Sleep Disorders Flashcards
What is wakefulness controlled by?
Reticular activating system
inhibition of RAS results in sleep
What is required to get good sleep?
At least 90 minutes of Stage IV sleep
4 main categories of patient sleep complaints
- Hypersomnia (excessive daytime sleepiness)
- Insomnia
- Disorders of circadian rhythm
- Parasomnias (unusual behaviors a/w sleep)
Treatment of insomnia
- Sleep hygiene (only sleep and sex a/w bed)
- Go to bed same time every day
- Melatonin
What is considered a sleep disturbance?
More than 5 wake ups a night
Describe circadian rhythm disorders
Normal sleep once pt is asleep, but sleep does not come at socially acceptable times
(jet lag, shift work)
Describe parasomnias
Unpleasant or undesirable behavior patterns a/w sleep
e.g. narcolepsy
Define narcolepsy
Sudden onset of REM sleep (NOT the time it takes to fall asleep)
Diagnostic test for narcolepsy
- Hypocretin receptor 2 gene deficiency
- Prehypocretin gene deficiency
Treatment of narcolepsy
- Amphetamine for hypersomnia
- Imipramine for cataplexy
- SSRIs (suppress REM sleep mildly)
- Daytime naps
When should a patient be considered for narcolepsy?
If patient has:
- Daytime sleepiness
- Cataplexy
- Sleep paralysis
- Hypnagogic/pompic hallucinations
Treatment of sleep apnea
- Avoid ETOH before sleep
- Lose weight
- Sleep on side (tennis ball on back)
- CPAP
- Surgery
Stages of sleep
I-IV (progressively deeper)
Describe REM
- Rapid eye movement
- Sleep with dreaming
After first 4 hours of sleep, how is sleep divided?
- Between stage II and REM
- REM stages get more frequent and longer as final 4 hours of sleep occurs
Describe insomnia
- Inability to fall or remain asleep
- Deterioration in quality of sleep NOT necessarily volume of sleep
Types of insomnia
- Primary (stress, anxiety)
- Secondary (lifestyle issues, active psych disorders, chronic/acute pain, drug abuse)
Describe sleep hygiene
Only sleep and sex should be a/w bed - remove TV, reading, computer, phones, etc.
How are OTC sleep aids used in insomnia?
- Usually of little benefit
- Include ETOH and benadryl
Define cataplexy
Sleep onset triggered by emotional outbursts, laughing, sexual arousal, anger, etc.
How to diagnose narcolepsy
Multiple sleep latency test (wake up patient 3 times after full sleep and see how fast they fall back into REM)
Pathophys of sleep apnea
- Originally thought to be mechanical (soft tissue “collapse)
- Now, neurons cause dysfunction of pharyngeal motor neuron activity resulting in decreased airway patency
