Sleep problems

Question 1

Give 3 minor, 3 psychological and 3 physical causes.

Answer 1

Minor: Stress, travel, shift work. Psychological: depression, anxiety, mania, grief. Physical: Drug use (+ steroids), pain, nocturia, sleep apnoea

Question 2

How many people have insomnia of some kind?

Answer 2

¼. This increases to ½ in >65s.

Question 3

Give 5 principles of management.

Answer 3

Eliminate physical causes. Treat mental health issues. Sleep hygiene -
Relaxation.
Medication

Question 4

Describe sleep hygiene.

Answer 4

S: Schedule (consistent).
L: Limit caffeine, nicotine and alcohol.
E: Eliminate factors creating poor sleep (noise, light etc).
E: Exercise in the day.
P: psychotherapy (CBT for insomnia, can also help with MH issues).

Question 5

When are medicines indicated? Which ones can be used and what are the risks?

Answer 5

Only when insomnia is ‘severe, disabling or subjecting individual to extreme distress’. Z drugs, benzos, amitriptyline, mirtazapine.
All cause rebound insomnia, all increase falls risk in elderly.
Z drugs and benzos addictive – not more than 4/52.

Question 6

What is obstructive sleep apnoea?

Answer 6

Intermittent and repeated upper airway collapse during sleep, terminated by partial arousal.

Question 7

Give 4 risk factors of obstructive sleep apnoea

Answer 7

Obesity (!!!!), male, middle age, smoker, alcohol

Question 8

Give 5 things that would be suggestive of OSA.

Answer 8

Sleepy in day, not refreshed by sleep, loud snoring, low concentration, irritability.

Question 9

Give 3 investigations of OSA. What is gold standard?

Answer 9

1. Polysomnography (gold standard – EEG, EMG and EOG (ocular),
2. SpO2 and airflow during sleep
3. Pulse oximetry or video recording can also be used

Question 10

How is mild disease of OSA treated?

Answer 10

Lose weight, stop smoking, decrease alcohol.

Question 11

What is gold standard treatment and how does it work?

Answer 11

CPAP – can be mask or nasally. Maintains upper airway patency in sleep. BiPAP for COPD patients

Question 12

How can you get a child to 1) get to sleep better and 2) stop coming into the parent’s bed?

Answer 12

1) Insist on a structured consistent routine before bed. 2) attend to the child ever more distantly

Question 13

What is a parasomnia?

Answer 13

Psychic event associated with sleep

Question 14

Who is it most common in? Give 3 causes in the other group.

Answer 14

Children. In adults: stress, lots of caffeine, alcohol can cause.

Question 15

What 3 groups of parasomnias are there? Give a specific of each.

Answer 15

Arousal disorders: sleepwalking
REM sleep parasomnias: Sleep paralysis
Others: Narcolepsy, hypnopompic/gogic hallucinations, drug induced

Question 16

How are parasomnias treated?

Answer 16

Clonazepam/amitriptyline/ carbamazepine

Question 17

What is narcolepsy caused by and characterised by?

Answer 17

Caused by autoimmune destruction of hypothalamic hypocretin-containing neurons. HLADR2 +ve. Characterised by irresistible attacks of inappropriate sleep +/- vivid hallucinations, cataplexy (sudden hypotonia), sleep paralysis.

Question 18

Give 2 treatments of narcolepsy

Answer 18

Methylphenidate

modafinil

Question 19

What is intellectual disability?

Answer 19

Below average general intellectual function, originating during the developmental period, associated with a fall in adaptive behaviour.

Question 20

What are these patients at high risk of?

Answer 20

Mental and physical health problems.

Question 21

Describe mild, moderate, severe and profound ID.

Answer 21

Mild: IQ 50-70. Makes up 80% of ID. Good development of language which emerges when schooling starts. Most can be independent.
Moderate: IQ 35-49. Most can talk.
Severe: IQ 20-34. Limited social activity.
Profound: IQ <20. Simple speech unachievable. Need special schooling. Can be counselling for families.

Question 22

Give 3 general physical clinical features. What psychiatric problems can occur?

Answer 22

Physical: Impaired motor skills, impaired sensory skills, incontinence. Epilepsy common. All psychiatric problems can occur but the presentation is modified by the impaired IQ.

Question 23

What causes up to 75% of severe ID?

Answer 23

Physical brain injuries.

Question 24

Give 2 chromosomal, 3 antenatal, 1 perinatal, and 2 postnatal causes of ID.

Answer 24

Chromosomal: Down’s, Fragile X. Antenatal: infections, alcohol, hypoxia. Perinatal: Cerebral palsy. Post-natal: Infection, physical injury

Question 25

Give 3 general measures of management.

Answer 25

Prevention key, advice and support for families, special needs teaching at school/work

Question 26

What is an important consideration when using antipsychotics?

Answer 26

Lower the seizure threshold