sleep disorders Flashcards
what are the possible functions of sleep try to name 6
conserve energy and effort, produce hormones, promote optimal performance, memory consolidation, mood regulation, augment immune system
at what stage do we enter sleep when healthy
normally sleep is entered through NREM
if sleep is entered through rem what can that suggest
If it is entered through REM, the person is
either depressed, sleep deprived or has narcolepsy
SWS sleep (slow wave) dominates what third of sleep
the first third
what third of sleep does rem predominate
last third
what percent of sleep does nrem and rem account for
nrem 75-80
rem is 20-25
what happens to heart rate in nrem sleep vs rem sleep
nrem hr regular
rem hr is irregular
what happens to BP in nrem vs rem
nrem regular
rem variable
what happens to RR in nrem vs rem
nrem regular
rem irregular
in nrem and rem how is the body responses to o2 and co2 change
nrem decreased,
rem significantly depressed
in nrem and rem what happens to muscle tone
nrem preserved
rem absent
what happens to brain o2 consumption and cbf
nrem reduced
rem increased
what happens to thermoregulation in rem and nrem
nrem homeothermic rem poikilothermic (not maintained can vary)
what happens to penile tumescense and vaginal engorgement in sleep
nrem infrequent
rem frequent
As you get older what happens to the different sections of sleep
total sleep time decreases
less SWS
less homeostatic drive
indivudal naps more
Medical, psychiatric, social (e.g. loss of role, reduced social
interaction), environmental factors (e.g. nursing home placement,
reduced exposure to light) and polypharmacy may have an impact
on sleep
other illness can affect sleep
as you get older in abscense of pathology what happens to sws and rem sleep
sws decreases,
rem sleep shifts slightly earlier in the night
what is a circadian rhythm sleep disorder
sleep disorder that occurs/disrupts over the normal sleep wake cycle over 24hrs
name intrinsic primary sleep disorders
they alter the circadian timekeeping system, these disorders include dspd aspd non-24hr (blindness) , irregular (dementia)
name extrinsic secondary sleep disorders which is a misalignment between extrinsic and intrinsic signal
shift work disorder
jetlag disorder
what is delayed sleep phase disorder
▪ Sleep is out of phase with socially acceptable sleep-wake times,
Clinical Features of DSPD
sleep is normal when they can sleep at their desired times. sleeping at conventional times causes sleep deprivation, insomnia or slipiness, unable to advance sleep.
symptoms will be chronic and persistent and may take drugs to help sleep and have a mental issue alongside
how do you treat dspd
make sure the person wants treatment.
phottherapy, then melatonin, then cbt-I, then examine for pyschiatric co morbidity(may need to treat that)
what is shift work disorder
Insomnia or excessive sleepiness with a recurring work schedule
that overlaps the usual time for sleep. normally one month of this can cause it, sleep log can support this
what are the consequences of swd short term
mood disturbances, short day time sleeps, higher risk of accidents, gi problems
what are long term risks of SWD
sleep disorder, mood disorder, cancer, drug abuse
what advice would tyou give to someone to improve their shift pattern and help swd remembering that each individual is different
dont do more than 3 consec night shifts, distribute rest days, use power naps and caffiene, time meals and melatonin use, choose your own shifts and take regular shifts
how much sleep do we get on average
The population mode is about 7.5 hours
how much sleep do we need
depends on age new born 12-18 hrs 3 months to 1 year 14-15 1-3 12-14 hrs 3-5 11-13 5-12 10-11 12-18 9 hrs 18+ 7-9 hrs
How do I know I’m getting enough sleep? as too much or too little can be bad
You know you're getting enough sleep when for most of the day most days you have enough energy to do what you want
what are some physiologic effects of sleep deprivation
irritability, cognitive impairment, impaired moral judgement, hallucinations, adhd symptoms, heart rate variability, heart disease, decreased reactions, tremours aches, t2dm, impaired immune
how can sleep deprivation effect ind at work
Concentration - 68%
- Handling stress - 65%
- Listening - 57%
- Relating to others - 38%
- Solving problems - 57%
- Decision making - 56%
how does sleep deprivation compare with alcohol
“Drowsiness is similar to alcohol in how it compromises driving ability by reducing alertness
and attentiveness, delaying reaction times, and hindering decision-making skills”
17 hours of sustained wakefulness impairs performance =
0.05% BAC (0.08% is the legal UK limit)
explain Hallucinations in Sleep Deprivation different types
▪ These occur at the sleep/wake transition
▪ Occur on going to sleep - Hypnagogic Hallucinations
▪ Occur on waking from sleep - Hypnopompic Hallucinations
Simple visual or auditory hallucinations (e.g. seeing shadows emerging from
the wall, hearing one’s name being called)
▪ Can be frightening, but insight is retained, and there is no delusional
expansion vs those hallucinations occurring in psychotic illnesses
what are parasomnias
▪ Abnormal behaviours that occur in association with sleep
▪ Occur during :
▪ NREM sleep
▪ REM sleep
why are parasomnias difficult to diagnose
▪ Diagnostically challenging
▪ Poor patient recall
▪ Limited history if no witness account
▪ Routine investigations are often normal
name some sws or nrem parasomnias
▪ Confusional arousal ▪ Sleep Walking (somnambulism) ▪ Night terrors (pavor nocturnus) ▪ Sleep-related Eating Disorder ▪ Sexsomnia
how can you treat night terrors a form of parasomnias
Education. CBT-I to stabilise sleep-wake patterns
▪ Scheduled awakening: 30min alarm method for children
▪ Keep the room safe; be aware of new environments
▪ Only wake fully if the episode lasts >45 mins
▪ Pregablin, Clonazepam
how can youtry to diagnose nrem parsomnias
▪ Family History
▪ Exacerbated by sleep deprivation, stress, alcohol, OSA,
fever
▪ Patient is often amnesic for the event, but may have partial
recollection
▪ Partner may describe tearfulness or confusion
how do you treat nrem parasomnias
Reassurance (benign)
▪ Education – CBT-I to improve sleep pattern
▪ Avoid triggers
▪ Safety
▪ Antidepressants (e.g. Fluoxetine, Trazadone)
▪ Clonazepam
▪ Melatonin
what are rem parasomnias
second half of night nightmares reccurent sleep paraylysis nocturnal groaning catathrenia rem sleep behaviour disorder
what signs present in REM sleep Behaviour Disorder
Often correlate with recalled vivid dreams – usually aggressive ▪ May injure bed partner second half of night normally aged 50 onwards
normally males
how are rbd and parkinsons associated
RBD is the most robust non-motor predictor of developing Parkinson’s
Disease, and it is a predictor of early cognitive impairment
how do you diagnose rbd
Clinical history may be highly suggestive but a v-PSG would confirm the
diagnosis (catching an episode or REM without atonia)
how do you treat rbd
patienbt education, stop medications that may be causing it, separate beds, clonazepam, melatonin
