sleep/wake disorders Flashcards
REM sleep
20-25% total sleep
story-like dreams occur
NREM stage 1
5% total sleep
transition from wake to sleep
NREM stage 2
50% of total sleep
deep sleep
NREM stage 3
20% total sleep
deepest level of sleep
sleep continuity
overall balance of sleep/wakefulness during the night
sleep architecture
amount/distribution of specific sleep phases
sleep efficiency
ratio of time spent asleep to time spent in bed expressed as a percentage
generalized definition of insomnia disorder
recurrent unsatisfactory because or at least 1:
-difficulty falling asleep
-difficulty staying asleep
-early waking w/ inability to go back to sleep
occurs despite adequate opportunity for sleep
time duration of symptoms for insomnia diagnosis
at least 3 nights/week for at least 3 months
specifiers for insomnia disorder
w/ mental disorder
w/ medical condition
w/ comorbid sleep disorder
episodic
persistent
recurrent
episodic specifier for insomnia
symptoms for at least 1 month but less than 3
persistent insomnia disorder
symptoms for 3+ months
recurrent insomnia disorder
2+ episodes in a year
what counts as early morning awakening
at least 1 hour before scheduled wake time
OR
before total sleep time has reached 6.5 hours
symptoms of increased arousal r/t insomnia and generalized activation of HPA axis
increased cortisol levels
HR variability
stress reactivity
increased metabolic rate
diagnostic criteria for hypersomnolence disorder
subjective excessive sleepiness despite adequate sleep period of 7+ hours with at least one manifestation
3 manifestations (of which you must have 1) of hypersomnolence disorder
-recurrent periods of sleep/lapses into sleep in the same day
-sleep longer than 9 hours that is nonrestorative
-difficulty being fully awake after abrupt awakening
time duration for dx of hypersomnolence disorder
at least 3/wk for at least 3 months
specifiers for hypersomnolence disorder
with mental disorder
with medical condition
with comorbid sleep disorder
duration of acute hypersomnolence disorder
less than 1 month
duration of subacute hypersomnolence disorder
1-3 months
duration of persistent hypersomnolence disorder
3+ months
mild hypersomnolence disorder
trouble 1-2 days/week
moderate hypersomnolence disorder
difficulty 3-4 days/week
severe hypersomnolence disorder
difficulty 5-7 days/week
sleep inertia
impaired performance/reduced vigilance following awakening from regular sleep episode (also called sleep drunkenness)
sleep efficiecy with hypersomnolence disorder
generally fall asleep quickly with good sleep efficiency
does cataplexy ever occur in hypersomnolence disorder
no
kleine-levin syndrome
recurrent episodes of hypersomnia
general description of narcolepsy narcolepsy
recurrent need to sleep, unintentional sleep, or napping within the same day along with 1 of 3 other manifestations
duration of symptoms for narcolepsy diagnosis
at least 3 days/week for 3 months
what are the three other manifestations of narcolepsy (of which you must have 1)
cataplexy
hypocretin deficiency in CSF
polysomnographic changes
cataplexy
brief sudden bilateral low muscle tone w/ maintained consciousness precipitated by joking/laughter
polysomnographic changes possible in narcolepsy
-REM sleep latency less than/equal to 15 minutes
-mean sleep latency less than 8 minutes on multiple tests
-2+ sleep onset REM episodes
narcolepsy type 1
with cataplexy or hypocretin deficiency
narcolepsy type 2
without cataplexy
without hypocretin deficiency (or unmeasured)
mild narcolepsy
need naps 1-2x/day
sleep disturbance mild
cataplexy absent/infrequent
moderate narcolepsy
-multiple naps daily
-sleep moderately disturbed
-cataplexy daily or every few days
severe narcolepsy
nearly constant sleepiness
highly disturbed sleep
cataplexy is drug resistant w/ multiple attacks daily
muscles involved in cataplexy
neck, jaw, arms, legs, whole body
(awake/aware during cataplexy)
associated features of narcolepsy
-automatic behaviors may occur
-hypnagogic hallucinations and sleep paralysis are common
-nocturnal eating may occur
what happens to reflexes during cataplexy
they are abolished
breathing-related sleep disorders
obstructive sleep apnea
central sleep apnea
sleep-related hypoventilation
2 types of diagnostic criteria for obstructive sleep apnea
-polysomnography show 5+ OSAs/hypopnea per hour and either there is nocturnal breathing disturbance of daytime sleepiness
OR
-polysomnography shows 15+ OSAs/hypopneas per hour regardless of other symptoms
mild obstructive sleep apnea
apnea-hypopnea index <15
moderate obstructive sleep apnea
apnea-hypopnea index 15-30
severe obstructive sleep apnea
apnea-hypopnea index >30
apnea
total absence of airflow
hypopnea
diminished airflow
common nonspecific symptoms of obstructive sleep apnea
-heartburn
-nocturia
-morning headaches
-dry mouth
-ED and reduced libido
diagnostic criteria for central sleep apnea
