Sleep Disorders Flashcards
Two States of Sleep
Non-rapid eye movement sleep (NREM)
- Stages I-IV ranging from light sleep to deeper sleep
- just markedly lower than wakefulness
REM sleep
- high levels of brain activity similar to wakefulness
- “Dream sleep”…20-25% of sleep
- 90 min latency period before entering REM…occurs every 90 min
- Amount decreases as we age… :(
Sleep Deprivation
Prolonged periods can lead to disorganization, hallucinations, and delusions
irritability, lethargy
Insomnia Disorder Diagnostic Criteria
Dissatisfaction with sleep quantity or quality with >/= 1…
- difficulty initiating sleep
- difficulty maintaining sleep
- early morning awakening, cannot return to sleep
Clinically signif distress or impairment
At least 3x/week for 3 months
Occurs despite adequate opportunity for sleep
What is the MC symptom in insomnia?
sleep maintenance – frequent/prolonged awakening at night
Insomnia Epidemiology
33% of adults report insomnia
onset commonly in early adulthood
40-50% also present with a comorbid mental disorder
Treatment for Insomnia
1- Sleep hygiene
2- Psychotherapy
3- Medications
Therapy types
- Stimulus control therapy (no phones; bed is only for sleep)
- Sleep restriction therapy (no naps; sleep diary; only stay in bed for as long as you’re actually asleep)
- CBT (change the way you think about sleep)
- Relaxation training
Pharm options for Insomnia
Hypnotics (selective benzo receptor agonists)
- Ambien
- Sonata
- Lunesta
- *not for patients w/ hx of sleep walking…meds have been shown to be associated with sleep walking/eating/driving**
Benzos
- Restoril
- Flurazepam
Melatonin receptor agonists
-Rozerem good for someone with sleep walking hx
Orexin receptor antagonists
- Belsomra
- Dayvigo
- Safer in old patients*
Hypersomnolence Disorder Diagnosis
Excessive sleepiness despite a main sleep period lasting at least 7 hours with >/= 1
- recurrent periods of sleep/lapses w/in same day
- sleep episode >9 hrs that is non-restorative/refreshing
- difficulty being fully awake after abrupt awakening
> /= 3 times per week for at least 3 months
significant distress or impairment in cognitive, social, occupational, or other areas
Eval for hypersomnolence Disorder
nocturnal polysomnography
- normal to prolonged sleep duration
- short sleep latency (fall asleep faster, stay asleep longer)
DDx
- OSA?
- MDD?
- bipolar depressive period
Narcolepsy Diagnosis
Recurrent periods of sleep attacks occurring within the same day
> /= 3 times/week for at least 3 months
+ >/= 1 of the following
- episodes of cataplexy (brief episodes of sudden muscle tone loss)
- hypocretin deficiency
- PSG with REM sleep latency = 15 min or mean sleep latency = 8 min + >/= 2 sleep-onset REM periods
What causes narcolepsy?
Loss of hypothalamic hypocretin-producing cells
Cell loss is likely autoimmune related or triggered by an infection (GAHS)
20-60% experience vivid hallucinations
Nightmares and vivid dreams are common
Peak onset of Narcolepsy
bimodal
15-25 yo
30-35 yo
Narcolepsy treatment options
Behavioral treatment
-fixed bed and wake times; scheduled naps
Wake promoting meds
- Provigil
- Nuvigil
Stimulant meds
- Ritalin
- Adderall
Sodium oxybate
Circadian Rhythm Sleep Disorders
Misalignment in internal biological clock & desired sleep-wake cycle
seen in shift workers a lot
treatment –> phototherapy &/or melatonin
Parasomnias
disorders of partial arousal from sleep
Non-REM…no conscious awareness of these activities
-sleep walking/eating/terrors
REM sleep disorder –> nightmares that the patient can recall…recurrent, vivid
-can cause fear of sleeping
Restless Leg Syndrome
uncomfortable sensation and urge to move the legs when resting and trying to sleep
Can last hours
Can be secondary to neuropathies, iron & folate deficiencies
Associated with fibromyalgias, RA, DM, COPD, opiate withdrawal
Treatment for Restless Leg Syndrome
- Mirapex
- Requip
Periodic Limb Movement Disorder
occurs in non-REM sleep
usually does not bother sleep
Secondary Sleep Disorders
-Depression MC –> report early morning wakening
Bipolar mania may present early with decreased need for sleep
Substance use disorder – Alcohol, stimulants, hallucinogens –> disrupt sleep architecture
Anxiety disorders
-worrying at night, hard to fall asleep
ADHD
A side effect of some medications
-Statins!!!!
