorative sleep.
Causesviral infection,head trauma and genetics.
TTT
amphetamine like drugs e.g modafinil
Scheduled napping

Question 5

A 40-year-old businessman states that over the past 2 years he has
had trouble staying awake for more than 2 hours before eventually
falling asleep. He then has a hard time sleeping through the night. As a
result, his performance at work is suffering. Diagnosis? Many diagnosis but also include:

Answer 5

Obstructive sleep apnea hypopnoea
Chronic breathing-related disorder characterized by repetitive collapse of the
upper airway during sleep evidence by ultrasonography.
Characterized by excessive daytime sleep,sleep snoring and sleep fragmentation.
RISK FACTORS
Obesity, increased neck circumference and narrowing of airway.
TTT
CPAP,BiPAP,weight loss, exercise, surgery (tonsillectomyand airway stimulation implants)

Question 6

Central Sleep Apnea

Answer 6

Evidenced by five or more central apneas per hour of sleep. It can be idiopathic, with Cheyne–Stokes breathing (pattern of periodic crescendo–decrescendo variation in tidal volume due to heart failure, stroke, or renal failure),
or due to opioid use. It is associated with insomnia and daytime sleepiness.
TTT
CPAP,BIPAP, supplemental O2,
Acetazolamide, hypnotics and theophylline.

Question 7

Mr. Richards is a 22-year-old college student with a history of persistent depressive disorder (dysthymic disorder) who arrives at the
outpatient psychiatry clinic complaining of daytime sleepiness. He
reports that during the past 2 years, he has fallen asleep while in social
situations and during his college classes. He often takes naps during
class, in movie theaters, and sometimes in the middle of conversations
with his girlfriend. His naps typically last for 5–10 minutes and he
awakens feeling better. However, within the next 2–3 hours he feels
sleepy again. His colleagues joke about his tendency to sleep everywhere, and he feels embarrassed by this.Dx?

Answer 7

Narcolepsy
Triad of
Sleep attacks,hypnagogic hallucinations and cataplexy.
Pathophysiology loss of hypothalamic neurons that produce hypocretin.
TTT
Sleep hygiene, avoidance of shift work, scheduled daytime naps, amphetamines and SSRIs.

Question 8

Circadian rhythm sleep wake disorders include
Delayed sleep phase
Advance sleep phase
Shift work disorder
Jet lag disorder

Answer 8

Delayed sleep phase disorder
Chronic or recurrent
delay in sleep onset and
awakening times with
preserved quality and
duration of sleep
Causes:
■ Puberty
■ Caffeine and nicotine use
■ Irregular sleep schedules
Treatment
■ Timed bright light phototherapy during
early morning
■ Administration of melatonin in the evening
■ Chronotherapy (delaying bedtime by a few
hours each night)
Advanced sleep
phase disorder
Normal duration and
quality of sleep with sleep
onset and awakening times
earlier than desired
Causes Older age
TTT
■ Timed bright light phototherapy prior to
bedtime
■ Early morning melatonin not recommended
(may cause daytime sedation)
Shift-work
disorder (SWD)
Sleep deprivation
and misalignment
of the circadian
rhythm secondary to
nontraditional work hours
causes■
Night shift work
■ Rotating shifts
■ Shifts >16 hours
■ Being a medical/psychiatry resident
TTT
■ Avoid risk factors
■ Bright light phototherapy to facilitate rapid
adaptation to night shift
■ Modafinil may be helpful for patients with
severe SWD
Jet lag disorder Sleep disturbances
(insomnia, hypersomnia)
associated with travel
across multiple time zones
Recent sleep deprivation ■ Disorder is usually self-limiting.
■ Sleep disturbances generally resolve
2–3 days after travel

Question 9

Parasomnias
Abnormal sleep related behaviors
Include
Non REM sleep related disorders
Nightmare disorders
REM sleep disorders
Restless leg syndrome

Answer 9

Non REM sleep disorders
Episodes of incomplete arousals that Occur during 1st one third of sleep (include sleep walking and sleep terrors)
TTT Education,reassurance addressing precipitating factors.
Nightmare disorders
Recurrent frightening dreams that occur during the second half of the
sleep episode.
Terminate in awakening with vivid recall.
TTT
Education, reassurance, Imagery Rehearsal therapy.
REM sleep disorders
Repeated arousals during sleep associated with vocalization or complex
motor behavior (dream enacting behaviors) occurring during REM, more
often in the second half of the sleep episode.
Sleep talking.
■ Yelling.
■ Limb jerking.
■ Walking and/or running.
■ Punching and/or other violent behaviors.
Causes
Older age,
Psychiatric medications such as TCAs, SSRIs, SNRIs, and β-blockers , Narcolepsy ,Highly associated with underlying neurodegenerative disorders, especially
Parkinson’s, multiple system atrophy, and neurocognitive disorder with
Lewy bodies.
Treatment
■ Discontinuation of likely causative medications if possible.
■ Clonazepam is efficacious in most patients.
■ Melatonin may also be helpful.
■ Ensure environmental safety such as removing potentially dangerous
objects from the bedroom and sleeping on the ground until behaviors can
be managed effectively.
Restless leg syndrome
The urge to move legs accompanied by unpleasant sensation in the legs,
characterized by relief with movement, aggravation with inactivity, and only
occurring or worsening in the evening.
Causes
Increases with age.
■ Strong familial component.
■ Iron deficiency.
■ Antidepressants, antipsychotics, dopamine-blocking antiemetics, and
antihistamines can contribute to or worsen symptoms.
■ Multiple medical comorbidities, including cardiovascular disease.
TTT
Behavioral strategies including regular exercise, reduced caffeine intake,
and avoiding aggravating factors have been shown to be beneficial.
■ Responds well to pharmacologic treatments.
■ Remove offending agents if possible.
■ Iron replacement if low ferritin.
■ Dopamine agonists and benzodiazepines are first-line treatments.
■ Gabapentin, gabapentin enacarbil (prodrug to gabapentin), and pregablin
are also used.
■ Low-potency opioids can be used for treatment-refractory patients