sleep disorders Flashcards
cortisol levels in insomnia
higher during early sleep hours due to HPA axis activation
cardiovascular symptoms in insomnia
higher BP and HR, especially at sleep onset
functional neuroanatomic changes in insomnia
several parts of the cortex show higher activity
EEG changes in insomnia
high frequency activity during NREM2 and NREM3
thinking/psych in insomnia
cognitive arousal and mood disturbance
epworth sleepiness scale
0-3 for likeliness of dozing in certain situations 0-9 is normal 10-14 mild 15-18 moderate 19-24 severe
adjustment (short term) insomnia is characterized by…
an acute stressor
how can adjustment insomnia become chronic?
if complicated by conditioned arousal
treatment of adjustment insomnia
- based on preventing complications
- sleep hygiene mostly
most common comorbidities with chronic insomnia
- psychiatric is the biggest
- circadian
- breathing disorders
psychiatric disorders most commonly comorbid with insomnia
MDD
anxiety disorders
personality disorders
psychosis
drug induced insomnia
- stimulants
- alcohol
- some anti-depressants
- withdrawal from sleep meds
pharm vs CBT for insomnia
- meds are good for short term relief
- CBT shows just as high effectiveness and lasts longer
- CBT+meds no better than just CBT
what should all chronic insomnia patients receive?
a course of CBT1 whenever possible
definition of narcolepsy
A disorder of sleep-wake regulation involving inappropriate manifestations of REM sleep
five primary symptoms of narcolepsy
- excessive sleepiness
- cataplexy - sudden loss of muscle tone associated with emotion
- sleep paralysis
- hypnagogic/hypnapompic hallucinations
- disturbed sleep
which symptom is virtually diagnostic of narcolepsy
cataplexy - intrusion of REM atonia into waking
HLA in 90% of narcoleptics
HLA-DQB1
narcolepsy results from……
destruction of hypocretin neurons
where are hypocretin neurons?
lateral hypothalamus
narcolepsy meds
- stimulants
- gammahydroxybuturate (GHB)
meds for cataplexy
goal is reduce onset of REM
- tricyclics
- SSRI/SNRI
what are parasomnias?
Abnormal events or behaviors which arise from sleep or sleep-wake transition
two categories of parasomnias and examples
1) nREM Disorders of arousal - Sleepwalking - Night terrors - Confusional arousals 2) REM Nightmares REM Behavior disorder Sleep paralysis
disorders of arousal occur during which stages of sleep?
3/4
who generally gets disorders of arousal?
kids 4-6
disorders of arousal meds
benzos
what is a REM behavior disorder?
Dream enactment behavior associated with loss of muscle atonia in REM sleep
- verbalizations
- walking/running
- violence
who generally has REM behavior disorder?
- elderly men
- 50% of neuropathology (parkinsons, lewy body)
