Sleep Disorders + Sexual Disorders Flashcards

0
Q

Most common of hypersomnias

A

Breathing related disorders

Eg: OSA, central sleep apnea

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1
Q

REM sleep

A

Characterized by

Increased BP, HR, RR

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2
Q

Sleep disorder classifications

A

Dyssomnias - insufficient, excessive or altered timing of sleep (primary insomnia, OSA, narcolepsy, idiopathic hypersomnia, Klein-levin syndrome, circadian rhythm sleep DO)

Parasomnias - unusual sleep related behaviors (sleepwalking, sleep terrors, REM sleep behavior DO, nightmare DO)

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3
Q

Acute insomnia

A

1-4 weeks

Assoc with stress or changes in sleep schedule and usually resolves spontaneously

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4
Q

Primary insomnia

  • Definition
  • symptoms
A

Difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 month

Significant distress or impairment in functioning

Does not occur exclusively in course of another sleep DO or mental DO

Not 2/2 substance or GMC

Types:
Sleep onset insomnia
Sleep maintenance insomnia
Sleep offset insomnia (early AM awakenings)
Nonrestorative sleep (wake up feeling fatigued)

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5
Q

Prevalence primary insomnia

A

5-10%

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6
Q

Chronic insomnia

A

> = 1 month - years

Assoc with reduced quality of life
And inc risk of psych illness

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7
Q

Non pharm tx primary insomnia

A

Sleep hygiene

CBT (first line for chronic insomnia)

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8
Q

Causes primary insomnia

A

Sub clinical mood or anxiety DO

Preoccupation with perceived inability to sleep

Poor sleep hygiene

Idiopathic

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9
Q

Pharm tx primary insomnia

A

Benzodiazepines

  • most common approved reason to put pt on long term benzodiazepines
  • reduce sleep latency and nocturnal awakening
  • as effective as CBT in short term
  • SE: tolerance, addiction, daytime sleepiness, rebound insomnia; falls, confusion, dizziness in elderly

Zolpidem, zaleplon

  • good short term
  • assoc with low incidence daytime sleepiness and orthostatic hypotension
  • inc risk falls and cognitive impairment in elderly

Antidepressants

  • trazadone, amitryptyline, doxepin
  • SE: sedation, dizzy, psychomotor impairment
  • trazadone esp for pts with insomnia and depression
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10
Q

OSA

A

Grin if breathing related DO 2/2 collapse of upper airway assoc with reduction in mood O2 saturation

Lots of daytime sleeping a
Apneic epi with cessation breathing 
Sleep fragmentation
Snoring
AM headaches
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11
Q

OSA risk factors and prevalence

A

Obesity
Inc neck circ
Airway narrowing

4% men
2% women

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12
Q

Tx OSA

A

CPAP
BiPAP

Wt loss

Surgery

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13
Q

Hypnagogic vs hypnopompic hallucination

A

HypnaGOgic = when GOIng to sleep

HypnoPOMPic = when coming from sleep (POMP and circumstance with awakening)

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14
Q

Narcolepsy

A

Excessive daytime sleepiness
Falling asleep at inappropriate times

Irresistible attacks of refreshing sleep occurring daily for at least 3 mo

Cataplexy

Hallucinations and/or sleep paralysis at beginning or end of sleep episodes

No REM latency

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16
Q

Narcolepsy

  • epi
  • prevalence
  • pathophys
A

.02-.16% US pop

Males = females

Linked to loss of hypothalamic neurons that contain hypocretin

Autoimmune component?

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17
Q

Cataplexy vs catalepsy

A

Catapexy = brief episodes of sudden bilateral LOSS of muscle tone

Catalepsy = unprovoked muscular rigidity (like in epiLEPSY)

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18
Q

Tx narcolepsy

A

sleep hygiene
schedule daytime naps
avoidance of shift work

For daytime sleepiness:

  • amphetamines
  • methylphenidate
  • modafinil (#1)
  • Na oxybate

Cataplexy:

  • Sodium oxybate (#1)
  • TCAs - imipramine, protriptyline, clomipramine
  • SSRIs - fluoxetine, fluvoxamine, venlafaxine
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19
Q

