Sleep disorders Flashcards
What is the first stage of sleep?
Transition phase between wakefulness and sleep
What is the second stage of sleep?
True sleep onset, 50% of total sleep is spent in stage 2
Can be easily aroused
What is the second and third stage of sleep?
Collectively = slow wave (delta) or deep sleep
restorative sleep stages that occur during deepest stages of sleep
What is a primary sleep disorder?
Causes sleeplessness or excessive daytime sleepiness
Categories:
- originating within the body
- those caused by external factors
- Those in which the timing of sleep phase is abnormal (circadian sleep-wake rhythm disorders)
What is a secondary sleep disorder?
Sleep disorder associated with medical, neurological, or psychiatric disorders wherein sleep is a major factor
What is a proposed sleep disorder?
A condition in which there is a need for further evaluation before each can be convincingly viewed as a disorder in its own right
Outline the 4 circadian rhythm sleep disorders (CRSDs)
Delayed sleep phase syndrome
- delayed bedtime and wake times (sleep late, wake up late)
Advanced sleep phase syndrome
- advanced bedtime and wake times (sleep early, wake early)
Non-24-h sleep-wake cycle
- free running rhythm
Jet lag
- severity of sx depends on number of time zones travelled
What is insomnia?
Characterised by complaints of disturbed sleep even though there has been adequate opportunity to sleep
Sx = difficulty falling asleep, difficulty maintaining sleep, early wakenings
What is chronic insomnia?
Difficulty initiating or maintaining sleep for at least three nights per week with associated daytime impairment for a duration of at least three months
What is the management approach for sleep disorders?
1) modify poor sleep practices, optimise management of comorbidities and/or change the use of problematic substances or medicines
2) Behavioural and cognitive therapies for insomnia
3) Drug therapy
What are some non-drug therapies for sleep disorders?
Cognitive therapy - techniques identify and change distorted thoughts
Stimulus control - suitable for people who have difficulty falling asleep
Sleep restriction - for those with difficulty staying asleep
Relaxation training - for those who cannot wind down
What is the general rule for pharmacotherapy in sleep disorders?
Use lowest effective dose for the shortest possible time
Preferably intermittently 2-5 nights per week for less than 2 weeks
What are the classes of drugs used for sleep disorders?
Benzodiazepines
Non Benzodiazepines (Z drugs)
Antihistamines
Chloral hydrate
Melatonin
What sleep medications should be avoided in the elderly?
Esp >60 y/o - Benzos - inc sedation, unsteadiness, memory loss
Use of long acting Benzos should be avoided (diazepam, flunitrazepam, nitrazepam) - inc sedation and accumulation
What is the general rule for weaning off of long-term benzos?
Dose reduction of 10-20% over 8-12 weeks or longer
