Sleep Medicine Flashcards
What are the features used to Dx restless legs syndrome?
URGE pneumonic
- Urge to move limb
- Rest (inactivity) worsens or precipitates the symptoms
- Getting up and moving improves the symptoms
- Evening or bedtime worsens or precipitates symptoms
Restless legs can be primary or secondary. Describe the phenotype of primary onset restless legs?
What are some causes of secondary restless legs?
Primary
- younger pts
- Slowly progressive / stable disease
Family Hx or idiopathic
Some causes of secondary inc
- Iron def, ESRF on HDx, preg, medication induced
What medicaitons can induce restless legs?
antidepressants, antihistamines, lithium and dopamine receptor blockers
What is the only pathological abnormality than can be identified in pts with restless legs?
Decreased iron store in the brain
Pt noted to have Periodic limb movements during sleep. What condition?
restless legs
- 80% of restless legs pts have PLMS
Medications of restless legs?
Dopamine agonists
Pregalablin, pregabalin (dont have augmentation or impulse control issues)
Opioids
What is the main issue with Rx restless legs with dopamine agonists? What to do if this occurs?
Augmentation
- symptoms actually get worse on dopamine agonists (usually initially improve)
- Aim to wean off Dop agonists and switch to another agent
Impulse control
- Dopamine agonists can cause issues with impulse control
What is a broad classification of parasomonias?
Sleep wake transition disorders
Non-REM parasomnias
REM parasomnias
What are risk factors for NREM parasomnias?
Priming factors (things that occur before sleep that make it more likely to occur that night)
- alcohol
- emotional stress
- sleep deprivation
- Zolpidem
Triggering factors (things that occur during sleep that can precipitate it. Basically anything that causes abrupt wake ups)
- OSA
- GORD
- SInus symptoms
What are some types of NREM sleep disorders?
Sleep walking
Confessional arrousals
Sleep terrors
How are NREM sleep parasomnia’s managed?
Conservatively
- prevent sleep deprivation
- Address exacerbating factors (ie etoh, sinus issues, OSA)
- Re-aasureance
- Safe environment
Pharm ( there is no RCTs in this space)
- Clonazapam has most evidence for NREM parasomnia in general
- Toperimatre for sleep related eating disorder
How does night eating syndrome differ from sleep related eating disorder?
Night eating syndrome is a psych condition, pts are aware of eating.
Linked to eating disorders
Sleep related eating disorder is a parasomnia, pts arent aware and have no recollection of the events
When do NREM parasomnias happen (sleep stage)?
Occur during non rem sleep by definition, usually N3 but sometimes N2 sleep
Usually first third of the night
What is the hallmark failure in a person with rem sleep behaviour disorder?
Loss of the usual REM sleep atonia
- this is why they can act out dreams in REM sleep
What is the main risk in pts with RBD?
pts with rem sleep behavior disorder are at very high risk of developing a alpha synucleinopathy in the future (parkinsons, LBD, parkinsons plus syndrome etc).
How is RBD Dx?
Requires re-enacting dreams
AND
Documentation of loss of atonia during REM sleep (polysomnography)
What is teh characterisitic features of acting out dreams due to REM sleep behaviour disorder?
Physically acting out dream
Impaired consciousness (ie pt is asleep)
Rapid return to baseline post waking (oriented and alert)
Pt can usually say they were dreaming, and can describe the dream (often correlates to the action ie fight = kicking and punching)
How does loss of atonia manifest on a leep study?
Chin and limb EMG activity during REM seel (evident rapid eye movements) on a sleep study
Management of rem sleep behaviour disorder?
Safe environ
- SLeep separately from people
- SLeep on the ground (ie not in high bed)
- SLeep in sleeping bag
- Wear restraints (lol)
Pharm:
- CLonazapam (usually respond very well to this)
- malatonin (only short acting is effective)