Sleep Disorders + Sexual Disorders Flashcards
Most common of hypersomnias
Breathing related disorders
Eg: OSA, central sleep apnea
REM sleep
Characterized by
Increased BP, HR, RR
Sleep disorder classifications
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)
Acute insomnia
1-4 weeks
Assoc with stress or changes in sleep schedule and usually resolves spontaneously
Primary insomnia
- Definition
- symptoms
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)
Prevalence primary insomnia
5-10%
Chronic insomnia
> = 1 month - years
Assoc with reduced quality of life
And inc risk of psych illness
Non pharm tx primary insomnia
Sleep hygiene
CBT (first line for chronic insomnia)
Causes primary insomnia
Sub clinical mood or anxiety DO
Preoccupation with perceived inability to sleep
Poor sleep hygiene
Idiopathic
Pharm tx primary insomnia
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
OSA
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
OSA risk factors and prevalence
Obesity
Inc neck circ
Airway narrowing
4% men
2% women
Tx OSA
CPAP
BiPAP
Wt loss
Surgery
Hypnagogic vs hypnopompic hallucination
HypnaGOgic = when GOIng to sleep
HypnoPOMPic = when coming from sleep (POMP and circumstance with awakening)
Narcolepsy
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
Narcolepsy
- epi
- prevalence
- pathophys
.02-.16% US pop
Males = females
Linked to loss of hypothalamic neurons that contain hypocretin
Autoimmune component?
Cataplexy vs catalepsy
Catapexy = brief episodes of sudden bilateral LOSS of muscle tone
Catalepsy = unprovoked muscular rigidity (like in epiLEPSY)
Tx narcolepsy
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
Idiopathic hypersomnia
Excessive daytime sleepiness
Prolonged nocturnal sleep episodes
Freq irresistible urges to nap
Kleine Levin syndrome
Recurrent hypersomnia \+ Episodes of daytime sleepiness w/ - hyperphagia - hypersexuality - aggression
Circadian rhythm sleep disorders
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
Delayed sleep phase disorder
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
Advanced sleep phase disorder
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
Shift work disorder
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
Jet lag disorder
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
Suprachiasmic nucleus
In hypothalamus
Coordinates 24 hr or circadian rhythmicity