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Psychiatry > Sleep Wake Disorders > Flashcards

Sleep Wake Disorders Flashcards

1
Q

What is the deepest stage of sleep?

A

N3

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2
Q

Which stage of sleep is important for memory consolidation?

A

Rem

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3
Q

Which sleep wake disorder has the predominant complant of dissatisfaction with sleep quality or quantity, associated with difficulty maintaing or initiating sleep and or early morning awakening

A

Insomnia disorder

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4
Q

Which sleep wake disorder presents with excessive sleepiness at least 3 times per week for at least 3 months despite a main sleep period lasting at least 7 hours

A

Hypersomnolence disorder

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5
Q

Which sleep wake disorder presents with recurrent periods of an irrepressible need to sleep or lapse into sleep, or napping occurring in the same day

A

Narcolepsy

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6
Q

Name 3 examples of breathing related sleep wake disorders

A
  • Obstructive sleep apnea/hypopnea
  • central sleep apnoea
  • Sleep related hypoventilation
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7
Q

Which sleep wake disorder presents with repeated episodes of arousals during sleep associated with vocalisation and or complex motor behaviours

A

Rem sleep behaviour disorder

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8
Q

Name 3 examples of parasomnias

A
  • Non-rem sleep arousal disorder :confusional arousals, sleepwalking (n 3 ), bruxism (n 2) sleep terrors (n3)
  • nightmare disorder
  • Rem sleep behaviour disorder
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9
Q

Which sleep wake disorder presents with an urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in legs

A

Restless legs syndrome

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10
Q

Time period of insomnia disorder?

A

At least 3 nights per week for 3 months

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11
Q

Define difficulty initiating steep

A

Subjective sleep latency greater than 20-30 minutes

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12
Q

Pharmacological treatment options for insomnia disorder? (5)

A

Short term < 2 weeks to restore normal sleep pattern

• Melatonin! receptor agonists : tasimelteon, ramelteon , agomelatine
• benzos (mainstay!)
• non-benzo hypnotics : “z” - zolpidem, zaleplon, zopiclone, eszopiclone
• Sedative hypnotics, gaba r agonists
• trazadone (sari)
• Sedating antipsychotics: quetiapine (atypical)
• antihistamines

Nb first line is sleep hygiene , light phase shift therapy , sleep diary etc

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13
Q

Time period of hypersomnolence disorder?

A

Excessive sleepiness at least 3 times per week for at least 3 months

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14
Q

Hypersommolence disorder symptoms? ( 3)

A

At least 1 of following:
• recurrent periods of sleep in same day
• prolonged non restorative sleep episode lasting at least 9 hours, wake up not refreshed
• Sleep inertia- difficulty being fully awake, feel groggy after waking

Despite a main sleep period lasting at least 7 hours

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15
Q

3 specifiers according to time period of hypersomnolence disorder?

A
  • acute: Less than month
  • subacute: 1-3 months
  • persistent: more than 3 months
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16
Q

What is mild Hypersomnolence disorder?

A

Difficulty maintaining daytime alertness 1-2 days per week

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17
Q

What is moderate hypersomnolence disorder?

A

Difficulty maintaining daytime alertness 3-4 days per week

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18
Q

What is severe hypersomnolence disorder?

A

Difficulty maintaining daytime alertness 5-7 days per week

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19
Q

Name 5 risk and prognostic factors for hypersomnolence disorder

A
  1. stress
  2. Alcohol
  3. Viral infections
  4. Head trauma
  5. Familial ad
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20
Q

Time period of narcolepsy?

A

At least 3 times per week for 3 mouths

21
Q

Name 3 diagnostic features of narcolepsy

A

At least 1:

  1. episodes of cataplexy
  2. Hypocretin deficiency in csf
  3. Nocturnal sleep polysomnogram showing rem sleep latency 15 or less minutes , or a multiple sleep latency test showing mean sleep latency 8 minutes or less and 2 or more sleep-onset rem periods
22
Q

First line drug treatment of narcolepsy? (3)

A

Stimulants to help stay awake:
• modafinil (provigil)
• methylphenidate (ritalin)
• Atomoxetine

( Can use ssri for hallucinations)

23
Q

Name 2 examples of non-rem sleep arousal disorders

A

• Sleepwalking
• sleep night terrors
Both n3.

24
Q

Which sleep wake disorder is described by repeated dysphoric, well remembered dreams involving efforts to avoid threats to survival/security or physical integrity.

A

Nightmare disorder - one of the parasomnias

25
Q

Which sleep wake disorder is described by repeated episodes of arousals during sleep associated with vocalisation and or complex motor behaviours?

A

Rem sleep behaviour disorder- type of parasomnias

26
Q

Which group sleep wake disorders is described by abnormal behaviour or physiological events during sleep?

A

Parasomnias

27
Q

Time period of restless legs syndrome?

