Sleep Disorders Flashcards
Module 2B
Short term insomnia lasts
Less than 3 months
Chronic insomnia is characterized by symptoms that occur
> 3x/week for >3 months
How many categories are there of sleep disorders?
7
What are 6 priority differentials of sleep disorders?
Medical conditions, medications, chronic pain, CHF, OSA, chronic lung disease (asthma)
CNS hypersomnies present with complaints of
Daytime sleepiness
The older patient is more likely to
Have difficulty falling asleep or staying asleep (or both)
What 2 H1 antagonists can contribute to insomnia?
Claritin and Allegra
OSA/hypopnea syndrome signs may include
Large neck size (>17in in men), enlarged tonsils, mallampati airway score of 3 or 4, low-lying soft palate (patients with HTN or cardiac disease)
A sleep log diary should be used over
1-2 weeks
What diagnostic tool is often used?
Pittsburgh Sleep Quality Index (PSQI)
What diagnostic labs should be ordered?
CBC, CMP or BMP, TSH with reflex to T4
What is the gold standard diagnostic of sleep disorders?
Polysomnography (PSG) - sleep study
Actigraphy may help document sleep patterns and circadian rhythms but is not ideal for
Insomnia
A split night study is a combination of
A full polysomnography and CPAP trial
What are 2 daytime studies?
Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT)
What drugs should be used for treatment of restless leg syndrome?
Antidepressants or dopamine agonists
Alcohol, tobacco, and exercise should be avoided for at least how long before bedtime?
4 hours
What drug is a melatonin agonist?
Ramelteon (Rozerem)
What heterocyclic antidepressant can be used as treatment?
Doxepin (Silinor)
What DEA class are medications used for treatment of sleep disorders?
DEA IV
What are 5 other drugs used for treatment?
Zolpidem (Ambien), Eszopiclone (Lunesta), Triazolam (Halcion), Temazepam (Restoril), and Suvorexant (Belsomra)
What are 4 benzodiazepines used for treatment?
Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin), and Lorazepam (Ativan)
What 6 drugs should not be used for treatment?
Trazodone, Tiagabine, Diphenhydramine, Melatonin, L-tryptophan, and Valerian
What is a common risk factor for OSA?
Obesity
What are the major impediments to successful CPAP therapy?
Comfort and acceptance
OSA can cause risk for
MVAs
OSA carries greater risk for increased morbidity/mortality than what other disorder?
Central sleep apnea
What should be ruled out when restless leg syndrome is suspected?
Peripheral neuropathy, Parkinson disease, B12 deficiency
What labs should be ordered for restless leg syndrome?
Vitamin B12, CBC, fasting serum iron level, TIBC, ferritin, transferrin saturation, CMP
What are 4 differential diagnoses for restless leg syndrome?
Arthritis, neuropathy, leg cramps, and vascular disease (claudication)
What 3 drugs are used to manage restless leg syndrome?
Carbidopa/Levodopa (Sinemet), Gabapentin (Neurontin), and Pregabalin (Lyrica)
A low dose dopamine agonist should be prescribed for
Restless leg syndrome
What drugs can be used in the treatment of sleep onset insomnia?
Triazolam, Temazepam, Ramelteon
What drugs should be used in maintenance insomnia?
Temazepam, Suvorexant, Doxepin
What drug can be used for both sleep onset and maintenance insomnia?
Temazepam
What is the most common sleep-related breathing disorder?
OSA
Diagnosis of sleep disorders should be performed with
Overnight sleep testing
What is the most common and effective treatment of OSA?
CPAP
Central sleep apnea is most common between
Young adulthood and middle age
An intrinsic CNS deficit results in
Hypersomnolence
What is a primary hypersonic that is characterized by EDS and inappropriate manifestations of REM sleep?
Narcolepsy
