Sleeping & Eating Disorders Flashcards
difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep
insomnia
insomnia symptoms that last at least 1 month but less than 3 months
episodic
insomnia symptoms that last 3 months or longer
persistent
two or more episodes of insomnia within the space of 1 year
recurrent
what is the most common form of insomnia?
acute insomnia (lasts a few days/weeks)
what 3 diagnostic tests should be considered for a patient presenting with insomnia?
polysomnography
thyroid-stimulating hormone
urine toxicology
what 2 questionaries can be used for a patient presenting with insomnia?
Pittsburgh sleep quality index (PSQI)
Sleep problems
what are 3 general managements for patients with insomnia?
counsel about sleep hygiene
cognitive behavioral therapy
medications
which medication can be used to treat insomnia chronically?
rozerem (melatonin receptor agonist)
7 medications used to treat insomnia, but have abuse potential
zalepion
zolpidem
eszopidone
triazolam
temazepam
estazolam
flurazepam
what should we counsel to patients with insomnia NOT to use?
OTC antihistamines
incurable rapid eye movement (REM) sleep disorder characterized by excessive daytime sleepiness; may be associated with cataplexy, hypnagogic hallucinations, or sleep paralysis
narcolepsy
what is type 1 narcolepsy?
narcolepsy with cataplexy
what is type 2 narcolepsy?
narcolepsy without cataplexy
which type of narcolepsy is most common?
type 1
narcolepsy results from the loss of the neuropeptides _____ and _____
orexin-A
orexin-B
what ages does narcolepsy peak?
15 and 35
infrequent cataplexy (less than once per week), need for naps once or twice per day, and less disturbed nocturnal sleep
mild narcolepsy
cataplexy once daily or every few days, disturbed nocturnal sleep, and need for multiple naps daily
moderate narcolepsy
drug-resistant cataplexy with multiple attacks daily, constant sleepiness, and disturbed nocturnal sleep
severe narcolepsy
what is the classic tetrad of narcolepsy presentation?
EDS
cataplexy
sleep paralysis
hypnagogic hallucinations
what are the 2 cardinal symptoms of narcolepsy?
EDS
sleep attacks during stimulating situations (driving)
how long can sudden sleep attacks last in narcolepsy?
5-20 mins
sudden transient episode of total or partial loss of motor tone, triggered by strong emotions (laughing, anger, or fright)
cataplexy
transient inability to move or speak either while falling asleep or on awakening
sleep paralysis
in which type of narcolepsy does sleep paralysis occur?
type 1
in which type of narcolepsy do hallucinations occur?
type 1
what kind of behavior may be present in narcolepsy? (2)
retrograde amnesia
automatic behavior
what are 2 diagnostics that can be used for narcolepsy?
polysomnography
multiple sleep latency test
what is the first step in treatment of narcolepsy?
improve sleep hygiene
what are the first line medications used to treat EDS for narcolepsy? (2)
modafinil
armodafinil
which medication is the only medication proven effective and FDA-approved for both EDS and cataplexy?
Xyrem
what medications are used as second line treatment for narcolepsy if first line fails or patient is unable to tolerate it?
methylphenidate (ritalin)
dextroamphetamine
abnormal behavioral, experimental, or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions
parasomnias
what are the 2 most common types of parasomnias?
Non-rapid eye movement (NREM) sleep arousal disorder
Rapid eye movement (REM) sleep behavior disorder
parasomnia of repeated episodes of complex motor behavior initiated during sleep, during any stage of NREM sleep
sleep walking
during which part of the night does sleep walking most commonly occur?
during first 3rd of the night
unwanted recurrent episodes of eating with varying degrees of amnesia, ranging from no awareness to full awareness without the ability to not eat
sleep-related eating
varying degrees of sexual activity occur as complex behaviors arising from sleep without conscious awareness
sexsomnia
repeated occurrence of precipitous awakenings from sleep, usually beginning with a panicky scream or cry
sleep terrors
when do sleep terrors usually occur? how long do they last?
during the first 3rd of the major sleep episode and last 1-10 mins
what diagnostic study can be used for parasomnias?
polysomnography with audiovisual monitoring
what are the 2 parasomnias?
sleep walking
sleep terrors
what medication can be used for adult patients with NREM parasomnias?
clonazepam
persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food; significantly impairs physical health or psychosocial functioning
feeding/eating disorders
what leads to the death of the patient if they have anorexia nervosa?
subsequent malnutrition = multiorgan damage
restriction of energy intake relative to requirement, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
anorexia nervosa
a patient presents with extensive exercise, amenorrhea, weakness, cold intolerance, constipation/bloating, growth arrest, and history of fractures. what are they suspicious for?
anorexia nervosa
what mnemonic do we use for anorexia nervosa and bulimia nervosa?
SCOFF
what are the parts of the SCOFF questionnaire?
Sick - make yourself sick because you feel uncomfortably full?
Control - worry about losing control over how much you eat?
One stone (14 pounds) - losing more than one stone in a 3-mo period?
Fat - believe yourself to be fat when others say you are too thin?
Food - food dominates your life?
how many yes answers to the SCOFF questionnaire provides a 100% sensitivity for anorexia and bulimia?
2 or more
what are 3 abnormal vital signs noted in anorexia nervosa?
hypothermia
bradycardia
orthostatic hypotension
in anorexia nervosa, a body weight of less than _____ of expected is present
85%
what are the 4 levels of anorexia nervosa?
mild: BMI about 17
moderate: BMI 16-16.9
severe: BMI 15-15.9
extreme: BMI less than 15
what type of management should be used for patients with anorexia nervosa?
outpatient
what is the average weekly weight gain goal for anorexia nervosa?
0.5 - 1kg
what are the 2 treatment goals for anorexia nervosa?
weight restoration
CBT
what type of medications can be used with CBT to treat anorexia nervosa?
SSRIs
a pattern of discrete periods of binge eating + lack of control overeating, followed by compensatory behaviors like self-induced vomiting and misuse of laxatives
bulimia nervosa
what is the time period of binge eating for bulimia nervosa?
within 2 hr period
how often must binge eating and compensatory behaviors occur to diagnose bulimia nervosa?
at least 1/week for 3 months
what is the first-line treatment for bulimia nervosa?
CBT
what medication can be used in conjunction with CBT for bulimia nervosa?
SSRIs (prozac)
eating a lot of food in a short period of time with loss of control
binge-eating disorder
what is the essential feature of binge-eating disorder?
recurrent episodes of binge eating at least 1/week for 3 months
an eating or feeding disturbance - apparent lack of interest in eating food - as manifested by persistent failure to meet appropriate nutritional needs
avoidant/restrictive food intake disorder
