Sleep Disorders

Question 1

Causes of morning tiredness?

Answer 1

Anxiety, depression

Stimulant intake during the day (caffeine, nicotine) delays sleep onset

Sleep disorder: insomnia, sleep apnoea, periodic limb movements, nightmares

Restless Legs

Poor sleep hygiene

Disorders of daytime sleepiness (narcolepsy)

sleeping at wrong time as body clock phase shift (Delayed Sleep Phase Disorder)

Hypothyroidism, Diabetes (anemia, leukemia)

RACGP Sleep Check 2015

Question 2

Restless legs:
Diagnostic criteria (URGES)

Answer 2

urge to move legs
rest or inactivity worsens sx 
getting up and moving = improves
evening or night = worse sx 
s not solely accounted for by another condition 

RACGP Sleep Check 2015

Question 3

Restless legs:

Causes

Answer 3

Primary - nil cause found, may have a +ve FHx

Ferritin <50ng/mL

Pregnancy (esp. in 3rd trimester 11-27%)

ESRF (40% of dialysis patients)

Drug induced:
- TCA’s, SSRI, Lithium, Antihistamines, Dopamine agonists (metoclopramide, prochlorperazine)

RACGP Sleep Check 2015

Question 4

Restless legs:

DDx

Answer 4

Akathisia
Psychogenic (uncommon)
Neuropathy (more likely to involve feet)
MS (high rate of RLS in patients with MS)
Parkinsons (more common, but RLS does not increase risk of Parkinsons)

RACGP Sleep Check 2015

Question 5

Restless legs:

Management

Answer 5

Non pharm

• stretches, comp stockings
• abstain from etoh, caffeine, nicotine
• r/v meds
• assess fe deficinecny

pharm
- fe therapy (maintain at 300ng/mL for 4-6wks)

• meds on etg

Question 6

What is the most common sleep disorder in Australia?

DDx for insomnia?

Answer 6

Insomnia

Short sleepers
Acute Situational Insomnia
Delayed sleep phase syndrome
Restless Legs

RACGP Sleep Check 2015

Question 7

What is? Delayed sleep phase syndrome

Answer 7

circadian rhythm disorder, characterized by late bed time and getting up time, no daytime dysfunction if the individual is able to sleep in later
RACGP Sleep Check 2015