Sleep problems Flashcards
Give 3 minor, 3 psychological and 3 physical causes.
Minor: Stress, travel, shift work. Psychological: depression, anxiety, mania, grief. Physical: Drug use (+ steroids), pain, nocturia, sleep apnoea
How many people have insomnia of some kind?
¼. This increases to ½ in >65s.
Give 5 principles of management.
Eliminate physical causes. Treat mental health issues. Sleep hygiene -
Relaxation.
Medication
Describe sleep hygiene.
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).
When are medicines indicated? Which ones can be used and what are the risks?
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.
What is obstructive sleep apnoea?
Intermittent and repeated upper airway collapse during sleep, terminated by partial arousal.
Give 4 risk factors of obstructive sleep apnoea
Obesity (!!!!), male, middle age, smoker, alcohol
Give 5 things that would be suggestive of OSA.
Sleepy in day, not refreshed by sleep, loud snoring, low concentration, irritability.
Give 3 investigations of OSA. What is gold standard?
- Polysomnography (gold standard – EEG, EMG and EOG (ocular),
- SpO2 and airflow during sleep
- Pulse oximetry or video recording can also be used
How is mild disease of OSA treated?
Lose weight, stop smoking, decrease alcohol.
What is gold standard treatment and how does it work?
CPAP – can be mask or nasally. Maintains upper airway patency in sleep. BiPAP for COPD patients
How can you get a child to 1) get to sleep better and 2) stop coming into the parent’s bed?
1) Insist on a structured consistent routine before bed. 2) attend to the child ever more distantly
What is a parasomnia?
Psychic event associated with sleep
Who is it most common in? Give 3 causes in the other group.
Children. In adults: stress, lots of caffeine, alcohol can cause.
What 3 groups of parasomnias are there? Give a specific of each.
Arousal disorders: sleepwalking
REM sleep parasomnias: Sleep paralysis
Others: Narcolepsy, hypnopompic/gogic hallucinations, drug induced
How are parasomnias treated?
Clonazepam/amitriptyline/ carbamazepine
What is narcolepsy caused by and characterised by?
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.
Give 2 treatments of narcolepsy
Methylphenidate
modafinil
What is intellectual disability?
Below average general intellectual function, originating during the developmental period, associated with a fall in adaptive behaviour.
What are these patients at high risk of?
Mental and physical health problems.
Describe mild, moderate, severe and profound ID.
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.
Give 3 general physical clinical features. What psychiatric problems can occur?
Physical: Impaired motor skills, impaired sensory skills, incontinence. Epilepsy common. All psychiatric problems can occur but the presentation is modified by the impaired IQ.
What causes up to 75% of severe ID?
Physical brain injuries.
Give 2 chromosomal, 3 antenatal, 1 perinatal, and 2 postnatal causes of ID.
Chromosomal: Down’s, Fragile X. Antenatal: infections, alcohol, hypoxia. Perinatal: Cerebral palsy. Post-natal: Infection, physical injury
Give 3 general measures of management.
Prevention key, advice and support for families, special needs teaching at school/work
What is an important consideration when using antipsychotics?
Lower the seizure threshold
