Sleep disorders Flashcards
Alpha rhythm is associated with ____
awake with eyes closed
vertex waves are associated with ______
NREM N1
K complex is associated with
NREM N2
Sleep spindles are associated with
NREM N2
Slow wave sleep is associated with
NREM N3
Saw tooth waves are associated with
REM
In _____ sleep, there is an increase in parasympathetic activity
NREM
In ___ sleep, there is an increase in sympathetic activity, dreaming, paralysis of skeletal muscle
REM
Differentiate between NREM parasomnias and REM parasomnias
NREM: overlap between wake and NREM sleep, behaviors are not under conscious control and not remembered upon awakening, most common in children who often “grow out of them”
REM: loss of paralysis, acting out dreams, eyes are closed, rapid alertness and recall on awakening, common in elderly men
List the differential diagnosis for a child with sleep terrors
NREM parasomnia
nocturnal panic attacks, nocturnal frontal lobe seizure, delerium, REM sleep behavior disorder
Describe the three step model for treatment of NREM parasomnias
- modify predisposing factors (avoid sleep deprivation, stress)
- improve safety of sleep environment
- pharmacotherapy (BZDs)
REM sleep behavior disorder is associated with ______ in young people
nacrolepsy
Among older men with REM sleep behavior disorder, there is an increased risk for developing ________
Parkinson’s
Describe management of REM sleep behavior disorder
- verify diagnosis with sleep study (elevated muscle tone)
- treat co-morbid sleep disorders
- remove iatorgenic causes (ex antidepressants)
- pharmacology: BZDs, melatonin, pramipexole
List major symptoms of narcolepsy
- excessive daytime sleepiness
- sleep paralysis
- hypnagogic imagery
- cataplexy
- automatic behaviors
Define cataplexy
Loss of muscle tone in response to emotional stimuli
Describe the cause of narcolepsy with cataplexy
Loss of hypocretin/orexin containing neurons in the lateral hypothalamus
Likely autoimmune
Describe treatment for narcolepsy
- avoid sleep deprivation
- scheduled naps
- stimulants to reduce daytime sleepiness
- antidepressants for cataplexy
- sodium oxybate for sleepiness and cataplexy
Restless leg syndrome is more common in (women/men), (young/elderly), and people of ________ descent
elderly women
Northern European descent
List major criteria of restless leg syndrome
URGE
U: urge to move legs, usually with other uncomfortable sensations
R: rest-induced
G: get better with movement
E: evening and night are worse; clear circadian rhythm to symptoms
What is the primary cause of restless leg syndrome?
Dysfunction of CNS iron metabolism
Describe non-pharmacologic therapy of restless leg syndrome
mental alerting activities
abstinence from nicotine, alcohol, caffeine
Iron replacement
remove medications that contribute
Describe pharmacologic therapy of restless leg syndrome
Dopamine agonist: pramipexole, ropinirole, rotigitine
calcium channel ligand: gabapentin, pregabalin
Shift work sleep disorder is considered an _____ circadian rhythm disorder
exogenous
Describe treatment for shift work sleep disorder
- increase sleep duration: sleep hygiene, hypnotic medications
- increase alertness: prophylactic naps, caffeine, wake-promoting drugs
- re-align circadian rhythm: adjust light exposure, melatonin
Delayed sleep phase syndrome is more common in ____ and advanced sleep phase syndrome is more common in ____
delayed in adolescents
advanced in elderly
90% of cases of chronic insomnia are caused by _____
comorbid conditions, not primary insomnia
List some risk factors for insomnia
older age female gender divorce/ widowhood psychiatric illness medical conditions cigarette smoking alcohol or caffeine consumption prescription drugs
List some psychological factors that contribute to insomnia
More reactive to stressors
Worries and intrusive thoughts prior to sleep
Over time may develop negative associations with bedtime/environment
Maladaptive responses may perpetuate insomnia
List common medical comorbidities seen with chronic insomnia
Cardiac, pulmonary, rheumatologic, neurologic, endocrine, gastrointestinal, renal, pain syndromes
Insomnia itself is a risk factor for incident ____
MDD
List medications linked to insomnia
Antidepressants Stimulants Steroids Decongestants Antihypertensives Caffeine Alcohol
List the 3 Ps used in the behavioral model of chronic insomnia
- predisposing
- precipitating
- perpetuating
Describe components of sleep hygiene
Avoid watching clock, stimulants, heavy meals before bedtime Keep the room dark, cool, quiet Increase daytime light exposure Practice relaxing routine Reduce time in bed
List pharmacologic approaches to insomnia
- BZDs
- melatonin agonists
- orexin antagonists (suvorexant)
- doxepin- TCA re-marketed for sleep, strong H1 affinity
List antidepressants used off label to treat insomnia and their advantages/ disadvantages
Mirtazapine, Trazodone, Nefazodone, Amitriptyline, Trimipramine
little abuse liability
some daytime sedation, weight gain, anticholinergic side effects
List anticonvulsants used off label to treat insomnia and their advantages/ disadvantages
gabapentin, pregabalin
little use liability and help with co-morbid RLS
Less effective than BZDs, cognitive impairment, daytime sedation, weight gain, edema
List antipsychotics used off label to treat insomnia and their advantages/ disadvantages
Olanzapine, Quetiapine, Risperidone, Ziprasidone
anxiolytic and help stabilize co-morbid bipolar disorder
less effective than BZDs, side effect profile, should not be used unless patient has underling psychotic disorder
