Sleep disorders Flashcards
Sleep disorders prevalence rates
- General sleepiness 0.5-36%
- Insomnia 4-19%
- OSA 2-4% in middle-aged adults
- DSPS 7% of adolescents
- Narcolepsy 0.03-0.16% (1 in 2000)
- Sleep walking 1-15% adults
- Sleep terrors 3% of children
Consequences of poor sleep
Consequences of poor sleep include: mortality, accidents, morbidity, obesity, metabolic syndrome, depression, suicide, poor performance, less enjoyable relationships, poor quality of life, poor driving ability
What successful treatment modalities exist for sleep disorders
Pharmacotherpy, Behavioural therapy, CPAP, dental appliances, surgical therapy
What does the sleep history include
Onset of symptoms, childhood sleep history, adult sleep history, past medial history, drug history, social history, occupation, driving, sleep hygiene
What various investigations can be done to assess a sleep disorder
Various scales include ESS, RLSS, PDRS and outpatient neurophysiology studies can be used including pulse oximetry, ambulatory EEG, actigraphy and polysomnography
Discuss insomnia
Insomnia can either be initial, middle of the night or terminal. Initial insomnia is where someone can’t get to sleep. They can often be fearful of going to sleep or find it hard to switch their mind off. It is important to tell the patient that hypnic phenomena is probably normal but things like exploding head syndrome are not. Middle of the night insomnia is where the patient wakes up multiple times during the night. This can often be due to other people or restless legs. Terminal insomnia is where the patient wakes up too early. This is usually patients with significant mental health issues who are fearful of being late. This is dangerous as it can create a sleep phase syndrome and this can interact with someones quality of life.
The way to treat insomnia is CBT.
Discuss sleep disordered breathing
SDB is high-pitched heavy snoring caused by obstruction to the airway. The patient stops breathing during the night and this wakes them up so their duration of sleep is very limited making for exhaustion during the day. In OSA the airflow stops and the chest and abdomen continue to work whereas in CSA everything shuts down as the brain isn’t working properly.
Discuss cataplexy
Cataplexy is where the body goes to sleep but the person is still aware of what is happening. They often show good recovery and are able to give a full history of what has happened. If someone has cataplexy they by definition have got narcolepsy type 1. The patient will appear to go atonic, reflexes disappear, floppy for a short period of time, often bounce down but this doesn’t have to be complete may only be the head or face. Epileptic attacks may look similar to cataplexy but the patient would not be able to recall this attack.
Discuss narcolepsy
Narcolepsy is a sudden intrusion of REM sleep that can come in the day or during any stage of sleep. This is why patients dream a lot during the night and often hallucinate during the night. Patients will get a poor nights sleep with no refreshment and feel tired during the day. Narcolepsy can also cause sudden sleep attacks during the day and intrusion of sleep can be dangerous. The disorder is more common in adolescence and middle age and is often triggered by emotional situations. Patients with narcolepsy have a deficiency in a chemical called hypocretin which controls the sleep wake cycle.
Discuss non-REM parasomnia (sleep walking)
Non-REM parasomnia is a disorder of arousal. Instead of coming slowly out of sleep the patient is very quickly enlightened from deep to wake, which can become confusing. This is why you should not try to wake a sleep walker. The patients often show quite functional behaviours like eating, drinking, having sex (sexsomnias).
Discuss REM behaviour disorder
REM behaviour disorder is a condition where you act out your dreams while asleep because your body is no longer paralysed during REM sleep. Often these patients have parkinsonism or some other neurodegenerative problem. Patients are usually violent and trying to fight someone off and can be distressing to others around them. They may remember the episode the next day. REM behaviour disorder can be very dangerous and people have even been reported to kill others during their sleep.
Discuss restless leg syndrome
This is the urge to move your legs and is often difficult