A

At least 3 times per week for 3 months

28
Q

Name 5 risk or prognostic factors for restless legs syndrome

A
  • Family history
  • trauma
  • iron deficiency
  • uraemia
  • pregnancy
  • chronic renal failure
29
Q

Name 5 drugs that can cause medication or substance induced sleep disorder

A

• Antipsychotics : daytime sedation, increased appetite risk osa, impact on sleep architecture and decreased rem sleep, da antagonism aggravates plmd / rls
• ssri :rem suppress, increased rem latency
• alcohol
• ampetamine
• tobacco
Cocaine, caffeine, cannabis, opioids…

30
Q

Name the 2 diagnostic features of osa

A

One of following;
1. Evidence by polysomnography of at least 5 osa or hypopneas per hour of sleep, with either of these symptoms
• nocturnal breathing disturbances: snoring, snorting, breathing pauses during sleep
• day time sleepiness, fatigue or non-refreshing sleep despite sufficient opportunity
2. Polysomnogram shows 5 or more osa and or hypopneas per hour of sleep regardless of symptoms

31
Q

Name 5 common comorbidities of osa

A 
• Cad
• heart failure
• CVA
• diabetes
• parkinsons
Depression
32
Q

Name 10 causes sleep disorders

A

SLEEP WAKE

  • substances: alcohol, opioid, caffeine, stimulant
  • lungs: asthma, copd, central alveolar hypoventilation
  • environment: hot, noisy
  • endocrine: hyperthyroid, hormone fluctuations eg menopause, hypogonadism
  • Psychiatric: MDD , anxiety, PTSD, panic disorder, stress, bereavement
  • withdrawal
  • aging
  • kidney: paroxysmal nocturnal haemoglobinuria
  • employment: shift work
  • drugs: antidepressants, benZos, bronchodilators
33
Q

Name 6 specifiers insomnia disorder

A
  • Episodic: 1-3 months
  • persistent: 3 or more months
  • recurrent: 2 or more episodes in 1 year
  • with non-sleep disorder mental comorbidity (including sud)
  • with other medical comorbidity
  • with other sleep disorder
34
Q

Name 3 types insomnia

A
  • Initial insomnia: sleep onset difficulty > 20-30 minutes
  • middle: maintenance
  • late /terminal: early morning awakening + inability to return to sleep
35
Q

Name 9 differential diagnoses insomnia

A
  • Normal sleep variation
  • insomnia disorder
  • situational/ acute insomnia (for a few days,associated life events)
  • delayed sleep phase + shift work: circadian rhythm shift work disorder
  • breathing related sleep disorders
  • restless leg syndrome
  • Narcolepsy
  • parasomnias
  • substance/ medication induced sleep disorder, insomnia type
36
Q

Name 5 subtypes narcolepsy

A
  • Narcolepsy without cataplexy but with hypocretin deficiency
  • narcolepsy with cataplexy but without hypocretin deficiency
  • autosomal dominant cerebellar ataxia, deafness and narcolepsy
  • autosomal dominant narcolepsy,obesity and type 2 diabetes
  • narcolepsy secondary to AMC
37
Q

Name 3 features non-rem sleep arousal disorders

A
  • Incomplete awakening from sleep during N3 with sleepwalking/ sleep terrors
  • no/little dream imagery recalled
  • amnesia for the episodes
38
Q

Name 2 criteria of nightmare disorder

A
  • Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical in­ tegrity and that generally occur during the second half of the major sleep episode.
  • On awakening from the dysphoric dreams,the individual rapidly becomes oriented and alert.
39
Q

Name 4 criteria of REM sleep behaviour disorder

A
  • Repeated episodes of arousal during sleep associated with vocalization and/or com­plex motor behaviors.
  • These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later por­tions of the sleep period, and uncommonly occur during daytime naps.
  • Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented.
  • Either of the following:
    1. REM sleep without atonia on polysomnographic recording.
    2. A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s disease, multiple system atrophy)
40
Q

Which medications should be used and avoided in REM sleep behaviour disorder (5)

A

Avoid:

  • mirtazepine ( ttad )
  • SsRI
  • venlafaxine (snri)

Use:

  • clonazepam
  • tad
  • melatonin
  • da agonists
41
Q

Name 2 specifiers of substance/medication induced sleep disorder

A
  • With onset during withdrawal
  • with onset during intoxication
42
Q

Name 3 types central sleep apnoea

A
  • Idiopathic: variability in respiratory effort
  • Cheyne -stokes breathing: crescendo-decrescendo variation in tv
  • central sleep apnoea comborbid with opioid use: affect resp rhythm generators in medulla
43
Q

Define sleep-related hypoventilation

A

Decreased respiration episodes associated with elevated co2 levels

44
Q

Name 3 specifiers for sleep-related hypoventilation

A
  • Idiopathic hypoventilation
  • congenital central alveolar hypoventilation
  • comorbid sleep related hypoventilation ( eg substance use, neuro disorders)
45
Q

Define apnoea

A

Absence breathing > 10 seconds

46
Q

Define hypopnea

A

Excessive decrease rate/ depth breathing ( > 50% reduction in ventilation for > 10 seconds)

47
Q

Name 3 specifiers obstructive sleep apnoea hypopnea

A
  • Mild: apnoea hypopnea index < 15
  • moderate: 15-30
  • severe: >30
48
Q

Name 15 sleep-wake disorders

A
  • Insomnia disorder (3/week for 3 mo for all)
  • hypersomnolence disorder
  • narcolepsy
  • obstructive sleep apnoea hypopNoea
  • central sleep apnoea
  • sleep-related hypoventilation
  • circadian rhythm sleep- wake disorders
  • ”s/m” induced sleep disorder
  • other specified insomnia disorder
  • unspecified insomnia disorder
  • other specified hypersomnolence disorder
  • unspecified hypersomnolence disorder
  • other specified sleep-wake disorder
  • unspecified sleep- wake disorder

Parasomnias:

  • restless legs syndrome
  • non-rapid eye movement sleep arousal disorders
  • rapid eye movement sleep behaviour disorder
  • nightmare disorder

Psychiatry (31 decks)

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