Sleep disorders Flashcards
What is the definition of sleep?
• ‘unconsciousness from which the person can be aroused by sensory or other stimuli’
What is the definition of a coma?
• Coma - unconsciousness from which the person can’t be aroused
How is the propotion of sleep that is REM sleep affected as you age?
- Proportion of non-REM to REM increases as you age
* REM time decreases as you age
How does REM sleep look in EEG and how can you tell that its REM?
Looks like awake - tell whether its REM by looking at the video, and muscle electrodes
What happens to your muscles in REM sleep
they are paralysed to stop you acting out dreams
What is a hypnogram
graph classifying the stages of sleep into 1-4 and REM
What are the sections of a history assessing sleep problems?
Collateral history (from the partner often) ONset of symptoms Childhood sleep history Adult sleep history Past medical history Drug history Social history Occupation Driver? Family history of sleep problems
Describe the subjective vs objective measurements of sleep quality
Subjective
o Epworth sleepiness scale – self-reported questionnaire based on chance of dosing in different scenarios
Objective
o Multiple sleep latency tests – how long they fall asleep, is there REM? REM should not be on onset
o Reaction times
o Driver simulators
What outpatient neurophysiology studies can be done to monitor sleep?
Pulse oximetry - if there are lots of dips in o2 likely OSA
Ambulatory EEG
Actigraphy (fitbit essentially with sleep diary completed too)
What inpatient neurophysiology studies can be done to monitor sleep ?
Polysomnography - overnight monitoring of EEG, repiration and movement detection.
MSLT - 5 daytime naps of 20 mins, EEG sleep staging and recording of sleep latency
What are the severity scales for MSLT?
Severe sleepiness: mean sleep latency onset of <5 mins
Mild- moderate: 6-8 mins
Normal: >8 mins
2 or more REM onset periods = narcolepsy
What are the 5 key sleep disorder classifications
Insomnia hypersomnia circadian rhythm disorders parasomnias movement disorders of sleep
What are the symptoms of insomnia?
- Difficulty falling asleep
- Difficulty maintaining sleep
- Lots of arousal/difficultly falling back asleep
- Prevelance 30-48%
- > 1 month duration
- Associated with fatigue, poor memory and concentration in short term sufferers
- PSG/MSLT usually normal in chronic cases
What are the treatments for insomnia?
- Exclude other sleep disorders
- Good sleep practice
- Drugs: zolpidem for 1 week
- CBT – to break the cycle, books, 70-80% patients benefit from CBT
- Make adjustments to threshold time by 15 mins at a time
What are the 3 main types of sleep disordered breathing?
obstructive sleep apnoea
central sleep apnoea
obesity hypoventilation syndrome
What are the symptoms of OSA?
- Excessive daytime sleepiness
- Unrefreshing sleep
- Memory disturbances
- Morning headache
- Depression
- Decreased libido
- Stomach ache
- Snoring
- Apneas
- Choking/gasping
- Sweating
- Dry mouth
- Palpitation
- Nycturia
What are the risk factors for OSA?
- Usually fat with thick neck
- Snores a lot
- Older
- Male
- Alcohol consumption before bed
- Race – middle eastern
- Smoking
- Craniofacial anomalies
- Hypothyroidism, acromegaly
What are the treatments for OSA?
- CPAP – treatment, forces air into lungs while sleep, lots of patients don’t tolerate
- Mandibular splints
- Surgery
What are the symptoms of narcolespy?
- Nocturnal sleep is poor leading to excessive daytime sleepiness
- Several night-time awakenings
- Dreams occur immediately on falling asleep
- Hypnagogic (sleep onset) hallucinations
- Hypnopompic (upon wakening) hallucinations
- Sleep paralysis – inability to move limbs head or breathe normally, associated with REM intrusion, can be terminated if patient is moved
What is cataplexy? What effects it ? How long does it last?
Cataplexy – sudden drop in muscle tone triggered by emotions (laughter, anger, excitation)
• Worsens with poor sleep
• May affect all striated muscles
• Consciousness is retained (differentiate from epilepsy)
• Duration varies from seconds to minutes
• Occasionally attacks last hours ‘status epilepticus’ precipitated by withdrawal of anticataplectic drugs
What is the criteria for a diagnosis of narcolepsy?
- Excessive daytime somnolence and at least 1 other symptom
- Cataplexy is characteristic and pathognomic
- MSLT – drug screen
- At least 2 REMs required to confirm diagnosis
What is narcolepsy type 1 and 2?
type 1 = with cataplexy
type 2 = without cataplexy
What is hypocretin?
Neuropeptides produced by neurons in later hypothalamus which are responsible for arousal and wakefulness
How does hypocretin relate to cataplexy?
A reduction in hypocretin in the CSF of patients with cataplexy has been discovered
What is the treatment for narcolepsy?
Narcolepsy Treatment • Planned afternoon naps of 15-20 mins • Good sleep hygiene • Modafinil • Methylphenidate
What is the treatment for cataplexy?
- Venlafaxine
- SSRIs
- Sodium oxybate
What are non-REM parasomnias? Describe this condition?
Sleepwalking
- Normally starts early in life – not much you can do
- Sedatives – clomazipam or SSRI but there are side affects
- Avoid triggers – new places, bed partners
- Not normal to induce violence – suspicious if patients are reporting to have done a violent crime due to sleep walking like sleep strangling
- Can have partial recollection of the events
- Different types e.g. sexsomnia
What is REM parasomnia?
Acting out dreams
- Injuries quite bad
- Link between Parkinsons and neurodegenerative disorders
- Often older
- Treatment – melatonin or clonazepam
what is restless leg syndrome?
- Sensorimotor disorder of extremities
- Irresistable urge to move legs – when move legs you feel relief
- Primary RLS is associated with earlier onset and more severe
- Worse in periods of rest and in the evening
What are the conditions associated with secondary restless leg syndrome?
• Secondary RLS associated with iron deficiency, end stage renal failure, pregnancy, drugs (antidepressants, antipsychotics)
What are the treatments for restless leg syndrome?
- Iron
- Dopamine agonists – keep needing to increase dose so not ideal
- Pregabalin
- Gabapentin
