Sleep-Wake Disorders Flashcards
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
What occurs during REM sleep??
Physiological activation
dreaming
paralysis
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
How does one diagnose a sleep disorder?
1) Interview with patient
2) Polysomnography (PSG)
What is the diagnostic criteria for Insomnia Disorder (primary insomnia)?
Difficulty initiating or maintaining sleep for > 3 months
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
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
What are the pharmacological approaches to treatment of insomnia?
Sedatives: benzodiazepines (diazepam)
Benzodiazepine-like drugs: Zolpidem (fewer side effects)(try these drugs first)
What are the side effects of pharmacological treatments?
poor sleep quality due to decreased slow wave sleep and REM
aka changes the sleep architecture
What is the diagnostic criteria for Hypersomnolence Disorder (primary hypersomnia)?
Excessive sleepiness despite significant sleep (at least 7 hrs) for > 3 months
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
What is the treatment for Hypersomnolence?
Stimulants (methylphenidate)
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
Cataplexy is the sudden loss of muscle tone while awake or while asleep?
while awake
When typically do cataplexy episodes happen?
precipitated by emotion
how is a nap attack different from cataplexy?
Nap attack occurs while sleeping
Cataplexy occurs while awake
Is cataplexy considered an aberrant manifestation of REM or non-REM sleep?
REM sleep
How would a physician diagnose hypocretin deficiency?
spinal tap needed
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)
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)
What are the two breathing related sleep disorders?
1) Obstructive Sleep Apnea Hypopnea (OSAH)
2) Central Sleep Apnea
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