Sleep Disorders Flashcards
Risk factors sleep apnea
- obesity (esp around neck): nonobese pts can also have osa
- structural abnormalties: enlarged tonsils, uvula, soft palate; nasal polyps; hypertrophy of muscles in pharynx; deviated septum; deep overbite w small chin
- fam hx
- alcohol and sedatives worsen
- hypothyroidism (multifactorial)
Obstructive sleep apnea (OSA)
- intermittent obstruction of airflow (typically level of oropharynx) produces periods of apnea during sleep
- each apneic period usually 20-30s long (may be longer) –> hypoxia, which arouses pt fr sleep; occurs many times/night
Clinical feataures obstructive sleep apnea
- snoring
- daytime sleepiness
- personality changes, decreased intellectual function or libido
- repeated oxygen desaturation and hypoxemia can –> systemic and pulmonary htn + cardiac arrhythmias
- other: morning headaches, polycythemia
Dx obsturctive sleep apnea
polysomnography (overnight sleep study in sleep lab) confirms dx
Treatment obstructive sleep apnea
- mild to moderate osa (20 apneic episodes w arterial oxygen desaturation)
- nasal continuous positive airway pressure: provides positive pressure –> prevent occlusion of upper pharynx; preferred for majoirty of pts bc noninvasive and efficacious; but noisy and a bit uncomfortable
- uvulopalatopharyngoplasty: remove redundant tissue in oropharynx to allow more air flow
- tracheostomy is last resort if all else failed or life threatening osa (severe hypoxemia or arrythmias)
Complications of obstructive sleep apnea
- increased pulmonary vascular resistance (due to hypoxemia); over time can –> pulmonary htn and eventually cor pulmonale (more likely if pt obese)
- systemic htn (due to increase in sympathetic tone)
Narcolepsy
inherited disorder, variable penetrance of REM sleep regulation;
REM sleep involuntarily occurs at random and inappropriate times
–> excessive sleepiness during the day
characterized by:
- involuntary “sleep attacks” any time of day during any activity that lasts several minutes
- cataplexy: loss of muscle tone generally occurring w intense emotional stimulus (laughter, anger)
- sleep paralysis (pt cant move when waking up)
- hypnagogic hallucinations (vivid hallucinations visual or auditory “dreams” while awake)
can range from mild to severe;
automobile accidents a major problem
Treatment of narcolepsy
methylphenidate (ritalin): planned naps during day may prevent sleep attacks
Questions to ask patient with insomnia
sleep hx, timing of insomnia, sleep habits
Acute Insomnia causes
- acute or transient insomnia usually due to psychological stress, travel over time zones “jet lag”
Causes of secondary Chronic insomnia
- secondary insomnia accounts for >90% of cases
- psychiatric conditions: depression, anxiety disorders, PTSD, manic phase of bipolar disorder, schizophrenia, obsessive compulsive disorder
- meds and substance abuse: alcohol, sedatives (w prolonged use, pts develop tolerance and withdrawal rebound insomnia), caffeine, beta blockers, stimulant drugs (amphetamines), decongestants, some SSRIs, nicotine
- medical problems: advanced COPD, renal failure, CHF , chronic pain
- other: fibromyalgia, chronic fatigue syndrome
Causes of primary chronic insomnia
dx of exclusion; either of the following (beware, this is based on DSM IV):
- difficulty initiating or maintaining sleep
- nonrestorative sleep that lasts for at least 1 month in absence of other medical, psychiatric, or other sleep disorders and causes clinically sig distress and social or occupational impairments
Treatment of insomnia
treat underlying cause if found!
consider psych eval if psych causes or primary insomnia suspected
use sedative-hypnotic meds sparingly and w caution for sx relief; smallest dose possible, avoid using for longer than 2-3 wks
