Sleep disorders Flashcards
Cataplexy
Sudden, brief loss of voluntary muscle tone triggered by strong emotions, such as laughter, surprise, or anger. Consciousness remains clear, memory is not impaired, and respiration is intact.
Narcolepsy
Narcolepsy is a disorder of unknown etiology that is characterised by the classic tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations.
Treatment of cataplexy
Tricyclic antidepressant
Narcolepsy onset
Narcolepsy most commonly begins in the second decade, with a peak incidence around 14 years of age.
Treatment of Narcolepsy
- Good sleep hygiene and ensure regular amounts of sleep
- Stimulant medications such as modafinil and pitolisant to reduce excessive daytime sleepiness.
- Sodium oxybate or pitolisant is recommended as first-line treatment for cataplexy.
Diagnosis of Narcolepsy
- Detailed clinical history
- PSG (polysomnography)
- MSLT (Multiple Sleep Latency Test) - conducted during the day following the PSG to measure how quickly the patient falls asleep in a quiet environment during the day. It assesses the presence of REM sleep, which can appear unusually quickly in narcolepsy patients.
Restless leg syndrome risk factors
Older age
Female sex
Pregnancy
Iron deficiency and anaemia
Renal failure
Hypothyroidism
Diabetes
B12 deficiency
Treatment of restless leg syndrome
Dopaminergic agents (e.g., ropinirole or pramipexole).
Iron supplements if iron deficiency is present.
Lifestyle changes and good sleep hygiene.
Describe restless leg syndrome
Restless legs syndrome is a disorder characterised by disagreeable leg sensations that usually occur prior to sleep onset and that cause an almost irresistible urge to move the legs.
The most characteristic feature is the partial or complete relief of the sensation with leg motion and the return of the symptoms upon cessation of leg movements. The sensations and associated leg movements usually interfere with sleep onset.
Which part of sleep is Sleepwalking associated with?
Sleepwalking originates from slow-wave sleep and, therefore, is most often evident during the first third of the night or during other times of increased slow-wave sleep, such as after sleep deprivation.
Sleepwalking age
Sleepwalking episodes can occur as soon as a child is able to walk, but reach a peak prevalence between ages four and eight years, and usually disappear spontaneously after adolescence.
Which psychotropic medication can exacerbate or induce sleepwalking?
Lithium
Treatment of sleepwalking
- Ensuring a safe sleep environment.
- Address underlying sleep disorders or stress.
- Scheduled awakening may be tried as an additional measure.
- Medications such as benzodiazepines (diazepam or clonazepam) in severe cases.
Sleep terror treatment
- Reassurance and ensuring safety.
- Address underlying sleep disorders or stress.
- Address sleep hygiene.
- Medications such as benzodiazepines (diazepam or clonazepam) in severe cases.
Sleep terrors
Sleep terrors are characterised by a sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic and behavioural manifestations of intense fear
What is Rhythmic movement disorder?
A group of stereotyped, repetitive movements involving large muscles, usually of the head and neck. The movements typically occur immediately prior to sleep onset and are sustained into light sleep.
Does rhythmic movement disorder indicate other significant psychopsthology?
The vast majority of affected individuals are otherwise normal infants and children. However, when it persists into older childhood or beyond, rhythmic-movement disorder of sleep may be associated with mental retardation, autism, or other significant psychopathology.
Treatment options for rhythmic movement disorder
Behavioural interventions and ensuring a safe environment.
Medications such as benzodiazepines if the movements cause significant disruption.
REM Sleep Behaviour Disorder
Characterised by repeated episodes of sleep-related vocalisation or complex motor behaviours occurring during REM sleep. These episodes often involve dream enactment.
Associated conditions with REM Sleep behaviour disorder
Rapid eye movement sleep behaviour disorder (RBD) can occur in an isolated form or secondary to other aetiologies such as neurodegenerative diseases, narcolepsy, and other disorders that impact the brainstem nuclei involved in rapid eye movement (REM) sleep. The isolated RBD often precedes the development of neurodegenerative disorders, especially the synucleinopathies, in which insoluble protein (alpha-synuclein) is deposited in brain tissue. The prototype condition in this category is Parkinson’s disease.
Treatment options for REM Sleep Behaviour Disorder
Ensuring a safe sleep environment.
Address sleep hygiene.
Clonazepam is often effective.
Melatonin supplements.
Treatment options for nightmares
- Reassurance (episodes likely to diminish over time).
- Imagery rehearsal (if recurrent themes) - discussing alternative endings to the recurrent nightmare.
- Cognitive-behavioural therapy for insomnia (CBT-I).
- For severe and refractory cases, the use of a rapid eye movement (REM)-suppressing agent, such as a tricyclic antidepressant or an SSRI, for a short period of time may be helpful.
- Good sleep hygiene.
Difference between nightmares and sleep terrors
The nightmare is almost always a long, complicated dream that becomes increasingly frightening toward the end. The long, dreamlike feature is essential in making the clinical differentiation from sleep terrors. The awakening occurs out of REM sleep.
Somnambulism (sleepwalking)
Occurs in NREM sleep and therefore not remembered upon waking. Involves complex behaviours that a person carries out while they are still asleep, such as walking, moving objects, or other routine activities that they might perform while awake.
