Sleep Disorders (insomnia) - waldron Flashcards
what are patients with sleep apnea more likely to have
23x more likely to have a heart attack
3x more likely to develop diabetes
what are complications of not sleeping
higher risk or exacerbation of health problems
higher risk of falling (especially in elderly)
trouble focusing/concentrating - task completion concerns
anxiety/mood changes
grumpiness/irritability
slower reaction times/coordination concerns
What is FFI
Fatal Familial Insomnia “the walking nightmare”
rare genetic condition where the disruption to sleep is so severe that it becomes terminal usually within 1-2 years
usual onset 32-62 years?
prion based disease
who is more likely to be affected by insomnia
elderly
W>Men
how many stages of sleep are there?
5 stages
what is stage 1 of sleep
transition period between wakefulness and sleep
lasts only 5-10 minutes, characterized by mixed frequency theta waves; slow, rolling eye movements
what is stage 2 of sleep
lasts ~ 20 minutes, involves mixed=frequency waves with rapid bursts of rhythmic wave activity aka sleep spindles
body temperature starts to decrease and HR begins to slow
what is stage 3 of sleep
characterized by 2–50% slow brain waves (delta waves)
transitional period between light and deep sleep
what is stage 4 sleep
greater than 50% delta waves, aka Delta sleep
lasts ~30 minutes
what is stage 5 sleep
AKA Rapid eye movement (REM) sleep, when most dreaming occurs
increase in RR and Brain activity
occurs ~q90 minutes
when is the first cycle of REM sleep
~90 minutes after falling asleep and only lasts a few minutes
What is primary insomnia
not linked to any other health conditions
stress (job loss, divorce, pandemics)
environment (lights, noise, temperature)
Sleep schedule changes (jet lag, shift work)
what is secondary insomnia
directly caused by another health condition
mental health issues (depression, anxiety)
Medications (sudafed, albuterol)
Pain and discomfort
caffeine, tobacco
hyperthyroidism or other endocrine concerns
What are the acute presentations of Insomnia
brief episodes of few nights
usually caused by a life event
usually resolves without treatment
what are the chronic presentation of insomnia
trouble falling or staying asleep
3+ nights per week for 3+ months
what are the typical presenting symptoms of insomnia
sleepiness during the day, fatigue, grumpiness, irritability, concentration/memory concerns/changes
how is insomnia diagnosed
routine H&P will focus on environment, life changes/events, chronic illness
Red Flags
Testing
what are the red flags of insomnia
disturbed sleep >1mo without apparent cause
sleep partner notes patient stops breathing
associated with life-changing event
previously rx’d sleep med no longer working/helpful
what are tests used for diagnosing insomnia
sleep diary
epworth sleepiness scale
ploysomnogram
actigraphy
mental health evaluation
how do we prevent insomnia
routine*
done use screens before bed
avoid nicotine, caffeine, alcohol late in the day
regular exercise
dont eat heavy meal late in the day
make bedroom comfortable
what initiation treatment medications are used for insomnia
Eszopicione (lunesta)
Ramelteon (Rozerem)
Zolpidem (ambien)
OTC anti-histamines
what maintenance treatment medications are used for insomnia
Doxepin (silenor)
what are alternative - herbal treatment options for insomnia
valerian root - sleep onset and maintenance
Chamomile
passionflower, hops, lemon balm
what are alternative treatment options for insomnia
melatonin
acupuncture
relaxation and meditation
exercise
What is Narcolepsy
chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep
difficult to stay awake for long periods of time, regardless of circumstances
What are risk factors for narcolepsy
10-30 years old
family history (20-30x higher)
what are narcolepsy symptoms
excessive daytime sleepiness
sudden loss of muscle tone - cataplexy
sleep paralysis
changes in REM sleep
hallucinations
automatisms
what are complications of narcolepsy
public misunderstanding of the condition
interference with intimate relationships
physical harm
increased risk of a car accidents, cuts and burns
obesity
how is narcolepsy diagnosed
sleep history/record-diary, actigraphy
