sleep disorders Flashcards
1
Q
normal sleep-wake cycle
A
- NREM/REM alternate every 90 min
- NREM: transition from waking state to deep sleep
- progression through NREM: slower brain wave patterns, higher arousal thresholds
2
Q
dyssomnia
A
insufficient, excessive, or altered timing of sleep
3
Q
parasomnia
A
unusual sleep-related behavior
4
Q
primary insomnia: dx
A
- difficulty initiating or maintaining sleep (or nonrestorative sleep) for 1+ MONTH
- clinically signif distress or impairment
- not exclusively in course of other sleep do
- not exclusively in course of other psych do
- not due to substance or GMC
5
Q
acute insomnia
A
- b/w 1-4 weeks in duration
- usually assoc with stress or changes in sleep schedule
- usually resolves spontaneously
6
Q
primary insomnia: epidem and etiology
A
- prev 5-10%
- subclinical mood/anxiety do
- preoccupation with perceived inability to sleep
- poor sleep hygiene
- idiopathic
7
Q
primary insomnia: tx
A
- sleep hygiene
- CBT (first line!)
- BZOs (short term efficacy only)
- zolpidem, eszopiclone, zaleplon (short term efficacy) - zolpidem causes increased risk of falls and cog impairment in elderly
- TRAZODONE, amitriptyline, doxepin (SEs: sedation, dizziness, psychomotor impairment)
8
Q
OSA: features
A
- excessive daytime sleepiness
- apneic episodes
- sleep fragmentation
- loud stertor
- frequent awakenings from gasping/choking
- nonrefreshing sleep
- morning headaches
9
Q
narcolepsy: features
A
- irresistible attacks of REFRESHING sleep
- occur DAILY for AT LEAST 3 MONTHS
- cataplex
- hallucinations and/or sleep paralysis at beginning/end of sleep episodes (hypnagogic - at beginning, hypnopompic - at end)
10
Q
narcolepsy: pathophys
A
- loss of hypothalamic neurons that contain hypocretin
- may have autoimmune component
11
Q
narcolepsy: tx
A
- sleep hygiene
- scheduled daytime naps
- avoidance of shift work
- daytime sleepiness: ampehtamines, methylphenidate, modafinil, sodium oxybate
- cataplexy: SODIUM OXYBATE (1st line), TCAs, SSRI/SNRI
12
Q
idiopathic hypersomnia
A
- excessive daytime sleepiness
- prolonged nocturnal sleep episodes
- frequent irresistible urges to nap
13
Q
Kleine-Levin syndrome
A
- recurrent hypersomnia with episodes of daytime sleepiness
- hyperphagia
- hypersexuality
- aggression
14
Q
delayed sleep phase do
A
- chronic/recurrent delay in sleep onset and awakening times; preserved quality and duration of sleep
- risk factors: puberty, caffeine/nicotine use, irregular sleep schedules
- tx: morning phototherapy, evening melatonin, chronotherapy
15
Q
advanced sleep phase disorder
A
- normal duration and quality of sleep with ONSET and AWAKENING times earlier than desired
- risk factors: older age
- tx: phototherapy, NO MORNING MELATONIN
16
Q
shit work disorder
A
- sleep deprivation and misalignment of the circadian rhythm 2/2 nontrad work hours
- risk factors: night shift, rotating shift, shifts >16h, being a medical/psych resident
- tx: avoid risk factors, phototherapy, modafinil if severe
17
Q
jet lag disorder
A
- sleep disturbances assoc with travel across multiple time zones
- risks: recent sleep dep
- tx: self-limiting, usually resolve after 2-3 days of travel
18
Q
sleepwalking: features
A
- simple to complex behaviors initiated during short wave sleep
- sitting up in bed, eating, going outdoors
- eyes are usually open, “glassy”
- difficulty arousing sleepwalker during episode
- confusion on awakening, amnesia for episode
- rare: violent behavior, esp with forced awakening
19
Q
sleepwalking: epidem
A
- 1-4% of adults
- 10-20% of children/adol
- more often in children with OSA
20
Q
sleepwalking: risk factors
A
- sleep dep
- irreg sleep sched
- stress
- hyperthyroidism
- OSA
- sz
- migraines
- sedatives/hypnotics, lithium, anitcholinergics
- Mg deficiency
21
Q
sleepwalking: tx
A
- address precipitating factors
- refractory cases: clonazepam, other BZOs, TCAs
22
Q
sleep terrors: features
A
- episodes of sudden arousal with screaming from slow-wave sleep
- sympathetic hyperactivation
- afterward, return to sleep without awakening
- usually amnesic about episode
- confused and disoriented upon forced awakening
- rare: awakening elicits aggressive behavior
23
Q
sleep terrors: epidem
A
- 1-6% of children, 1-2% of adults
- prev higher in 1st degree relatives
- high comorbidity with sleepwalking
24
Q
sleep terrors: risk factors
A
- fever
- nocturnal asthma
- GERD
- sleep dep
- CNS-stimulating mx
- other sleep disorder
25
Q
sleep terrors: tx
A
- reassurance (benign, self-limited)
- low-dose short-acting BZOs if refractory?
- sleep hygience, psychotherapy
26
Q
nightmare do: features
A
- recurrent frightening dreams that terminate in awakening with vivid recall
- no confusion or disorientation upon awakening
- can cause signif distress, anxiety
27
Q
nightmare do: epidem
A
- 5% of adults, women > men
- at least 50% of PTSD
28
Q
nightmare do: tx
A
- imagery rehearsal therapy
- severe: antidepressants?
29
Q
REM sleep behavior do: features
A
- muscle atonia during REM sleep and complex motor activity with dream mentation
- dream-enacting behaviors
- presenting complaint: violent behaviors during sleep –> injury to patient or bed partner
30
Q
REM sleep behavior do: epidem
A
- 0.5% prev
- men > women
31
Q
REM sleep behavior do: risk factors
A
- older age
- psych mx (TCAs, SSRIs, MAOIs)
- narcolepsy
- brain stem lesions
- dementias
32
Q
REM sleep behavior do: Tx
A
- clonazepam: works in 90%
- imipramine, carbamazepine, pramipexole, levodopa
- environmental safety
