Sleep Wake Disorders Flashcards
Define sleep
Rapidly reversible state of decreased responsiveness, decreased motor activity and decreased metabolism
Neurotransmitters involved in sleep
Serotonin
ACh
Norepinephrine
Dopamine (wakefulness)
Causes of sleep wake disorders
SLEEP WAKED
Substances
Lungs - COPD, Asthma, OSA
Environment - loud, hot
Endocrine - hyperthyroidism, menopause
Psychiatric - MDD, GAD, PTSD, stress, panic disorder
Withdrawal
Age increasing
Kidney - paroxysmal nocturnal haemoglobinuria
Employment - shift worker
Drugs - benzo’s, bronchodilators, antidepressants
Specifiers for insomnia disorder
Episodic (sx 1month to 3 months)
Persistent (sx >3 months)
Recurrent (2 or more episodes in one year)
Types of insomnia disorder
Initial insomnia (sleep onset)
Middle insomnia (sleep maintenance)
Late/terminal insomnia (early morning awakening and inability to return to sleep)
DSM for insomnia disorder
A: Decrease in sleep quality/quantity associated with at least one of:
>difficulty initiating sleep
>difficulty maintaining sleep
>early morning awakening with failure to fall back asleep
B: sleep disturbance causes significant distress/impairment in social, occupational, education, behaviour functioning
C: occurs at least 3 nights/week for at least 3 months, occurs despite adequate sleep opportunity
D:not explained/occur during by another sleep wake disorder
E: not attributable to physiological effect of substance
F: AMC doesn’t explain insomnia
Pharmacotherapy used for insomnia disorder
Short term treatment to allow return of normal sleep pattern
>melatonin
>non-benzo hypnotic
>melatonin-receptor agonists
>trazadone (antidepressant)
>antihistamine (ACh side effects)
>benzodiazepines = mainstay of short term treatment
Grading of hyperspmnolence
Mild: 1-2days/week
Moderate: 3-4days/week
Severe: 5-7days/week
Define hypersomnolence
Excessive daytime sleepiness at least 3 times per week for at least 3 months, despite main sleep period lasting at least 7 hours
Manifestations of hypersomnolence
1) recurrent periods of sleep in same day
2) prolonged non-restorative sleep episode (at least 9 hours)
3) sleep inertia (groggy, difficulty being fully awake)
Risk factors for hypersomnolence
Stress
Alcohol use
Head trauma
Viral infections
Famailial
Define narcolepsy
Recurrent periods of an irrepressible need to sleep or lapse into sleep or napping occurring in the same day, at least 3 times per week over 3 months
What is cataplexy
The sudden loss of muscle tone while the person is awake leading to weakness and loss of voluntary muscle control, often triggered by laughing, fear, anger, stress or excitement
What are needed in narcolepsy according to DSM
At least 1
>cataplexy episodes (history)
>hypocretin deficiency (CSF)
>nocturnal sleep polysomnogram (multiple sleep latency test: Non-REM latency <15mins or mean sleep latency <8mins and > sleep onset REM periods)
Define parasomnia
Abnormal behavioural events occurring in association with sleep
