Sleep disorders Flashcards
What are intrinsic sleep disorders?
Narcolepsy
psychopsychologic insomnia
idiopathic hypersomnia
restless leg syndrome
periodic limb movement disorder
OSA
What are extrinsic sleep disorders?
inadequate sleep hygiene
alcohol dependent sleep disorder
What are circadian rhythm disorders?
Jet lag syndrome
Shift work sleep disorder
Irregular sleep wake pattern
Delayed sleep phase syndrome
Advanced sleep phase disorder
What are arousal disorders?
sleep walking
sleep terrors
What are sleep wake transition disorders?
rhythmic movement disorder
sleep talking
nocturnal leg crampsW
What are parasomnias associated with REM sleep?
Nightmares
Sleep paralysis
What is sleep bruxism?
teeth grinding in sleep
How can OSA present?
Excessive sleepiness
Insomnia
Poor sleep quality
Fatigue
How is OSA diagnosed in adults?
- Frequency of obstructive events >15 per hour
- Frequency >5 per hour and a. sx attributable to disorder e.g. sleepiness
or b. nocturnal respiratory distress or observed apnoea/habitual snoring reported
c. HTN, mood disorder, cognitive dysfunction, CAD, stroke, CCF, AF, T2DM present
How is OSA diagnosed in children?
Frequency of obstructive events >1 per hour accompanied by signs and sx
What are treatment options for OSA?
CPAP
Weight loss, positional therapy, avoiding alcohol and sedatives
Surgical options e.g. uvulopalatopharyngoplasty
What are the four main features of narcolepsy?
Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypangogic/hypnapompic hallucinations
What deficiency is narcolepsy associated with?
Hypocretin
What is the treatment of cataplexy?
TCAs
Protryptiline hydrochloride
Imipramine hydrochloride
When does narcolepsy begin?
second decade
How is narcolepsy diagnosed?
PSG - polysomnography
MSLT - multiple sleep latency test
HLA-DQB1*0602 antigen
What is treatment of narcolepsy?
Good sleep hygiene and regular amounts of sleep
Stmulants - modafinil and pitolisant
Sodium oxybate or pitolisant for cataplexy
What is periodic limb movement disorder?
characterised by periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep. The movements usually occur in the legs and consist of extension of the big toe in combination with partial flexion of the ankle, knee, and sometimes hip.
What symptoms can be present in periodic limb movement disorder?
Excessive sleepiness
What are treatment options fo periodic limb movement disorder?
Dopaminergic agents - pramiprexole or ropinirole
Sleep hygiene and poss benzos
What are treatment options for restless legs syndrome?
Dopaminergic agents - pramipexole or ropinirole
Iron supplements if iron deficiency present
Lifestyle changes
What are RFs for restless legs syndrome?
older age
female
pregnancy
IDA
Renal failure
Hypothyroidism
Diabetes
B12 deficiency
WHat is required for a diagnosis of jet lag syndrome?
Jet travel of at least 2 time zones
How long does it take for jet lag syndrome to improve?
2-3 days
For jet lag syndrome, do symptoms last longer for eastward or westward flights?
eastward
What are treatment options for jet lag syndrome?
artificial light
melatonin
Short term hypnotics
What is non 24 hour sleep wake syndrome?
Chronic steady pattern comprising one to two hour daily delays in sleep onset and wake times
What is the treatment of sleep walking?
ensure safe sleep environemnt
address underlying sleep disorders
scheduled awakening
medications such as benzos in severe cases
What are sleep terrors?
sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by autonomic and behavioural manifestations of intense fear
How do sleep terrors present?
severe autonomic discharge - tachycardia, tachypnoea, flushing skin, diaphoresis, mydriasis, decreased skin resistance, increased muscle tone
What is treatment of sleep terrors?
sleep hygiene
meds - benzos
What is rhythmic movement disorder?
Stereotyped repetitive movements involving large muscles usually of the head and neck.
Movements typically occur immediately prior to sleep onset and sustained into light sleep
What is most common variant of rhythmic movement disorder?
head banging
What are treatment options for rhythmic movement disorder?
behavioural interventions
benzos
What are sleep starts?
Sudden brief contractions of the legs, sometimes arms and head occuring at sleep onset
What is treatment of sleep starts?
generally benign
reduce caffeine
What is treatment of nocturnal leg cramps?
stretching and massage
hydration and electrolyte balance
quinine
What is 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.
What is treatment of rapid eye movement sleep behaviour disorder?
ensure safe sleep environment
address sleep hygiene
clonazepam
melatonin sypplements
When do people wake from nightmares in sleep cycle?
out of REM sleep
What is treatment of nightmares?
reassurance
imagery rehearsal
CBT-I
REM
TCA
What cycle of sleep does sleep paralysis occur?
REM
What are features of sleep paralysis?
paralysis after waking up or before sleeping
hallucinations
What is treatment of sleep paralysis?
reassurance and education
sleep hygiene
anxiolytics if particularly distressing