polysomnogram
multiple sleep latency test
what is the treatment of Narcolepsy
stimulants - methylphenidate
non-stimulants - modafinil, armodafinil
SSRI, SNRI - suppress REM sleep
TCA - imipramine, suppresses cataplexy
what is shift work sleep disorder
sleep disorder that commonly affect those who work non-traditional hours
causes difficulties adjusting to different sleep/wake schedules
what are the symptoms of shift work sleep disorders
excessive sleepiness when need to be awake, alter and productive
insomnia
sleep that feels unrefreshing or insufficient
difficulty concentrating
lack of energy
irritability or depression
difficulty with personal relationships
what are complications of shift work sleep disorders
increased risk for
accidents and work - related errors
irritability or mood problems
poor coping skills and impaired social functioning
health related complaints (GI, CV, and metabolic issues)
drug and alcohol dependence
how are shift work sleep disorders managed
minimize exposure to light
maintain bedtime rituals and regular sleep schedule
at home, family/friends help create quiet, dark, peaceful setting during sleep time
ask household members to wear headphones with music/TV
people in household to avoid noisy activities
“do not disturb” sign so delivery people/friends dont knock or ring doorbell
how is shift work sleep disorders treated
maintain sleep diary
decrease number of night shifts worked in a row
after string of nigh shifts, take > 48 hours off if possible
avoid extended work hours
ensure time to sleep and participate in family and social activities
avoid long commutes
avoid frequently rotating shifts
get enough sleep on days off - sleep hygiene
plan a nap
caffeine and prescription wake-promoting drugs
sleep aids
light exposure
what is Willis-Ekbom disease
Restless leg syndrome
What is RLS
strong urge to move legs (maybe arms, face, torso or genital region but rare) usually accompanied or caused by uncomfortable and unpleasant sensation in the legs
when does RLS improve and get worse?
improves: with movement
gets worse: when resting or inactive and in the evening or night than during the day
what needs to be excluded in RLS diagnosis
iron deficiency (with or without anemia)
peripheral neuropathy
renal failure
spinal cord conditions
what are non-pharmacologic treatments for RLS
baths/massages
warm or cool packs
sleep hygiene
exercise
avoid caffeine
foot wrap
stretch beginning and end of day
dont resist urge to move
what are pharmacologic treatments for RLS
ropinirole (requip), Rotigotine (Neupro) and pramipexole (mirapex) - FDA approved for treatment of moderate to severe RLS - increase DA in brain
Gabapentin, lyrica
opioids (tramadol to oxycodone)
muscle relaxers
sleep medications
What is sleep walking
non-rem parasomnias
getting up from bed and walking around while still sleeping
may involve other complex actions
eyes usually open with confused glossy look
okay to wake but do not restrain
what is confusional arousal
non-rem parasomnia
mind is still foggy as you wake or just after waking
speak slowly, confused thinking, poor memory, blunt answers
tend to have no memory of the episode
what are night-terrors
non-rem parasomnias
sit up in bed and scream, usually intense look of fear on face, eyes wide open
no memory of event/episode
usually happens in first half of sleep/night
what is sleep behavior disorder
REM parasomnia
act out vivid dreams as sleep-may kick, punch, flail
episodes usually get worse with time and can injury self, partner
what is nightmare disorder
REM parasomnia
frequent and recurrent nightmares
may prevent sleep due to anxiety/fear
what is sleep paralysis
REM parasomnia
when falling asleep or waking up, cannot move arms, legs or head
cannot speak
may hallucinate during episodes
may last seconds to minutes
What is exploding head syndrome
hear loud imaginary nose just before falling asleep or awakening
alleviated with increased sleep per night
what is sleep related eating disorder
binge eat and drink after waking during night, usually high caloric and strange combinations
may only be partially awake
may have no memory of episode
concern for injury (burns from cooking) or toxic ingestion
