sleep/wake disorders Flashcards
clinical presentation of insomnia disorder
difficulty falling asleep, staying asleep, or early morning awakening with inability to return to sleep sufficient enough to impair function
clinical presentation of hypersomnolence disorder
excessive sleeping/sleepiness not d/t disrupted circadian rhythm problems
clinical presentation of narcolepsy
overwhelming desire to fall asleep (may do so spontaneously) when inappropriate. May experience cataplexy
definition of cataplexy
sudden loss of muscle tone while conscious ranging from transient weakness to complete paralysis that is often precipitated by laughter or strong emotions
what is psychophysiologic insomnia
conditioned to remain awake when thinking of sleeping
what is idiopathic insomnia
lifelong difficulty obtaining adequate sleep
what is paradoxical insomnia
person thinks they are awake and having insomnia but EEG shows healthy sleep
definition of klein-levin syndrome
recurrent periods of prolonged sleep with intermittent periods of healthy sleep and alert waking
classic presentation of klein-levin syndrome
18-20 hour sleep period with waking time characterized by voracious eating, hypersexuality, and disinhibition
what deficit is highly associated with narcolepsy
hypocretin
what are the types of central sleep apnea
idiopathic
cheyne-stokes breathing
comorbid with opioids
high altitude periodic breathing
d/t medical disorder
d/t substance
primary sleep apnea of infancy
types of circadian rhythm sleep wake disorders
delayed sleep phase type
advanced sleep phase type
irregular sleep-wake type
non-24-hour sleep-wake type
shift work type
jet lag type
unspecified type
difference between irregular sleep-wake type and non-24-hour sleep-wake type
irregular is unpredictable w/ no discernable circadian rhythm and non-24-hour circadian cycle is longer or shorter than 24 hours so sleep phases drift
types of parasomnias
NREM-related parasomnias
REM-related parasomnias
types of NREM-related parasomnias
sleepwalking
sleep terrors
confusional arousals
sleep-related eating disorder
what sleep phase does sleepwalking occur in
slow-wave sleep
another term for sleepwalking
somnambulism
sleep phase that sleep terrrors occur in
slow-wave sleep
REM related parasomnias
nightmare disorder
REM sleep behavior disorder
recurrent isolated sleep paralysis
when does sleep paralysis become a parasomnia
when it occurs at sleep onset or arousal
what are the other, less common parasomnias
exploding head syndrome
sleep-related hallucinations
sleep enuresis
d/t substance
d/t medical condition
what do yo always check in RLS
ferritin level
definition of periodic limb movement disorder
brief stereotypic repetitive movements of limbs usually in NREM approximately every 20-40 seconds and frequently associated with brief arousals and involves extension of big toe
which conditions can cause periodic limb movement disorder
folate deficiency
renal disease
anemia
antidepressant use
what is sleep-related bruxism?
grinding teeth in sleep
definition of sleep-related rhythmic movement disorder
repetitive movements typically involving head/neck occurring during transition from wakefulness to sleep or in light sleep
clinical tests for sleep disorders
polysomnography
home sleep test
multiple sleep latency test
maintenance of wakefulness test
actigraphy
what clinical test is needed for dx of narcolepsy
multiple sleep latency test
what confirms dx of narcolepsy
REM sleep on 2+ nap occasions
what is a multiple sleep latency test
provided opportunity for 20 minute nap every 2 hours without resisting sleep to determine sleep stage and sleep latency
what is a maintenance of wakefulness test
40 minutes sessions every 2 hours where patient sits in a dark room in a comfortable chair with a pillow and sleep latency is measured
what is actigraphy
device worn on wrist that measures and records movement
treatment options for insomnia
meds
CBT
universal sleep hygeine
stimulus control therapy
sleep restriction therapy
cognitive therapy
paradoxical intention
First-line pharmacologic treatment for insomnia
benzodiazepine receptor agonists (Z drugs)
pharmacologic treatments for insomnia other than Z drugs
benzodiazepines
low-dose antihistamine (doxepin)
melatonin
ramelteon
suvorexant
what is sleep restriction therapy
decreasing time spent awake in bed and avoid naps
what is stimulus control therapy
rules for sleep routines that must be followed consistently
types of relaxation therapy techniques
self-hypnosis
progressive muscle relaxation
guided imagery
breathing exercises
what is used to treat hypersomnolence disorder
usually stimulants
what are the wake-promoting agents utilized for narcolepsy
pitolisant
solriamfetol
REM sleep-repressing drugs used for narcolepsy
imipramine
protriptyline
sodium oxybate
therapeutic approaches to treating narcolepsy
scheduled naps
lifestyle adjustments
counseling
drug holidays
treatment options for obstructive sleep apnea
CPAP
BiPAP
oral appliance
position therapy
surgery
weight loss
treatment options for circadian rhythm sleep-wake disorders
light therapy
medication
chronotherapy
medication to treat nightmares
prazosin
behavioral techniques for nightmare disorder
desensitization and exposure therapy
image rehearsal therapy
lucid dream therapy
cognitive therapy
medication for sleep enuresis
desmopressin
first line medications for RLS
pramipexole
rotigotine
ropinirole
(dopaminergic agonists)
second-line meds for RLS
levodopa (dopamine precursor)
benzodiazepines
opiates
antiepileptics
benzodiazepines used to treat insomnia
flurazepam
temazepam
quazepam
estazolam
triazolam
nonbenzodiazepine agonists used to treat insomnia
zolpidem (Ambien)
zaleplon (Sonata)
eszopiclone (Lunesta)
zolpidem peak concentration and half-life
peak in 1.5h
half-life 2.6h
peak concentration and half-life of zaleplon
peak: 1h
half-life: 1h
peak concentration and half-life of eszopiclone
peak: 1h
half-life 6h
what is given for benzodiazepine OD that can also reveres ambien and sonata
flumazenil
does tolerance develop to ambien/sonata
no
dosage and clinical guidelines for Zaleplon
start 10mg (elderly and hepatic impairment 5mg)
need 4 hours of sleep
max dose 20mg
dosage and clinical guidelines for eszopiclone
2-3mg
startin dose NTE 1mg w/ hepatic impairment or if taking CYP3A4 inhibitors
dosage and clinical guidelines for zolpidem
5mg for females, elderly, and frail
5-10mg for males
impairs for 7-8 hours
melatonin agonists used for insomnia
melatonin
ramelteon
peak concentration and half-life of ramelteon
peak: 45 minutes
half-life: 1-2.6 hours
dosage and clinical guidelines of ramelteon
8mg within 30min of bedtime
do not take w/ high-fat meals
peak concentration and half-life of prazosin
peak: 3 hours
half-life: 2-3 hours
dosage and clinical guidelines for prazosin
6-15mg in divided doses
(higher than 20mg not more effective)
reduce to 1-2mg TID if on diuretic or antihypertensive