Idiopathic hypersomnia

A

Excessive daytime sleepiness
Prolonged nocturnal sleep episodes
Freq irresistible urges to nap

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20
Q

Kleine Levin syndrome

A
Recurrent hypersomnia
\+
Episodes of daytime sleepiness w/ 
- hyperphagia
- hypersexuality
- aggression
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21
Q

Circadian rhythm sleep disorders

A

Intrinsic defects in circadian pacemeker or impaired entrainment (absence of light or other time-signaling stimuli)

Ex:
Delayed sleep phase disorder
Advanced sleep phase disorder
Shift work disorder
Jet lag disorder
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22
Q

Delayed sleep phase disorder

A

Chronic or recurrent delay in sleep onset and awakening times
preserved quality and duration of sleep

Risk factors:
Puberty
Caffeine + nicotine
Irregular sleep schedules

Tx:
Timed bright light in AM
+ melatonin in PM
Chronotherapy = delaying bedtime by few hrs each night

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23
Q

Advanced sleep phase disorder

A

Normal duration + quality of sleep
Sleep onset and awakening times earlier than desired

Risk factors:
Older age

Tx:
Timed bright light in AM
Early AM melatonin NOT recommended

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24
Q

Shift work disorder

A

Sleep deprivation + misalignment of circadian rhythm 2/2 nontraditional work hrs

Risk factors:
Night shift work

Tx:
Avoid risk factors
Bright light phototherapy
Modafinil if severe

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25
Q

Jet lag disorder

A

Sleep distrubances (insomnia, hypersomnia) assoc w/ travel across multiple time zones

Risk factors:
Recent sleep deprivation

Tx:
DO self limiting
Sleep disturbances resolve 2-3 days after travel

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26
Q

Suprachiasmic nucleus

A

In hypothalamus

Coordinates 24 hr or circadian rhythmicity

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27
Q

Sleepwalking

A

Behaviors initiated during slow wave sleep –> walking during sleep

Eyes usually open with glassy look

Difficult to wake up

Confusion w/ waking; amnesia for episode

Rare for violence to occur

28
Q

Sleepwalking

  • epidemiology
  • risk factors
  • pathophys
A

1-4% adults
10-20% kids
More often in kids w/ OSA

Risk factors:

  • sleep deprivation
  • stress
  • hyperthydoism
  • seizures
  • Mg deficiency
  • sedatives/hypnotics, lithium, anticholinergics

Familial basis in 1/3 cases

29
Q

Tx sleepwalking

A

Addressing precip factors (make sure safe environment, proper sleep hygiene)

Refractory cases:

  • clonazepam
  • TCA
30
Q

Sleep terrors

A

Episodes sudden arousal w/ screaming from slow wave sleep

Sympathetic hyperactivation (tachy, tachypnea, diaphoresis)

Usually go back to sleep w/o waking

Confused + disoriented w/ forced awakening

31
Q

Sleep terrors

  • epi
  • risk factors
A

1-6% kids
1-2% adults

Prevalence more in 1st degree relatives of affected

High comorbidity w/ sleepwalking

Risk factors:

  • fever
  • nocturnal asthma
  • GERD
  • sleep deprivation
  • CNS stimulating meds
32
Q

Tx sleep terrors

A

reassure condition benign and self limited

Low dose short acting benzos (clonazepam, diazepam) in refractory

Sleep hygiene

Psychotherapy

33
Q

Nightmare disorder

  • features
  • epi
A

Recurrent frightening dreams

Stop w/ awaking - vivid recall

No confusion or disorientation w/ waking

Can cause lots of distress + anxiety

5% adults, women > men

Nightmares in at least 50% PTSD pts

34
Q

Tx nightmare disorder

A

Imagery rehearsal therapy (IRT)

  • very good for recurrent nightmares in PTSD
  • use of mental imagery to modify outcome of recurrent nightmare

Prazosin

35
Q

REM sleep behavior disorder

A

Muscle atonia during REM sleep

Complex motor activity assoc w/ dream mentation (dream enactment)

Dream enactment behaviors:

  • sleep talking
  • limb jerking
  • violence
  • walking/ running

Presents w/ violent behaviors during sleep usually causing injury to bed partner or pt

36
Q

REM sleep behavior disorder

  • epi
  • risk factors
A

0.5%
Males > women

Risks:

