Sleep Disorders Flashcards
What is dysomnia?
Primary disorder where there is an abnormality with the quantity, timing or quality of sleep. This includes:
-> Insomnia
-> Hypersomnia
-> Narcolepsy
-> Circadian rhythm sleep disorder
What is parasomnia?
Quality and quantity of sleep is normal, however abnormalities occur during sleep which causes disruption. Parasomnias are typically secondary to medical or psychiatric disorders. This includes:
-> Night terrors
-> Sleep walking/taling
-> Sleep paralysis
-> REM sleep behaviour disorder
What is primary insomnia?
Deficiency of sleep with difficulty of initiation or maintaining sleep persisting for at least 1 month, which leads to distress and impairment of social or occupational functioning.
This is a co-morbidity with major depressive episode, mania and anxiety.
Associated with the use of antidepressants, bronchodilators and corticosteroids.
What are the characteristics of chronic insomnia disorder?
Chronic insomnia is associated with females, older adults and those with a co-morbid psychiatric condition. It is characterised by:
->Difficulty initiating/maintaining sleep
->Waking earlier than desired
->Resistance to going to bed on appropriate schedule
->Evidence of irritability, daytime sleepiness and proneness for errors.
What is short term insomnia disorder?
Meets the criteria for chronic insomnia disorder however the duration is for less than three months, induced by an identifiable trigger or precipitating from daytime stressors.
What are the NICE guidelines for the management of short-term insomnia?
-> Management of identifiable triggers
->Improving sleep hygeine
->Severe daytime impairment can necessitate a short course of hypnotic z-drug at the lowest effective dose for shortest period.
-> Information leaflets and websites
Review after 2 weeks for insomnia and referral for CBT if symptoms persist
What are the NICE guidelines for the management of chronic insomnia?
Referral to psychological services for cognitive/behavioural intervention
Promoting good sleep hygeine through reduced stimulation from caffeine, exercise and use of relaxation techniques.
Referral to a sleep clinic
Adults over 55 years old can be treated with modified release melatonin for 3 weeks.
Hypnotics can be used for severe or acute exacerbation with the lowest effective dose for the shortest time period.
What is primary hypersomnia?
Excessive daytime sleepiness which persists for over 1 months, often due to major depressive episode or dysthymia disorder.
What is obstructive sleep apnoea?
Repeated episodes of upper airway obstruction o cessation of breathing during sleep which is assoicated with reduced blood oxygen saturation.
This typically affects middle aged overweight men with excessive body fat.
In children,
How is obstructive sleep apnoea managed?
Conservative measures with weight loss and avoidance of sedative drugs and smoking/alcohol consumption. Avoidance of back sleeping.
Mechanical measures using a machine that provides continuous positive airway pressure (CPAP)
What is narcolepsy?
Type of hypersomnia where there is excessive sleepiness during wakefulness with sudden loss of muscle tone, triggered by a strong emotional response as patients sleep or awaken.
It can be treated with stimulants such as antidepressants
What is circadian rhythm sleep disorders?
Persistent or recurrent pattern of sleep disruption due to a mismatch of an individual’s sleep-wake environment with their environment.
Greater risk with evening chronotopes, adolescent age, increased exposure to bright light in the late evenings or frequent travel across time zones.
What is the management of circadian rhythm sleep disorder?
-> Darken bedroom and the use of soundproofing
-> Limit caffeine intake and hard to digest food
-> Establishing regular waking time with no napping
-> Ensure all family members learn shift pattern
-> Increased exposure to sunlight during the day
What are sleep terrors?
Type of parasomnia where there is abrupt awakening from sleep with a scream intense fear and marked autonomic arousal of tachycardia and mydriasis. There are unresponsive efforts to efforts and resistance to physical contact. The individual typically has no memory of the event.
What is the epidemiology for sleep terrors?
Typically affects children and occurs in the early evening
Evidence of genetic heritability
Precipitated by fever, sleep deprivation and depressant medication
