Sleep Disorders

Question 1

Level 1 sleep study

Answer 1

Measures: EEG, EOG, EMG, ECG, airflow, resp effort, digital oximetry
Useful for diagnosing many sleep disorders
Done in a sleep lab

Question 2

Level 3 sleep study

Answer 2

Done at home
Useful only for sleep apnea investigation
No information on sleep stages (EEG or EMG)
Measurements (airflow, resp effort, digital oximetry, +/- body position)

Question 3

CBT advice for insomnia

Answer 3

Wind down at least an hour before bedtime
Do not go to bed until sleepy
Use the bed only for sleep and sex
Keep a consistent wake time

Question 4

Obstructive sleep apnea

Answer 4

Cessation of airflow for at least 10s
But respiratory effort persists
You cannot breathe because of obstruction
Don’t die from this because will wake up

Question 5

Central sleep apnea

Answer 5

Apneas and hypopneas occur but there is no respiratory effort
Something has damaged the part of your brain that tells you to breathe

Question 6

Physical features increasing OSA risk

Answer 6

Obesity
Large neck
Macroglossia
Dental overjet and retrognathia
High and narrow hard palate
Elongated and low lying uvula
Enlarged tonsils and adenoids

Question 7

Narcolepsy features

Answer 7

Excessive daytime sleepiness is often inital sx
Unwanted episodes of sleep several times daily, often in undesirable circumstances
Can have cataplexy, sleep paralysis, hallucinations, sleep disruption

Question 8

Pathophys of narcolepsy

Answer 8

Deficiency in hypothalamic peptide hypocrein (orexin)

Body kills off the cells and we cannot regulate certain neurochemicals that keep us awake

Question 9

Tx for narcolepsy

Answer 9

Modafinil (promotes wakefulness, unknown MOA)
Methypheidate, dextroamphetamine (stimulates that increase NOR and DA)
GHB (be careful!!)

Question 10

Restless leg syndrome

Answer 10

Urge to move the limbs often associated with paresthesias or dysesthesias
Symptoms worse or present only during rest
Partially or temporarily relieved by activity
Nocturnal worsening of symptoms

Question 11

Periodic limb movement disorder

Answer 11

EMG shows repetitive, highly stereotyped limb movements

Clinical sleep disturbance or complaint of daytime fatigue means you should treat it

Question 12

REM sleep behaviour disorder

Answer 12

Presence of REM sleep without atonia (acting out their dreams)
Most of these people end up with PD, DWLB, or MSA
Injury is common secondary to violent dream enactment