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Sleep disorders Flashcards

1
Q

What is the definition of sleep?

A

• ‘unconsciousness from which the person can be aroused by sensory or other stimuli’

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2
Q

What is the definition of a coma?

A

• Coma - unconsciousness from which the person can’t be aroused

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3
Q

How is the propotion of sleep that is REM sleep affected as you age?

A
  • Proportion of non-REM to REM increases as you age

* REM time decreases as you age

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4
Q

How does REM sleep look in EEG and how can you tell that its REM?

A

Looks like awake - tell whether its REM by looking at the video, and muscle electrodes

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5
Q

What happens to your muscles in REM sleep

A

they are paralysed to stop you acting out dreams

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6
Q

What is a hypnogram

A

graph classifying the stages of sleep into 1-4 and REM

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7
Q

What are the sections of a history assessing sleep problems?

A 
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
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8
Q

Describe the subjective vs objective measurements of sleep quality

A

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

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9
Q

What outpatient neurophysiology studies can be done to monitor sleep?

A

Pulse oximetry - if there are lots of dips in o2 likely OSA
Ambulatory EEG
Actigraphy (fitbit essentially with sleep diary completed too)

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10
Q

What inpatient neurophysiology studies can be done to monitor sleep ?

A

Polysomnography - overnight monitoring of EEG, repiration and movement detection.

MSLT - 5 daytime naps of 20 mins, EEG sleep staging and recording of sleep latency

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11
Q

What are the severity scales for MSLT?

A

Severe sleepiness: mean sleep latency onset of <5 mins
Mild- moderate: 6-8 mins
Normal: >8 mins
2 or more REM onset periods = narcolepsy

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12
Q

What are the 5 key sleep disorder classifications

A 
Insomnia 
hypersomnia 
circadian rhythm disorders 
parasomnias 
movement disorders of sleep
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13
Q

What are the symptoms of insomnia?

A
  • 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
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14
Q

What are the treatments for insomnia?

A
  • 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
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15
Q

What are the 3 main types of sleep disordered breathing?

A

obstructive sleep apnoea
central sleep apnoea
obesity hypoventilation syndrome

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16
Q

What are the symptoms of OSA?

A
  • Excessive daytime sleepiness
  • Unrefreshing sleep
  • Memory disturbances
  • Morning headache
  • Depression
  • Decreased libido
  • Stomach ache
  • Snoring
  • Apneas
  • Choking/gasping
  • Sweating
  • Dry mouth
  • Palpitation
  • Nycturia
17
Q

What are the risk factors for OSA?

A
  • Usually fat with thick neck
  • Snores a lot
  • Older
  • Male
  • Alcohol consumption before bed
  • Race – middle eastern
  • Smoking
  • Craniofacial anomalies
  • Hypothyroidism, acromegaly
18
Q

What are the treatments for OSA?

A
  • CPAP – treatment, forces air into lungs while sleep, lots of patients don’t tolerate
  • Mandibular splints
  • Surgery
19
Q

What are the symptoms of narcolespy?

A
  • 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
20
Q

What is cataplexy? What effects it ? How long does it last?

A

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

21
Q

What is the criteria for a diagnosis of narcolepsy?

A
  • 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
22
Q

What is narcolepsy type 1 and 2?

A

type 1 = with cataplexy

type 2 = without cataplexy

23
Q

What is hypocretin?

A

Neuropeptides produced by neurons in later hypothalamus which are responsible for arousal and wakefulness

24
Q

How does hypocretin relate to cataplexy?

A

A reduction in hypocretin in the CSF of patients with cataplexy has been discovered

25
Q

What is the treatment for narcolepsy?

A 
Narcolepsy Treatment
•	Planned afternoon naps of 15-20 mins 
•	Good sleep hygiene 
•	Modafinil 
•	Methylphenidate
26
Q

What is the treatment for cataplexy?

A
  • Venlafaxine
  • SSRIs
  • Sodium oxybate
27
Q

What are non-REM parasomnias? Describe this condition?

A

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
28
Q

What is REM parasomnia?

A

Acting out dreams

  • Injuries quite bad
  • Link between Parkinsons and neurodegenerative disorders
  • Often older
  • Treatment – melatonin or clonazepam
29
Q

what is restless leg syndrome?

A
  • 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
30
Q

What are the conditions associated with secondary restless leg syndrome?

A

• Secondary RLS associated with iron deficiency, end stage renal failure, pregnancy, drugs (antidepressants, antipsychotics)

31
Q

What are the treatments for restless leg syndrome?

A
  • Iron
  • Dopamine agonists – keep needing to increase dose so not ideal
  • Pregabalin
  • Gabapentin

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