Sleep Disorders Flashcards
why do we need sleep?
- memory consolidation
- healing
- growth
- immune response
sleep-wake cycle: competition/balance between ________ and ________
sleep-wake cycle: competition/balance between SLEEP LOAD and CIRCADIAN ALTERING SIGNAL
deepest level of sleep?
NREM III
(non-REM III)
-get most rest/relaxation
what occurs during REM sleep?
- dreams
- mental/physical relaxation
- memory consolidation
- emotional processing
physiologic occurances in REM sleep
- rapid eye movement
- increased brain activity
- complete paralysis
as the night progresses, does REM get progressively shorter or longer?
REM gets progressively longer
primary sleep disorders
Dyssomnias
- idiopathic hypersomnia
- narcolepsy
- sleep apnea
- periodic leg movements
- restless leg syndrome
- insomnia
Parasomnias
- sleep terror
- sleep walking
- sleep talking
- nightmare disorder
- REM behavior disorder
secondary sleep disorders
due to external issues
- mental disorders (anxiety, depression, PTSD)
- medical disorders (arthritis, fibromyalgia)
- substance use (drugs, alc, meds)
- sleep deprivation due to schedule etc
MORE COMMON THAN PRIMARY DISORDERS
circadian rhythm disorders
- delayed sleep phase disorder
- advanced sleep phase disorders
- free running type
- jet lag disorder
- shift work disorder
most adults need ____ hours of sleep per night
7-9 hours
in laboratory rats, complete sleep deprivation leads to
- failure to thrive
- excessive food intake with decreased weight
- loss of hair
- skin abnormalities
- hyperactivity
- death at day 22
effects of caffeine on sleep architecture
- caffeine blocks adenosine receptors
- sleep structure completely abnormal
ways to test for excessive daytime sleepiness
- history
- Epworth sleep scale
- polysomnography
- multiple sleep latency test (MSLT)
- maintenance of wakefulness test (MWT)
management of a sleep disorder
-treat any underlying sleep pathology
Patient education
- adequate total sleep time
- proper sleep hygeine
- limited role for medications
state boundary disorders
the 3 distinct states (awake, non-REM, REM) are somewhat overlapping
ex: narcolepsy, parasomnias
narcolepsy
intrusion of REM sleep features into the waking state
parasomnias
inappropriate release of awake behaviors during sleep
classic tetrad of daytime sleepiness (narcolepsy)
- cataplexy
- hypnogogic hallucinations
- sleep paralysis
neuronal level explanation of narcolepsy
- inconsistent inhibition of REM-on neurons
- go into REM sleep during the day
- REM-on neurons of pons tell medullary inhibitory region to inhibit motor neurons
- –paralysis causes cataplexy
- might start to dream
cataplexy
- sudden bilateral loss of muscle tone
- preserved consciousness
- triggered by strong emotions
- localized or generalized
- seconds to minutes
10-50% of narcoleptics do NOT have cataplexy
hyponogogic/hypnopompic hallucinations
- upon falling asleep or awakening
- realistic awareness of presence of someone/something in the room
- possible visual, tactile, kinetic, auditory phenomena
- often associated with SLEEP PARALYSIS
40-80% of narcoleptics have this
sleep paralysis
- inability to move/speak during onset of sleep or upon awakening
- muscular control regained within several minutes
- may occur in gen pop with sleep deprivation
40-80% of narcoleptics experience this
prevalence of narcolepsy in US
1 in 2,000
- equal in men and women
- presents between ages of 15-30
diagnosis of narcolepsy
- symptoms (cataplexy is diagnostic)
- overnight polysomnography
- –sleep fragmentation
- –short REM latency
- mean sleep latency test (MSLT)
neurochemical basis of disease
90% of patients with narcolepsy with cataplexy have low HYPOCRETIN (orexin) levels in CSF
genetic basis for narcolepsy
90% of narcoleptics with cataplexy have HLA DQB1 allele
—also in 25% of gen pop without narcolepsy
treatment for narcolepsy
- planned short naps, avoid sleep deprivation
- avoid sedentary jobs
wake promoting drugs
- methylphenidate, dextrophetamine, methamphetamine
- modafinil, armodafinil, sodium oxybate
treatment of cataplexy
- SSRIs
- SNRIs (Serotonin-NE)
- sodium oxybate
non-REM parasomnias
- night terrors
- sleep talking/walking
- sleep related eating disorder
- confusional arousal
- sleep enuresis
inappropriate release of instinctual behaviors
REM parasomnias
- nightmare disorder
- REM behavior disorder
timing of REM vs non-REM parasomias
REM: last few cycles (second half of the night)
non-REM: first few cycles (last half of the night)
sleep terror
- sudden cry or piercing scream
- intense fear
- eyes may be open, but cannot see parent
- forget it happened the next day
sleep walking
- sitting up or bolting from bed
- eyes open with glassy stare
- hard to arouse
- routine/inappropriate behavior
- amnesia of episode next day
sleep related eating disorder
- involuntary eating and drinking during main sleep period
- consumption of peculiar food
- potential injury
- morning amnesia
neuronal level of explanation for REM parasomnias
- REM on neurons NOT active
- —do not inhibit pons
- pons does not inhibit muscles (no sleep paralysis)
- enact dreams
REM behavior disorders have a strong association with _________
REM behavior disorders have a strong association with PARKINSONS
insomnia
- difficulty initiating sleep or maintaining sleep
- waking up too early
- non restorative sleep
- despite adequate sleep opportunity
- associated with daytime impairment
insomnia could be an early marker for _________
insomnia could be an early marker for DEPRESSION (or other psychiatric disease)
-also high risk for alcohol abuse
acute insomnia
- adjustment, transient, stress related
- temporally associated with identifiable stressor
chronic insomnia
- psychophysiologic
- idiopathic
- paradoxical
comorbid insomnia
- due to mental disorder
- due to drug/substance
- due to medical condition
psychophysiologic insomnia – predisposing, precipitating, perpetrating factors
Predisposing factors
- habitual light sleepers
- episodic poor sleepers
Precipitating factors
- stress
- environmental
- life change
Perpetuating factors
-anxious concern over health and well being
proper sleep hygeine
Proper sleep hygeine
- standardized sleep/wake times
- limit time awake in bed
- remove bedroom clock
- limit bright light exposure at night
- avoid late evening exercise
- limit naps
- reduce/eliminate alcohol, caffeine, tobacco
behavioral therapies (for insomnia)
- relaxation techniques
- sleep restriction
- paradoxical intension
- biofeedback
- circadian rhythm entrainment
- CBT
OTC meds for insomnia
- melatonin
- antihistamines
- analgesis
- valerian root
prescription meds for insomnia
- benzodiazepines
- benzodiazepine receptor agonists
- melatonin receptor agonists
- sedating antidepressants
- anticonvulsants
- atypical antipsychotics
