Sleep disorders

Question 1

What conditions must be ruled out with insomnia?

Answer 1

restless leg syndrome and disordered breathing

Question 2

What do maintenance difficulties indicated?

Answer 2

intrinsic sleep disorder that requires sleep study

Question 3

What causes psychophysiologic insomnia?

Answer 3

learned sleep-preventing associations

paradoxical improvement in sleeping lab

Question 4

What causes fatal familial insomnia?

Answer 4

prion protein
autonomic dysfunction
rare neurodegenerative process

Question 5

What is the prevalence sleep apnea?

Answer 5

2-4% of population

rising due to rising obesity

Question 6

What are some clinical aspects of obstructive sleep apnea?

Answer 6

17” neck circumfrence
obesity
excessive daytime sleepiness, pseudodepression
morning headache
crowded oropharynx, nasal disorders
positionally worse, and aggravated by sedatives or alcohol
common in neuromuscular disorders
polychythemia (increased rbc) and hypothyroidism

Question 7

Define apnea vs. hypopnea

Answer 7

Apnea: absent airflow for 10 seocnds
hypopnea: reduced airflow for 10 seconds

Question 8

What are the types of apnea/hypopnea?

Answer 8

Obstructive
central
Mixed: starts central, becomes obstructive

Question 9

What is the cutoff for apnea/hypopnea index/ Respiratory disturbance index?

Answer 9

<5 (events/hour sleep)

Question 10

How is apnea/hypopnea treated?

Answer 10

conservative measures and cpap (contineous positive airway pressure), dental devices, sometimes surgery

Question 11

What are possible causes of central apnea?

Answer 11

Lateral medullary syndrome
atlantoaxial sublaxation
myotonic dystrophy
heart failure
syringobulbia

Question 12

Define restless leg syndrome

Answer 12

urge to move
begins or worsens with rest
partially/totally relived by moving
worse at night/evening

Question 13

What is the difference between restless leg syndrome and periodic limb movement disorder?

Answer 13

RLS: sensation
PLMD: manifestation 0.5-10 s, at 5-90 s intervals
90% of RLS have PLMD
50% of PLMD have RLS

Question 14

What are common causes of RLP/PLMD?

Answer 14

Central (spastisity) or peripheral (radiculopathies, and neuropathies)
pregnancy
ferritin deficiency

Question 15

How is RLS/PLMD treated

Answer 15

underlying cause ex. iron folate def
Firs line role for dopaminergic agonists an hour or two before bed
Sinemet (carba-levo dopa)
clonazepam may cause tachyphylaxis (reduced response)
opioids in some circumstances

Question 16

What is the classic tetrad for narcolepsy?

Answer 16

1- excessive daytime sleepiness
2- cataplexy (full muscle weakness while awake)
3- hypnagogic hallucinations
4- sleep paralysis

Question 17

How is narcolepsy treated?

Answer 17

strategic napping
alerting agents: modafininl, methylphenidate, other amphetamines
anticataplectic: anticholinergic agents (TCA)
SSRI
Methlphenidate
sodium oxybate/GHB

Question 18

Where is hypocretin/orexin synthesized? where does it project to?

Answer 18

Synthesized in the lateral and posterior hypothalamus
projects diffusely to anterior projecting systems important for maintaing wakefulness
explains a series of symptomatic narcolepsies