Sleep Disorders Flashcards
What are some potential causes of sleep disorders?
- Medical conditions
- Physical conditions
- Sedative withdrawal
- Use of stimulants
- Major depression
- Mania or anxiety
- Neurotransmitter abnormalities
How do the following neurotransmitter abnormalities affect sleep?
- Elevated dopamine or NE:
- Elevated acetylcholine:
- Elevated serotonin:
- Elevated dopamine or NE:
- Decreased total sleep time
- Elevated acetylcholine:
- Increased total sleep time and increased proportion of REM sleep
- Elevated serotonin:
- Increased total sleep time and increased proportion of delta wave sleep
What are the two types of primary sleep disorders?
- Dyssomnias: disturbances in the amount, quality, or timing of sleep
- Parasomnias: abnormal events in behavior or physiology during sleep
What types of waves and percentage of sleep are associated with the following…
- Non-REM sleep:
- Stage 1 sleep:
- Stage 2 sleep:
- Stage 3-4 sleep:
- REM sleep
- Non-REM sleep: 75% of sleep
- Stage 1 sleep: Decreased alpha waves; 5%
- Stage 2 sleep: Sleep spindles and k-complexes; 45%
- Stage 3-4 sleep: Delta waves; 25%
- REM sleep: Sawtooth waves; 25%
What is required for a diagnosis of insomnia?
Difficulty initiating or maintaining sleep, resulting in daytime drowsiness or difficulty fulfilling tasks
Disturbance occurs three or more times per week for at least 1 month
What percentage of the population is affected by insomnia?
30%
What sleep hygeine measures are used to treat insomnia (1st line treatment)
- Maintain regular sleep schedule
- LImit caffeine intake
- Avoid daytime naps
- Exercise early in day
- Soak in hot tub prior to bedtime
- Avoid large meals near bedtime
- Remove disturbances such as TV and telephone from bedroom
What pharmacotherapy is used to treat insomnia?
- Benadryl, Ambien (zolpidem), Xonata (zaleplon), Desyrel (trazodone)
How is primary hypersomnia diagnosed?
- At least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition, medications, poor sleep hygeine, insufficient sleep, or narcolepsy
- Usually begins in adolescence
How is hypersomnia treated?
Stimulant drugs (amphetamines) are first line
SSRIs may be useful in some patients
How is Narcolepsy diagnosed?
Repeated sudden attacks of sleep in the daytime for at least 3 months, associated with:
- Cataplexy - collapse due to sudden loss of muscle tone; associated with emotion, particularly laughter
- Short REM latency
- Sleep paralysis - brief paralysis upon awakening (50%)
- Hypnagogic (patient falls asleep or is falling asleep) or hypnopompic (as patient wakes up; dream persists) hallucinations (30% of patients)
Narcolepsy is more common in ______ (males/females)
equal in both (gotcha!)
What is the treatment for narcolepsy?
Timed daily naps plus stimulant drugs (amphetamines adn methylphenidate)
SSRIs
Sodium oxalate for cataplexy
How are breathing-related disorders (OSA, CSA) diagnosed?
Sleep disruption and excessive daytime sleepiness (EDS) caused by abnormal sleep ventilation from either obstructive or central sleep apnea
What other symptoms are correlated with…
Obstructive sleep apnea:
Central sleep apnea:
OSA: strong correlation with snoring
CSA: correlated with heart failure
What are some risk factors for OSA?
- Male gender
- Obesity
- Shirt collar size >17
- Prior upper airway surgeries
- Deviated nasal septum
- “kissing” tonsils
- Large uvula, tongue
- Retrognathia
How is OSA treated?
Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery, or uvulopalatoplasty
How is CSA treated?
Mechanical ventilation (such as b-PAP) with a backup rate
What is the difference between excessive daytime sleepiness (EDS) and fatigue?
EDS is falling asleep when you don’t want to
Fatigue is being too tired to complete activities
What is the difference between OSA and CSA?
OSA: respiratory effort is present, but ventilation is disrupted by physical obstruction of airflow
CSA: periodic cessation of respiratory efort
What is Circadian Rhythm Sleep Disorder?
What are the subtypes?
Disturbance of sleep due to mismatch between circadian sleep-wake cycle and environmental sleep demands
Subtypes include jet lag type, shift work type, and delayed sleep or advanced sleep phase type
How do you treat the following subtypes of circadian rhythm sleep disorder…
- Jet lag type:
- Shift work type:
- Delayed sleep/advanced sleep phase type:
- Jet lag type: Usually remits untreated after 2-7 days
- Shift work type: Light therapy may be useful
- Delayed sleep/advanced sleep phase type: Melatonin can be given 5.5 hours before desired bedtime
What is nightmare disorder and during which phase of sleep does it occur?
Repeated awakenings with recall of extremely frightening dreams
Occurs during REM sleep and causes significant distress
When is the onset of nightmare disorder?
Onset most often in childhood
What are treatment options for nightmare disorder?
Usually nothing, but TCA or other agents that suppress total REM sleep may be used
What findings are often observed in the diagnosis of Night terror disorder?
- Repeated episodes of apparent fearfulness during sleep
- Usually begins with a scream and associated with intense anxiety
- Episodes usually occur during the first third of the night during stage 3 or 4 sleep
- Patients are not awake and do not remember the episodes
Night Terror disorder is more common in ____ (boys/girls)
boys
Night terror disorder has a high association with what other sleep disorder?
Sleepwalking disorder
What treatment options are available for patients with night terror disorder?
Usually nothing, but small doses of diazepam at bedtime may be effective if necessary
What is Somnambulism (sleep walking disorder)?
Repeated episodes of getting out of bed and walking associated with blank stare and difficulty being awakened
How does sleepwalking usually terminate?
Usually terminates with patient returning to bed, but patient may awaken with confusion for several minutes
During which part of the night does sleepwalking disorder occur?
Episodes occur during the first 3rd of the night during stages 3 and 4 sleep and are never remembered
When is the usual onset for somnambulism? When is the peak prevalence
Onset usually between ages 4 and 8; peak prevalence at age 12
How is Somnambulism treated?
Measures to prevent injury in surrounding environment
