Sleep wake d/o

Question 1

What are the 10 disorders/disorder groups that encompass sleep/wake d/o’s

Answer 1

Insomnia disorder,
hypersomnolence disorder,
narcolepsy,
breathing-related sleep disorders,
circadian rhythm sleep disorders,
non-rapid eye movement (NREM) sleep disorders,
nightmare disorder,
rapid eye movement (REM)
sleep behavior disorder,
restless leg syndrome,
substance-medication induced sleep disorder

Question 2

How do MH d/o contribute/cause sleep problems?

Answer 2

MDD: most consistently associated with early morning awakening
SUD: sleeping too deeply/over-sedation
PTSD: easily awakened/sleeping too lightly, associated with hyperarousal

Question 3

What are some examples of substance/medication induced sleep disturbances?

Answer 3

caffeine, ETOH, cannabis, ADHD/stimulant tx

Question 4

What is a primary neurotransmitter implicated in regulation of sleep?

Answer 4

Serotonin - it is derived from amino acid tryptophan and synthesized in the raphe nuclei of the brain stem. Regulates sleep, mood, pain, and appetite.

Question 5

What tool is used to review/diagnose sleep probeles?

Answer 5

Electroencephalogram

Question 6

How long must an insomnia be present to diagnose?

Answer 6

Must be present for minimum of 3 months.

Question 7

What are parasomnias?

Answer 7

Disorder characterized by abnormal behavior: edperientail or physiological event occurring in association with sleep, specific sleep stages or sleep-wake transitions.
Non-REM sleep around disorders is a type of parasomnia

Question 7

DMS-5 Criteria for Insomnia d/o

Answer 7

• Dissatisfaction with sleep quality or quantity, associated with difficulty initiating/maintaining sleep, or early AM wakening w/ inability to return to sleep
  -Sleep disturbances causes clinically significant distress or impairment in social, occupational, ed, academic, behavioral functioning
  -Sleep difficulty occurs at least 3 nights/week
  -Sleep difficulty present for at least 3 months
  -Sleep difficulty occurs despite adequate opportunity for sleep
  -Not better explained by another sleep-wake d/o, or a co-existing MH d/o, or physiological effects of substance

Question 8

What are the different types of insomnia? 3

Answer 8

1. Sleep onset - initial insomnia usually >20-30 mins
2. Sleep maintenance - middle insomnia >20-30 mins (most common)
3. Late - early AM awakening w/inability to return to sleep

Question 9

What is psycho-physiologic insomnia?

Answer 9

It involves conditioned arousal w/the thought of sleeping. Generally caused by anxiety, trying too hard to sleep, rumination, tension, and sleeping better away from person’s own bed.

Question 10

What is idiopathic insomnia?

Answer 10

Characterized by pt’s with a life-long inability to obtain adequate sleep. Predates any psychiatric condition.

Question 11

What is paradoxical insomnia?

Answer 11

Dissociation between sleep and it’s usual attendant unconsciousness.

Question 12

What percentage of pt’s w/ insomnia have co-morbid MH d/o?

Answer 12

35% with MDD being most common

Question 13

What is hypersomnolence d/o symptoms?

Answer 13

Self-reported excessive sleepiness despite a main sleep period of at least 7 hrs.
-In addition has at least 1 of the following:
–recurrent periods of sleep
–lapses into sleep in the same day
–prolonged main sleep period >9hrs/day (non-refreshing)
–difficulty being fully awake after abrupt awakening (sleep inertia: period of impaired performance/reduced vigilance following awakening from reg sleep episode)

Question 14

What are hypersomnolence d/o dx criteria?

Answer 14

In addition to symptoms must occur at least 3x/week for at least 3 months
Causes significant distress
Not better explained y another d/o
Acute (<1 month); subacute (1-3 month), persistent (>3 months)

Question 15

What conditions can predispose to hypersomnolence d/o?

Answer 15

A subset of pts have family history and may have sx of ANS dysfunction where they have recurrent vascular HA’s, reactivity or peripheral vasc sys (Rayaud’s) and fainting
Infections: viral infxn such as HIV, pneumonia, mono, Guillan-Barre.
Can appear w/in 6-18 months of a head trauma

Question 16

Narcolepsy diagnostic criteria and prevalence?

Answer 16

Commonly occurs in late teens and 20’s.
Must have occurred at least 3x/week over 3 months.
Must have at least:
-Cataplexy
-Hypocretin deficiency (measured in CSF)
-Nocturnal sleep PSG showing REM sleep </= 5 mins
-Multiple sleep latency tests showing mean sleep latency </= 8 mins
-2 or more sleep onset REM periods

Question 17

What is cataplexy?

Answer 17

Term for transient loss of motor tone in the presence of strong emotions (embarrassment, laughter, fear). Must attack the reflexes (are abolished) this is an important dx finding to separate cataplexy from conversion d/o.

Question 18

What circadian rhythm sleep-wake d/o?

Answer 18

A persistent/recurrent pattern of sleep disruption primarily d/t an alteration of the circadian system or to a misalignment b/w the endogenous CR and the slee-wake schedule required by an individual’s schedule (shift-work d/o).

Question 19

Name non-REM sleep arousal d/o’s?

Answer 19

Sleep terrors: espisodes of screaming or intense fear/flailing 2-3 hrs after falling asleep, often paired w/ sleep walking, which are not remembered. Most common in kids b/w age 2-12
Somnambulism: sleepwalking, mostly kids, mostly boys. Sedatives tend to worsen rather than cure.
Nightmare d/o: different from sleep terrors b/c they can remember and usually occurs during REM.

Question 20

REM-related parasomnias

Answer 20

Nightmare d/o: sometimes called dream anxiety attacks and usually free from other mental d/o such as PTSD
Recurrent isolated sleep paralysis: inability to make voluntary movements during sleep. Occurs at sleep onset or awakening. Very distressing and often part of a tetrad of sx associated w/ narcolepsy

Question 21

Name other parasomnias (4)?

Answer 21

RLS
Exploding head syndrome: hear a loud/imagined noise like an explosion
Sleep enuresis: bedwetting (usually resolves by age 6)
Parasomnia due to drugs or substances, or medical conditions (seizure d/o, ETOH, sleeping pills, Parkinson’s, Dementia)

Question 22

What are the breathing related sleep disroders?

Answer 22

OSA: dx w/ PSG showing at least 5 obstructive apneas or hyponeas per hr of sleep and either nocturnal breathing disturbances (snoring, gasping, breathing pauses, daytime sleepiness, fatigue or unrefreshing sleep despite sufficient opportunity).
-or PSG of >/=15 obstructive apneas/hr of sleep
Central sleep apnea