Sleep-wake disorders Flashcards

1
Q

Sleep disorders are divided into either

A

Dyssomnias: insufficient (insomnia), excessive (hypersomnia), or altered timing of sleep
Parasomnias: unusual sleep-related behaviors

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2
Q

Components of a sleep history

A
Activities prior to bedtime 
Bed partner 
Consequence on waking function/QOL
Drug regimen, meds
Exacerbating/relieving factors
Frequency/duration
Genetic factors/FH
Habits (EtOH, caffeine, nicotine, etc)
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3
Q

What are the main types of symptoms of insomnia disorder?

A

Difficulty going to sleep (sleep-onset insomnia)
Frequent nocturnal awakenings (sleep-maintenance insomnia)
Early morning awakenings (sleep-offset insomnia)
Nonrestorative sleep

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4
Q

Diagnostic criteria for insomnia disorder

A
  • Difficulty initiating or maintaining sleep
  • At least 3x/wk for 3 months
  • Causes distress or dysfunction
  • Occurs despite adequate opportunity to sleep
  • Does not occur exclusively during another sleep-wake disorder
  • Not from medications, meds, etc
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5
Q

Etiology of insomnia disorders

A

Subclinical mood or anxiety disorder
Preoccupation with perceived inability to sleep
Poor sleep hygiene

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6
Q

Management of insomnia disorder

A

Sleep hygiene
CBT
Drugs: Benzos, zolpidem, eszopiclone, zaleplon, trazodone, amitriptyline, doxepin

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7
Q

Diagnostic criteria for hypersomnia disorder

A
  • Excessive sleepiness despite at least 7 hours of sleep with at least one of: multiple times sleeping in the same day; prolonged non-restorative sleep >9hrs; difficulty being fully awake
  • At least 3x/wk for at least 3 mos
  • Distress or dysfunction
  • Etc…
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8
Q

Etiology of hypersomnia disorder

A

Viral infections (HIV, mono, Guillan-Barre)
Head trauma
Genetic

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9
Q

Treatment of hypersomnia disorder

A

Modafinil or stimulants

Scheduled napping

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10
Q

What are the characteristics of central sleep apnea?

A

Five or more central apneas per hour of sleep. Can be idiopathic with Cheyne-Stokes respirations (periodic crescendo-decrescendo variation in tidal volume due to heart failure, stroke, or renal failure) or due to opioid use

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11
Q

Treatment for central sleep apnea

A

Treat underlying condition
CPAP/BiPAP
Supplemental O2
Medications (acetazolamide, theophylline, sedative-hypnotics)

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12
Q

Diagnostic criteria for narcolepsy

A

Recurrent episodes of needing to sleep, lapsing into sleep, or napping during the day, occuring at least 3x/wk for at least 3 months with at least one of:
–Cataplexy
–Hypocretin deficiency in CSF
–Reduced REM sleep latency on polysomnography
Hallucinations and/or sleep paralysis at the beginning or end of sleep episodes are common but not necessary for diagnosis

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13
Q

Management of narcolepsy

A

Sleep hygeine
Scheduled daytime naps
Avoidance of shift work
Amphetamines or non-amphetamine stimulants for excessive daytime sleepiness
For cataplexy: sodium oxybate, TCAs, or SSRIs/SNRIs

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14
Q

What is delayed sleep phase disorder?

A

Chronic or recurrent delay in sleep onset and awakening times with preserved quality and duration of sleep

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15
Q

Risk factors for delayed sleep phase disorder

A

Puberty, caffeine or nicotine use, irregular sleep schedules

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16
Q

Treatments for delayed sleep phase disorder

A

Timed bright light phototherapy in early morning
Administration of melatonin in the evening
Chronotherapy (delay bedtime by a few hours each night)

17
Q

What is advanced sleep phase disorder?

A

Normal duration and quality of sleep with sleep onset and awakening earlier than desired

18
Q

Risk factors for advanced sleep phase disorder

19
Q

Treatment for advanced sleep phase disorder

A

Timed bright light phototherapy prior to bedtime

20
Q

What is shift-work disorder?

A

Sleep deprivation and misalignment of circadian rhythm 2/2 nontraditional work hours

21
Q

Risk factors for sleepwalking

A
Sleep deprivation
Irregular sleep schedules
Stress
Fatigue
OSA
Nocturnal seizures
Fever
Meds, including sedatives/hyponotics, lithium, anticholinergics
Family history
22
Q

Management of sleepwalking

A

Education, reassurance, ensure safe environment, sleep hygiene, low-dose benzos if refractory

23
Q

What are the features of sleep terrors?

A

Recurrent episodes of sudden terror arousals that occur during slow-wave sleep
Signs of autonomic arousal (elevated BP, RR, diaphoresis)
Difficulty arousing during an episode
Dreams aren’t remembered and there is amnesia for the episode

24
Q

What are the features of nightmare disorder?

A

Recurrent frightening dreams that occur during the second half of sleep episode
Terminate in awakening with vivid recall
Causes clinically significant distress or dysfunction

25
Management of nightmare disorder
Reassurance Desensitization/imagery rehearsal therapy Medications rarely indicated, but can use prazosin and antidepressants
26
Risk factors for REM sleep behavior disorder
Older age, generally >50 Psychiatric meds including TCAs, SSRIs, SNRIs, B-blockers Narcolepsy Neurodegenerative disorders: Parkinson's, multiple system atrophy, Lewy body dementia
27
Treatment for restless leg syndrome
Drugs: pramipexole, ropinirole, or benzos Iron replacement if ferritin is low Remove offending agents if possible