  • elderly
  • TCAs, SSRIs, MAOIs
  • narcolepsy
  • brain stem lesions
  • dementia
37
Q

Tx REM sleep behavior disorder

A

Clonazepam 90% efficacious

Imipramine
Carbamazepine
Pramipexole
Levodopa

38
Q

Drugs

  • increasing libido
  • decreasing libido
A

Increasing:

  • EtOH and Marijuana by suppressing inhibitions
  • cocaine, meth

Decreasing:

  • long term EtOH use
  • narcotics
39
Q

Pharm causes of sexual side effects

A

Anti HTN

Anti cholinergic

Antidepressants

Antipsychotics

40
Q

Hormone causing sexual dysfunction

A

Decreased estrogen (vaginal dryness)

Decreased testosterone

Increased progesterone (blocks androgen receptors)

41
Q

Which neurotransmitters inhibit and enhance libido?

A

Inhibit - serotonin

enhance - dopamine

42
Q

Disorders of desire

A

Hypoactive sexual desire disorder - dec desire or fantasies

Sexual aversion disorder - avoid genital contact w/ sex partner

43
Q

Disorders of arousal

A

Male erectile disorder - inability to maintain erection

Female sexual arousal disorder - inability to maintain lubrication until completion of sex act (common)

44
Q

Disorders of orgasm

A

Primary - never achieved orgasm
Secondary - acquired

Female orgasmic DO - inability to have orasm after nl excitement phase

Male orgasmic DO - achieves orgasm with great difficulty

Premature ejaculation - ejaculate eralier than desired; high prevalence

45
Q

Sexual pain disorders

A

Dyspareunia

  • genital pain peri-sexual act
  • women > men
  • often assoc with vaginismus

Vaginismus
- involuntary muscle contraction of outer 1/3 of vagina during insertion of penis or object

46
Q

Most common sexual DO in women

A

SExual desire disorder

Orgasmic disorders

47
Q

Most common sexual DO in men

A

Secondary ED

Premature ejaculation

48
Q

Dual sex therapy

A

uses concept of marital unit for therapy

meet as couple with a male and fem therapist

Tx is short term

Therapy most useful when no other psychopath is involved

49
Q

Behavior therapy

A

Approaches sex dysfunction as learned maladaptive behavior

Use systemic desensitization

50
Q

Other sex therapies

A

Hypnosis (best as adjuvant)

Group therapy

Analytically oriented psychotherapy

51
Q

Pharm tx sexual dysfunciton

A

Erectile dysfunction
- PDE5 inhibitors (sildenafil orally or alprostadil injection)

Premature ejaculation

  • SSRI
  • TCA

Hypoactive sexual desire disorder

  • Testosterone replacement men + women
  • estrogen replacement in women
52
Q

Paraphilias

A

Sexual disorders characterized by engagement in unusual sexual activities and/or preoccupation wiht unusual sexual urges for at least 6 mo that cause impairment in daily function

53
Q

3 most common paraphilia

A

Pedophilia
Voyeruism
Exhbitionism

54
Q

Pedophilia

A

Like children < 13 yo

55
Q

Frotteurism

A

Like touching or rubbing nonconsenting person

56
Q

Voyeurism

A

Waching unsuspecting nude ppl

57
Q

Exhibitionism

A

Expose genitals to strangers

58
Q

Sadism

A

Like hurting others

59
Q

Fetishism

A

Sex preference for inanimate objects

60
Q

Transvestic fetishism

A

Sex gratifiction in men from wearing women’s clothing

61
Q

Masochism

A

sex excitement from being beaten

62
Q

Necrophilia

A

Like sex w/ dead ppl

63
Q

Telephone scatologia

A

Like calling unsuspecting women and engaging in sexual convo with them

64
Q

Tx paraphilias

A

INsight oriented psychotherapy

Aversion therapy

Pharm therapy - antiandrogens to reduce sexual desire

65
Q

Gender identity disorder

A

Feeling born in wrong sex

Start before age 3 yo

66
Q

If someone has severe distress and depressive sx because of conflict between homosexuality and values of society, may have…

A

Adjustment disorder

or

MDD

67
Q

decreased latency of REM sleep seen in…

A

depression