Sleep Disorders Flashcards
what are 3 criteria for sleep
- difficulty initiating and/or maintaining sleep. waking too early
- sleep difficulty persists even with adequate opportunity
- daytime complaints
what defines acute insomnia
less than 3 months duration
related to identifiable stressor
what are 5 inadequate sleep hygiene
- Irregular sleep schedule
- use of sleep disturbing substance before bedtime
- mentally or physically stimulating activities before bed
- Frequent use of bed or bedroom activities unrelated to sleep
- uncomfortable sleep envirnment
what is psychophysiological insomnia
learned sleep-preventing insomnia
- racing thoughts, anxiety
idiopathic insomnia when does it begin
infancy or early childhood
what might idiopathic insomnia be related to
ADHD
Paradoxical insomnia
normal EEG
overestimate time to fall asleep
underestimate total sleep time
what are some medical conditions assoicated with insomina
pulmonary
heart
depression, anxiety
caffeine
what happens to prevalence of insomnia with age
increases
what gender gets insomnia more
women
what is a clinical feature of insomnia
difficulty falling asleep greater than 30 min
staying sleep for less than 6 hours
on three or more nights per week
-DAYTIME SLEEPINESS
what are 2 situations in which they are not insomnia
short duration sleep ( no daytime complaints)
Sleep deprivation
obstructive sleep apnea
recurrent episodes of upper airway collapse during sleep
-associated with recurrent oxyhemoglobin desaturations
clinical features of obstructive sleep apnea
daytime sleepiness
sensation of choking
snoring
physical exam findings for obstructive sleep apnea
narrow airway
large neck
elevated blood pressure
treatment for obstructive sleep apnea
positive airway pressure therapy
how does doctor diagnose obstructive sleep apnea
polysomnography
asymptomatic: greater than 15 apneas
symptomatic: less than 15 apneas
EEG moniters
sleep stages
EOG electrooculography monitros
horizontal and vertical eye movements
onset of REM
EMG electromyogrpahy monitors
atonia during REM
limb movements
effort during respiratory events
Polysomnography monitors what
airflow
others: ecg, pulse oximetry
what are risk factors for central sleep apnea
age greater 65 men heart failure stroke long-acting opioid use
clinical findings for central sleep apnea
daytime sleepiness
how do you diagnose central sleep apnea
polysomnography
treatment for central sleep apnea
positive airway pressure
treat underlying disorder
Narcolepsy
disorder of sleep-wake control
etiology of narcolespry
loss of orexin A and B signaling from hypothalamus
genetic factors
role of Orexin A and B
stabilize wakefulness
prevent inappropriate transitions to REM or NREM sleep
what genetic factor is present in patients with Narcolepsy
DQB1 0602 haplotype
clinical feature of narcolepsy
daytime sleepiness: fall asleep throughout day with little warning
sleep paralysis: occur without falling asleep
cataplexy ( strong emotion/laughter)
hallucinations: occurs while falling asleep
when do narcolepsy patients enter REM sleep, normal person
n: within 20 min
normal: 90 mins
what diagnostic tool is sued for Narcolepsy
polysomnography
multiple sleep latency test (MSLT)
what is multiple sleep latency test (MSLT)
subjects monitered while trying to fall asleep
sleep latency measured if less then 8 min–> narcolepsy
normal is 10-15 minutes
must occur at least 2 times
Restless leg syndrome
spontaneous, continous leg movements
unpleasant paresthesias
what relieve restless leg syndrome
movement
what is related to secondary RLS associations
iron deficiency
end stage renal disease
what is periodic limb movement of sleep
sudden jerking leg movements
what is the difference between diagnosis of primary and secondary restless leg syndrome
primary: normal neurologic exam
secondary: abnormal neurologic exam
polysomnography not necessary
clinical feature of shift work disorder
difficulty sleeping past noon
traveling east to west is easier for who
individuals with sleep-wake cycle longer than 24 hours
