Sleep Disorders Flashcards
Area of brain that regulates sleep
- suprachiasmatic nucleus
- pineal gland
blue light to retina, projects to SCN, projects to pineal gland and inhibits melatonin production
List 7 general causes of insomnia
- poor sleep hygiene
- Psychiatric conditions
- medical conditions
- acute stressors
- circadian rhythm disorders
- medications
- primary sleep disorder
Examples of poor sleep hygiene that can cause insomnia
alcohol
caffeine
nicotine
sleep schedule
examples of psychiatric conditions that can cause insomnia
anxiety
depression
Examples of medical conditions that can cause insomnia
lung disease
heart failure
neuro disorders
pain disorders
Examples of acute stressors that can cause insomnia
bereavement
relocation
marriage/divorce
Examples of circadian rhythm disorders that can cause insomnia
- advanced or delayed sleep phase
- irregular sleep/wake
Examples of medications that can cause insomnia
- BB
- bronchodilators
- CNS stimulants
- corticosteroids
- decongestants
Examples of primary sleep disorders that can cause insomnia
sleep apnea
primary therapy for insomnia
cognitive behavioral therapy
Online program that is as effective as face-to-face CBT for insomnia
www. cbtforinsomnia.com
- 5 weeks, 5 sessions, all online CBT
Drug categories that have been evaluated for insomnia management
- BZDs
- Orexin receptor antagonists
- Melatonin (Ramelteon)
- off label (Trazodone MC, TCAs like amitriptyline, mirtazapine, quetiapine, hydroxyzine
Define narcolepsy
Sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, possible cataplexy
Define cataplexy
Partial or total loss of muscle control, often triggered by strong emotion like laughter
State role of orexin/hypocretin receptors in sleep
- Interact with all wake-promoting areas of the brain and spinal cord
- Pts with narcolepsy (esp with cataplexy) are deficient in orexin
- Thought is if can antagonize orexin, can put person to sleep
What is the role of orexin/hypocretin receptors in therapy of narcoplepsy
Thought is if can antagonize orexin (which is low in people with narcolepsy), can put person to sleep
What wavelength of light stimulates the retina and ultimately affects melatonin levels?
blue light
Define mixed apnea
combo of OSA and CSA
Define treatment induced CSA
can be caused by inappropriately titrated CPAP settings
What is GS dx test for sleep apnea
polysomnogram
aka “sleep testing”
What is PSG, how is it used in testing/management of apnea
polysomnogram
- Record of sleep activity.
- Includes EEG to determine stages of sleep, EKG to look for arrhythmias (bradycardia and afib most common)
- Determines how many episodes of apnea happen in the session
What is PAP titration, how is it used in testing/management of apnea
positive air pressure titration
- Everyone’s pressure requirement is different
- Procedure to change the pressure of the CPAP until enough pressure to tx sleep apnea but not too high (can confuse RAS and cause “induced central apnea”)
What is split night, how is it used in testing/management of apnea
half the night’s testing is to figure out the dx, the second half of the night is to figure out a tx plan
What is MSLT, how is it used in testing/management of apnea
- multiple sleep latency testing
- For excessive sleepiness syndromes (like narcolepsy)
- Go to lab during day, have 5 scheduled 20 minute nap sessions
- Look for sleep latency and how quickly pt entered REM sleep
- Considered abnl if pt enters REM in 2 or more of the naps
What is MWT, how is it used in testing/management of apnea
- maintenance of wakefulness
- Put pt in a boring room, tell pt not to sleep
- Used for truck drivers and pilots to prove pt is appropriately treated and will stay awake when necessary
GS tx for sleep apnea
PAP therapy
What is the utility of mandibular advance devices in managing sleep apnea
not good, don’t use
Restless limb syndrome
- MC secondary cause
- best way to dx
- recommended therapy
- iron deficient anemia
- test for ferritin levels
- iron supplement to tx OR anti-da drugs bc is a muscular movement disorder
Define periodic limb movement disorder. how is it usually IDed?
- Kick all night but not aware
- often IDed by spouse who is sick of being kicked
What is the site of endogenous circadian cycle control?
Suprachiasmatic nucleus
What is the primary determinant of circadian phase
nadir (lowest part) of core body temp
what is definition of entrainment
Process by which light synchronizes the SCN to a 24 hour cycle
What happens to phase response curve when there is light exposure before the nadir of core body temp
leads to phase delay (light later in the day)
- example is to treat advanced sleep phase
What happens to phase response curve when there is light exposure after the nadir of core body temp
leads to phase advance (light in the morning)
- example is to treat delayed sleep phase
Delayed sleep phase
- Delay in the phase of sleep period in relation to desired sleep time
- Chronic or recurrent complaint of inability to fall asleep at a desired time and inability to awaken at a desired/socially acceptable time
- Classic teenage sleep pattern
Advanced sleep phase
- Converse of delayed sleep phase
- Go to bed early and wake up early
- Middle aged and elderly
Jet lag
- Insomnia and excessive daytime sleepiness associated with jet travel
- Impairment of daytime function, general malaise, GI disturbance
- Occur bc endogenous circadian rhythm is misaligned to external clock
Shift work sleep disorder
- Constant state of circadian misalignment
- Work and sleep at the wrong circadian phase
Therapy for delayed sleep phase
- Blue light 30 minutes following rise time, advance 30 minutes earlier every few weeks until desired wake time is achieved
- Melatonin: given 12 hours prior to light exposure
Therapy for advanced sleep phase
- Blue light 30-60 min prior to patient’s bed time
- Melatonin not effective
- Possibly pharm options and caffeine
Therapy for jet lag
- Blue light (using process for delayed and advanced sleep phases)
- Avoidance of light
- Melatonin 12 hours prior to light therapy like for delayed sleep phase
Therapy for shift work sleep disorder
- Light therapy
- Melatonin
- Hypnotics to improve sleep quality
- To improve alertness: caffeine, modafinil/armodafinil, scheduled naps
What is the dual mechanism interaction of sleep
Homeostatic
- accumulates as a function of wakefulness
- important factor in sleep quality
Endogenous
- core temp and melatonin
- important for sleep quantity
