week 8- sleep Flashcards

Question

4 features of Narcolepsy

Answer 1

EXCESSIVE DAYTIME SLEEPINESS CATAPLEXY HYPNAGOGIC HALLUCINATIONS SLEEP PARALYSIS

Answer 2

Prevalence - 0.02-0.05% Israel - 0.002% Japan - 0.18%

Answer 3

Symptoms represent REM sleep components intruding into wake cataplexy - REM sleep atonia sleep paralysis - REM sleep atonia hallucinations - intrusion of dreams REM appears at sleep onset (and in MSLT) (Day time sleepiness- cant resist the urge- sleep attacks – feel good afterwards Catalexy- loss of skeletal tone in response to strong emotion- happinss normally- had drop- wek at knees- or severe complete loss of muscle tone Hallucntions? Paralysis- woken up but unable to move)

Answer 4

Orexin is involved in controlling sleep-wake and NREM-REM sleep transitions. Orexin signalling is altered in Narcolepsy Narcolepsy often develops in the teens/20’s following an illness/occasionally vaccination indicating an auto-immune component.

Answer 5

abnormal immune function ~ HLA subtyping PSG (short SOL, short REM latency, increased wake) MSLT (rapid sleep onset, REM onset) (Chromosome 6 15-30% people have gene mutation HLA gene mutation Associated with autoimmune disorder But not all people with narcolepsy have it Not fully understood yet Rem sleep very short Increased wakefulness in sleep compared to normal)

Answer 6

APNEA = cessation of airflow HYPOPNEA = reduction in airflow Central sleep apnea = absence of ventilatory effort Obstructive sleep apnea (OSA) = ventilatory effort + closure of upper airway Prevalence is ~10-20%. Higher in males and older individuals (Excessively sleeping during the day, no problem going to sleep Reduce in airflow 2 forms: central sleep apnoea: body doesn't even try to breath Obstructive- trying to breath but closed up Men with heart failure)

Answer 7

``` -SYMPTOMS chronic loud snoring gasping and choking episodes during sleep excessive daytime sleepiness cognitive difficulties - SIGNS obesity, especially around the neck systemic hypertension nasopharyngeal narrowing ```

Answer 8

``` Repeated arousals Disruption of normal sleep architecture cardiac consequences depression / irritability excessive sleepiness sexual dysfunction learning / memory difficulties ```

Answer 9

``` -BEHAVIOURAL weight loss (including exercise) avoidance of alcohol/sedatives before bedtime avoidance of supine sleeping position -NASAL CPAP non-invasive short term efficacy Patient compliance variable (mostly quite poor) ```

Answer 10

``` ORAL / DENTAL DEVICES useful in mild cases OXYGEN SURGERY invasive not uniformly effective + risk (Oral- only successful in 50% and need to invest 6 months Sugery- 50% successful and very painful ) ```

Answer 11

``` Unpleasant/undesirable behaviours or experiential phenomena that occur during the sleep period. NREM parasomnias (arousal disorders) spectrum: ```

Answer 12

``` -Bruxism/ confusional arousals -Sleep Talking -Sleep Walking/ Sex/ Eating -Sleep Terrors ```

Answer 13

- Occur in association with an arousal from SWS - Mental confusion and disorientation - Relative non reactivity to external stimuli - Poor response to efforts to provoke behavioural wakefulness - Retrograde amnesia for the event - Only fragmentary or no recall of dream mentation

Answer 14

-Common in childhood -Triggers: fever, sleep deprivation, alcohol, other sleep disorders. -Sleep Walking -Calm or agitated -Prevalence: children 1%-17%, adults 4%. -Sleep Terrors -Screaming, Panic, Fear, motor activity (injury) Inconsolable

Answer 15

-Children: Considered a natural feature of sleep. In most instances they should not be treated as the events will cease with development. -Adults: Reassurance and avoidance of triggers adequate in many cases. Tricyclic antidepressants and benzo’s can be effective.

Answer 16

- Seen in children of all ages, but is a prominent feature of adolescence. - Difficulty of falling asleep at expected bedtimes. - Late (but consistent) time of sleep onset. - Difficult to awaken at desired time. - Normal sleep on delayed schedule