polysomnography shows 5+ central sleep apnea episodes per hour not better explained by another sleep disorder
specifiers for central sleep apnea
idiopathic
cheyne-stokes breathing
comorbid w/ opioid use
cheyne-stokes breathing
periodic crescendo/decrescendo variation in tidal volume resulting in apneas/hypopneas
onset of Cheyne Stokes breathing is typically associated with what
development of HF
diagnostic criteria for sleep-related hypoventilation
polysomnography shows episodes of decreased respirations associated with increased CO2 levels
specifiers for sleep-related hypoventilation
idiopathic
congenital central alveolar
comorbidities
idiopathic hypoventilation
not attributable to any readily identifiable condition
congenital central alveolar hypoventilation
perinatal shallow breathing or cyanosis/apnea during sleep
comorbid sleep-related hypoventilation
occurs as a consequence of a medical condition
diagnostic markers for sleep-related hypoventilation
-increased arterial pCO2 to >55mmHg during sleep
OR
-greater than or equal to 10mmHg increase in pCO2 levels over awake supine values
types of circadian rhythm sleep wake cycle disorders
delayed sleep phase type
advanced sleep phase type
irregular sleep phase type
non-24 hour sleep wake cycle
shift work type
unspecified type
definition of delayed sleep phase type
delayed sleep onset/awakening (usually greater than 2 hours) w/ inability to sleep/wake at desired times
definition of advanced sleep phase type
advanced sleep onset/awakening with inability to stay awake/asleep until desired time
definition of irregular sleep phase type
temporarily disorganized sleep-wake cycle w/ variable timing of sleep/wake periods throughout the day
definition of non-24-hour sleep/wake type
sleep/wake cycle not synced to 24 hour environment with consistent daily drift of onset/wake times
episodic circadian rhythm disorders
lasting at least 1 month but less than 3
persistent circadian sleep wake disorders
lasts 3+ months
recurrent circadian rhythm sleep wake cycles
2+ episodes in a year
definition of irregular sleep wake type
complete lack of circadian rhythm
no major sleep period
sleep is fragmented into at least 3 periods during 24 hours
definition of non-24 hour sleep wake type
c/o insomnia/hypersomnia r/t lack of synchronization between light/dark and circadian cycles
sleep latency/sleep phase in non-24-hour sleep-wake type
sleep latency gradually increases until sleep onset insomnia. Sleep phase drifts so sleep is in daytime w/ c/o hypersomnia
what types of patients typically develop non-24-hour sleep wake cycle type
visually impaired. Rare in sighted people
dx and symptoms of shift-work type
dx made primarily based on hx of shift work w/ c/o sleepiness at work and difficulties sleeping at home
list the different parasomnias
NREM sleep arousal disorders
nightmare disorder
REM sleep behavior disorder
diagnostic criteria for NREM sleep arousal disorder parasomnia
episodes of incomplete waking accompanied by either sleepwalking or sleep terrors that the patient doesn’t remember2
types of sleepwalking
with sleep eating
with sleep-related sexual behavior
onset of sleepwalking in adulthood should prompt suspicion of what
sleep apnea, nocturnal seizures, or medication side effects
diagnostic criteria for nightmare disorder
repeated nightmares that rapidly awake patient and cause clinically significant distress
specifiers for nightmare disorder
during sleep onset
comorbidity
duration
severity
comorbidity specifiers for nightmare disorder
with mental disorder
with medical condition
with another sleep disorder
(code comorbid disorder after nightmare disorder)
duration specifier for nightmare disorder
acute - 1 month or less
subacute - >1 month, <6 months
persistent - longer than 6 months
severity specifiers for nightmare disorder
mild - <1 episode/week
moderate - 1+ episode/week, less than nightly
severe - nightly
diagnostic criteria for REM sleep behavior disorder parasomnia
repeated arousals w/ vocalization and/or complex behaviors
what phase of sleep does REM sleep behavior disorder arise from
REM
usually in later half of night
main adverse effect of REM sleep behavior disorder parasomnia
significant injury from “acting out dreams”
definition of restless leg syndrome
frequent urge to move legs in response to uncomfortable sensations
characteristics of urges in RLS that are required for dx
-worsens during rest/inactivity
-partially/totally relieved by movement
-worse in the evening/night
duration of symptoms for RLS dx
at least 3x/wk for at least 3 months
what is NOT typical on exam for RLS
-leg cramps relieved w/ 1 position change
-joint limitations
-soreness on palpation
type specifiers for substance/medication-induced sleep disorder
insomnia type
daytime sleepiness type
parasomnia type (abnormal sleep behaviors)
mixed type
what are onset specifiers for substance/medication-induced sleep disorder
onset during intoxication
onset during withdrawal
onset after medication use
