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
