Sleep Disorders Flashcards
What is sleep apnea
Repetitive collapse of airway during sleep (15+ times)
What needs to be present if only 5+ episodes of sleep apnea occur
- S/Sx of excess sleepiness, fatigue, or insomnia
- Waking up breathless, choking, or gasping
- Habitual snoring or breathing interruption (noted by partner)
- HTN, T2DM, mood disorder, cognitive dysfunction, CAD, stroke
What does sleep apnea cause
Excess daytime sleepiness
snoring, choking, or gasping during sleep
What does a sleep apnea PE show
+/- obesity, crowded OP airway, HTN, cor pulmonale
RF for OSA include
Male Obese older craniofacial morphology or upper airway soft tissue abnormality (more common in african americans)
What can you use to eval level os obstruction
Mallampti classification
Friedman tongue scale
How do you diagnose OSA
Polysomnography
How do you treat OSA
Weight loss and exercise (if needed)
Avoid alcohol and benzos
Initial therapy: CPAP
(then can do upper airway surgery, oral appliance, or hypoglossal nerve stimulation )
What is insomnia
Difficulty initiating or maintaining sleep
Who is insomnia common in
women low SES unemployed widowed/divorced substance abuse disorder
How do you diagnose insomnia
Clinically- sleep history
but, look for other conditions, meds, or substance abuse
What is criteria for insomnia diagnosis
Symptoms 3x week
Difficulty initiating or maintaining sleep Adequate opportunity to sleep
Leads to daytime consequences
How long can insomnia last
Short term: <3 mo, usually due to stressor
Chronic: >3 months
How do you treat insomnia
Sleep hygiene, stimulus control, relaxation, sleep restriction, CBT, THEN drugs
- Benzo’s (short term d/t ADE): Lorazepam
- Non-benzo sedative: Eszopiclone, Zaleplon
- Melatonin agonist, Doxepin, Suvorexant
What do many patients try if insomnia persists
EtOH
What is narcolepsy
loss of hypothalamic neurons that make Orexin (promote wakefulness, inhibit REM)
Narcolapsy results in
Excess daytime sleepiness (but feels rested upon awakening)
Difficulty sustaining wakefulness, bad REM regulation, disturbed nocturnal sleep
What is cataplexy
Sudden muscle weakness w/o LOC, triggered by strong emotions
What are the types of Narcolepsy
Type 1: With catcplexy
Type 2: withOUT cataplexy
Clinical manifestations of narcolepsy include
Hypnagogic hallucinations (dream like hallucination at sleep onset) Sleep paralysis (when waking up or just before sleep) Sleep attacks, fragmented sleep, obesity
How do you diagnose Narcolepsy
- H&P
- Polysomnograph to r/o other causes
- MSLT
What are narcolepsy findings on Polysomnograph
REM within 15 minutes
What are narcolepsy findings on MSLT
Sleep latency <8 minutes with REM in at least 2 daytime naps
What is the Epworth Sleepines sScale score for most with narcolepsy
> 15
How do you treat Narcolepsy
Non-pharm: avoid benzos and alcohol, opiates and anti-psychotics. get good night sleep, 1-2 20 min naos. Screen for depression, anxiety, CV Sx
Pharm: MODAFANIL (promote wakefulness)
Cataplexy: antidepressant, sodium oxybate
What is a parasomnia
Undesirable physical event or experience during entry/ within/arousal from sleep
More common in kids
NREM or REM related
When does NREM parasomnia occur
During N3 in first 1/3 of sleep cycle, due to dysfunction in neural pathway regulating sleep-wake cycle
What are the types of NREM parasomnias
Confusional arousal
Sleep walking
Sleep terror
Sleep related eating disorder
How do you diagnose Parasomnias
History
PSG (if w. comorbid sleep disorder)
What is the criteria for Parasomnias
Recurrent episodes of incomplete awakening
Inappropriate responsiveness
No cognition or dream report
Complete/partial amnesia
How do you treat parasomnias
Avoid sleep deprivation, EtOH Maintain consistent sleep-wake cycle Anticipatory awakening Dont arouse, calmly coax back to bed Allow free movement
