week 6: sleep disorders

Question 1

Describe classic features of sleep apnea.

Answer 1

-respiration ceases for relative brief periods of time, followed by brief arousals during which breathing resumes and patient falls back to sleep
-obstructive or central
Key features
-excessive daytime sleepiness
-morning sluggishness, headache, irritability
-non-refreshing naps
-snoring and respiratory pauses followed by gasps for air

Question 2

Describe classic features of narcolepsy

Answer 2

Tetrad

1. Excessive daytime sleepiness-described as urge to sleep or sleep attacks, fall asleep within 3-5 mins
2. Cataplexy- sudden loss of muscle tone, often preceded by emotional charged stimulus
3. Sleep Paralysis-in transition from wakefulness to sleep or other way around, muscles are inhibited but brain is aware of physiologic change. Brain is aware but patient unable to move
4. Hypnagogic hallucinations-brief, dream like fragments, bizarre, experienced during transition between wakefulness and sleep

Question 3

List at least 6 principles of good sleep hygiene

Answer 3

1. set regular time to sleep and wake up
2. regular exercise during the day, avoid vigorous exercise at night
3. avoid daytime naps
4. don’t eat late evening meals, or lots of liquids at night. Don’t eat heavy or spicy foods in evening
5. bedroom made comfortable, cool dark and quiet. Secure.
6. Bedroom only for sleep activities
7. move to another room if not asleep within 20 mins
8. sleep only as much as needed
9. avoid/minimize caffeine, alcohol, tobacco
10. avoid routine hypnotics
11. stress management and relaxation

Question 4

List at least 6 principles of the ideal hypnotic

Answer 4

1. rapid sleep induction
2. sufficient duration with no “hangover”
3. lack of habituation/tolerance
4. normal sleep pattern
5. high therapeutic index
6. lack of drug interactions

Question 5

Describe the advantages and limitations of barbiturates for insomnia.

Answer 5

• decreased REM sleep, REM rebound, decreased delta sleep

- ineffective at initial dose within 14 days

Question 6

Describe the advantages and limitations of non barbiturate non benzodiazepines for insomnia.

Answer 6

questionable REM suppression, effective for as little as 3-5 nights, protein binding displacement, GI irritation

Question 7

Describe the advantages and limitations of antidepressants for insomnia.

Answer 7

highly sedating, high anticholingergic and hypotensive properties, improves sleep in depression, high in orthostatic hypotension

Question 8

Describe the advantages and limitations of antihistimines for insomnia.

Answer 8

likelihood of morning “hangover”

Anti-cholinergic side effects: dry mouth, constipation,

Question 9

Describe the advantages and limitations of natural products for insomnia.

Answer 9

?

Question 10

Describe the advantages and limitations of benzodiazapines for insomnia.

Answer 10

-Little REM suppression, dealt suppression

Question 11

Describe the advantages and limitations of melatonin receptor for insomnia.

Answer 11

Short acting, reduces sleep latency, inconsistent effects on total sleep time, promote sleep and shift circadian phases

Question 12

Describe the advantages and limitations of BZD1 receptor specific non benzodiazepines for insomnia.

Answer 12

FIRST LINE TREATMENT
-advantages: tolerability and low dependence
Little effect on sleep stages, may have drowsiness, dizziness, headache, nausea, diarrhea
-some are short acting, good for sleep initiation
-one has middle of night awakening