Sleep Disorders Flashcards
Two major stages of sleep
REM and Non- REM
Every 90 minutes Non-REM alternates with REM
NREM initiates transition from waking state to deep sleep
In REM EEG looks like that of an aroused person
Dsysomnia
Insufficient, excessive or altered timing of sleep
Parasominia
Unusual sleep related behavior
Primary Insomnia
Number of symptoms that interfere with duration and or quality of sleep despite adequate opportunity for sleep.
Difficulty initiating sleep
Frequent nocturnal awakenings
Early morning awakenings
Acute insomnia: between 1-4 weeks
Chronic Insomnia: Lasts greater than one month.
Tx: Better sleep hygiene, CBT, Benzos, Hyponotics (zolpidem, zaleplon.. not foot for elderly), Antidepressants (Trazadone, Amitryptiline and doxepin)
Obstructive Sleep Apnea
Repetitive collapse of the upper airway usually associated with reduction in blood oxygen saturation
Excessive daytime sleepiness Apnea characterized by cessation of breathing Loud snoring Frequent awakenings due to choking Non-refreshing sleep Morning headaches.
Risk factors include obesity and increased neck circumference
Tx: CPAP and BiPAP, weight loss and exercise , surgery.
Narcolepsy
Excessive daytime sleepiness and falling asleep at inappropriate times
Irressistable attacks of refreshing sleep that occurs daily for at least 3 months.
Cataplexy (brief episodes of sudden bilateral muscle tone loss often associated with INTENSE EMOTION).
Hallucinations and or sleep paralysis at the beginning or end of sleep episodes.
loss of hypothalamic neurons that contain hypocretin
Treatment: Sleep Hygiene. Avoid shift work. AMPHETAMINES (for daytime sleepiness) Sodium Oxybate (for cataplexy)
Kleine Levin Syndrome
Recurrent hypersomnia with episodes of day time sleepiness with hyperphagia, hypersexuality and aggression
Sleepwalking
Simple/Complex behaviors that are initiated during slow wave sleep and result in walking during sleep
Sleep Terrors
Sudden arousal with screaming during a low wave sleep
Sympathetic Hyperactivation (Tachycardia, Tachypnea, Diaphoresis and increased muscle tone.)
Typically amnesic about the episode.
Tx: Reassurance. Low dose short acting benzos to those with refractory cases.
Nightmare Disorder
Recurrent Frightening Dreams that tend to terminate in awakening with vivid recall
No confusion or disorientation upon awakening
Can lead to significant distress and anxiety
Tx: Imagery Rehearsal Therapy
Severe cases can be given anti-depressants
REM Sleep Behavior Disorder
Muscle Atonia during REM sleep and complex motor activity associated with dream mentation.
Sleep talking Yelling Limb Jerking Walking and or Running Punching and or other violent behaviors
Tx: Clonazepam is efficacious in 90% of patients.
