Sleep-Wake Disorders Flashcards by Nicole Pritchard

What are the stages of non-REM sleep?

1: Transitional
2: Light Sleep
3 and 4: disoriented upon awakening and amnesia for a brief awakening
night terrors

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What occurs during REM sleep??

Physiological activation
dreaming
paralysis

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What are the six major sleep wake disorders?

1) Insomnia Disorder
2) Hypersomnolence Disorder
3) Breathing related sleep disorder
4) Narcolepsy
5) Circadian Rhythm Sleep Disorder
6) Parasomnias

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How does one diagnose a sleep disorder?

1) Interview with patient

2) Polysomnography (PSG)

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What is the diagnostic criteria for Insomnia Disorder (primary insomnia)?

Difficulty initiating or maintaining sleep for > 3 months

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What is the etiology for Insomnia?

The bed is used for wakefulness activities therefore the bed is not a cue for sleep its a cue for wake

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What is one of the treatments for Insomnia?

Stimulus Control Technique:
Make the bed a cue or trigger for falling asleep.
Only go to bed when your really tired after 10 minutes if not asleep then get out of bed and do another activity.
Do not go to bed until you fall asleep in 10 minutes
takes a few weeks to cure this

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What are the pharmacological approaches to treatment of insomnia?

Sedatives: benzodiazepines (diazepam)

Benzodiazepine-like drugs: Zolpidem (fewer side effects)(try these drugs first)

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What are the side effects of pharmacological treatments?

poor sleep quality due to decreased slow wave sleep and REM

aka changes the sleep architecture

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What is the diagnostic criteria for Hypersomnolence Disorder (primary hypersomnia)?

Excessive sleepiness despite significant sleep (at least 7 hrs) for > 3 months

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What are the features of an individual who has hypersomnolence?

Sleeping average of 9 hours a night
Taking naps throughout the day
Normal PSG
Still tired even though enough sleep is had

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What is the treatment for Hypersomnolence?

Stimulants (methylphenidate)

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What is the diagnostic criteria for Narcolepsy?

1) Irresistible sleep occurring within the same day, several times per week, for >3 months
2) At least one of the following
* Cataplexy
* Hypocretin deficiency
* characteristic PSG abnormalities

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Cataplexy is the sudden loss of muscle tone while awake or while asleep?

while awake

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When typically do cataplexy episodes happen?

precipitated by emotion

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how is a nap attack different from cataplexy?

Nap attack occurs while sleeping

Cataplexy occurs while awake

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Is cataplexy considered an aberrant manifestation of REM or non-REM sleep?

REM sleep

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How would a physician diagnose hypocretin deficiency?

spinal tap needed

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The final criteria measure for a diagnosis of Narcolepsy is PSG abnormalities. What is seen with REM sleep in the PSG?

Decreased REM sleep latency (aka individuals enter REM super fast) (normally takes 90 minutes for individuals to enter REM)

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What are the treatments for Narcolepsy?

1) Stimulants (modafinil) –> help with the tiredness
2) Antidepressants —> helps with the cataplexy
these two need to be given together
(Xyrem aka sodium oxybate is an option but this is very tightly controlled)

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What are the two breathing related sleep disorders?

1) Obstructive Sleep Apnea Hypopnea (OSAH)

2) Central Sleep Apnea

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What is the diagnostic criteria for obstructive sleep apnea hypopnea (OSAH)?

Multiple episodes of breathing cessation/reduction occur per night due to an upper airway obstruction

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In OSAH what causes the obstruction?

extra tissue in the throat that occludes the trachea when person lays on back

What is the typical profile of a patient who has OSAH?

middle aged fat male who snores

YUMMY–> Vanessa’s Future Husband

Why do periods of apneas/hypopneas cause sleepiness?

Rise in CO2 causes temporary arousal from sleep which makes person go from deep to light sleep Often patients are unaware because they dont awake so they think they are getting enough sleep

What is the gold standard treatment for patients with OSAH?

Continuous Positive Airway Pressure (CPAP) | device maintains an open airway at specific air pressure

What is the diagnostic criteria for central sleep apnea (CSA)?

Multiple episodes of cessation of breathing per night caused by CSN dysregulation of breathing

What is the etiology of CSA?

Idiopathic (aka no idea) Drugs CHF

How does a PSG test distinguish OSAH from CSA?

OSAH --> thoracic effort occurs | CSA --> No thoracic effort occurs

Which is more severe OSAH or CSA? Why?

CSA because individuals just stop breathing and the cause is usually unknown

What is the diagnostic criteria for circadian rhythm sleep wake disorder (CRSWD)??

Excessive sleepiness or insomnia resulting from a mismatch between a persons circadian sleep wake pattern and the sleep wake schedule required by the environment

What is the treatment for CRSWD?

phototherapy at strategic times during the day

Settings of the circadian clock is governed by which nucleus?

suprachiasmatic nucleus (SCN)

Describe the pathway for waking up

Light --> SCN --> inhibits pineal gland --> decreases melatonin --> alert

Describe the pathway for a drowsy person

No light --> SCN --> activates pineal gland --> increases melatonin -> drowsy

What are the parasomnias?

1) Non-REM sleep arousal disorder 2) Nightmare disorder 3) REM sleep behavior disorder 4) Restless leg syndrome 5) Periodic Limb movements

In general terms what is Non-REM sleep arousal disorder?

Repeated episodes of incomplete awakening from sleep with either sleep walking or sleep terrors

can patients have both sleep walking and sleep terrors?

of course

What is the difference between sleep walking and sleep terrors?

walking ---> walking about with a blank and staring face; difficulty awakening Terrors --> abrupt terror arousals

what is the treatment for non-rem sleep arousal disorder?

Benzodiazepines

typically when does non-rem sleep arousal disorder occur?

within first 1/3 of sleep (during slow wave sleep (SWS))

In general what does nightmare disorder involve?

Extremely dysphoric dreams that typically involve threats to survival, security or physical integrity.

What is nightmare disorder characterized by?

1) Awakening in the 2nd half of sleep period (during REM sleep) 2) Rapid alterness upon awakening 3) Dream content is well remembered 4) good recall of awakening the next morning

What is a treatment option for nightmare disorder?

antidepressants to decrease REM

Describe REM sleep behavior disorder (RSBD)

Vocalizations and/or complex motor movements occur during REM sleep

REM sleep without atonia in RSBD is confirmed by what test?

PSG

What are typical features of RSBD?

action filled, violent dreams immediately awake, oriented and alert with dream recall most common in males >50 y.o progressive and associated with neurodegenerative disease

What is the key drug used for treatment of RSBD?

Clonazepam (benzodiazepine)

What are the features of restless leg syndrome (RLS)?

urge to move legs in response to uncomfortable sensations with features: * occurs/worsens during inactivity * nocturnal worsening of symptoms * temporary relief from discomfort by moving

During RLS are patients aware of their symptoms ?

YES | typically complain of insomnia

What is the treatment for RLS?

Anti parkinson's drugs due to increased DA

Describe periodic limb movements (PLMs)

repetitive muscle contractions during sleep, usually of the lower limb.

what typically does the patient complain of in PLMs?

daytime sleepiness

is patient aware movements during PLMs?

Is PLMs associated with a specific sleep stage?

no | involves multiple sleep stage arousals

How do you confirm PLMs?

leg electromyogram during PSG

What are treatments for PLMs?

Same drugs as RLS