Sleep Disorders Flashcards
EEG awake eyes closed NREM1 NREM2 NREM3 REM
low amplitude
alpha
theta (vertex waves)
sleep spindles and K
complexes (precursors to slow waves (gen via thalamic reticular complex)
slow waves (delta: large amplitude) coordinated waves
parasomnias
undesirable physical, experiential, behavioral phenomena occur during sleep
arise when elements of specific brain states co=occur
physiology of sleep
NREM: up PS, down HR, CO, BP, EMG activity
REM: up sympathetic, paralysis, rapid eye mvmts
NREM + wake co-occur
sleepwalking/terrors, confusional arousals
REM + wake co-occur
RBD
sleep paralysis/nightmares
sleepwalking
resolves by adolescense
STRONG genetic component
sleep terrors
motor behavior w/affective discharge
up ANS activity
caution
PSG if?
co-morbid sleep d/o
dangerous parasomnia
evaluation & MGT
modify factors: avoid sleep deprivation/stress; improve safety of env; meds
BZD: clonazepam
REM parasomnias
RBD assoc w?
during REM: paralysis, dreaming, up ANS activity
RBD: loss of paralysis, act out dreams, eyes closed, unresponsive, rapid alertness on awakening, self-injury
elderly men
assoc w parkinsons!
Causes of RBD
rx?
antidepressants (serotonergics can cause loss of atonia during REM)
BZDs (clonazepam), melatonin, pramipexole
NREM parasomnias
REM parasom: RBD
common in kids, resolve spontaneously
elderly men, assoc w/parkinson’s
narcolepsy: 4 cardinal sx
excessive daytime sleepiness sleep paralysis hypnagogic/hypnopompic imagery cataplexy (highly specific for narc) and automatic behaviors
narcolepsy
tx?
onset in kids/teens/YA
w/ and w/o cataplexy
w/: loss of hypocretin/orexin neurons in lateral hypoT; autoimmune rxn
w/o: less clear
antidepressants for cataplexy
sodium oxybate: stabilize sleep
restless leg syndrome
4 cardinal sx?
more in women and elderly
N. European descent
dx made clinically
assoc w/periodic limb movements
URGE U: urge to move legs (akasthesia) R: rest-induced G: get better w/movement E: evening predominance
primary/secondary RLS causes?
tx?
primary: CNS iron metabolism dysfxn
secondary: iron def anemia, renal failure, pregnancy, med-induced (antidepressants, antiemetics, antipsychotics, antihistamines)
iron supplementation DA agonist (prami/ropinir) a2 Ca channel (pregabalin)
delayed sleep phase syndrome
advanced sleep phase syndrome
adolescents; initial insomnia and difficulty waking
think: alerting signal shifts right
elderly; early AM awakening
think: alerting signal shifts left
circadian rhythm d/o tx
regularizing sleep/wake patterns, light exposure, melatonin
vast majority type of insomnia?
co-morbid
women>men
smoking/alcohol/drugs
depression w/insomnia?
2 fold RR of developing depression if you have insomnia
most medications for insomnia focus on what factors?
perpetuating (these stick around after precipitating ones are gone)
CBT is…
just as effective as meds for insomnia
drugs for insomnia
BZDs: zolpidem melatonin agonists (ramelteon) but not good for maintenance bc short half-life
orexin antagonists (suvorexant)
doxepin for sleep maintenance
