88b - Sleep Disorders

Question 1

Which neurotransmitter is likely to be low in people with Narcolepsy with Cataplexy? (Narcolepsy Type 1)

Answer 1

Orexin (aka hypocretin)

Question 2

What is the most effective treatment for insomnia?

Answer 2

Cognitive Behavioral Therapy

• Effective in 75% of cases
• Stimulus control, sleep restriction, relaxation techniques

Question 3

What causes narcolepsy?

Answer 3

Destruction of orexin-producing cells

• Remmeber, orexin stabilizes the “awake” state

Question 4

How do you differentiate between narcolepsy and idiopathic hypersomnia?

Answer 4

Both have excessive daytime sleepiness

If narcolepsy, may also have:

• Sleep paralysis
• Vivid dreams
• Cataplexy

Question 5

How is restless leg syndrome treated?

Answer 5

• Replace iron in patients with serum ferritin <75 mcg/L
• Dopamine agonists or prebablin/gabapentin

Question 6

What is a parasomnia?

Answer 6

Unpleasant or undesirabel behavioral or expiremental phenomena that occurs predominantly or exclusively during the sleep period

Can be NREM or REM sleep parasomnias

Question 7

REM Behavior Disorder is often an early symptom of which kind of neurodegenerative disease?

Answer 7

Synucleinopathy

Remember REM Behavior Disorder = acting out dreams; diminished atonia during REM sleep

Question 8

What is the most effective treatment for obstructive sleep apnea?

Answer 8

CPAP

Question 9

How do you differentiate between obstructive sleep apnea and central sleep apnea?

Answer 9

• Obstructive
  
  • Breathing stops but effort persists
• Central
  
  • No effort made to breathe

Question 10

What is hypersomnia?

What are some of the common causes?

Answer 10

Excessive daytime sleepiness

• Inadequate sleep at night
• Poor quality of sleep
  
  • May be due to OSA, restless leg syndrome, other
• Effect of medication or substance
• If the above are ruled out, may be a primary disorder of daytime sleepiness
  
  • Narcolepsy
  • idiopathic hypersomnia

Question 11

How do you differentiate NREM and REM parasomnias?

Answer 11

• NREM
  
  • Arousal from NREM sleep
  • Sleeper can perform complex tasks, but they are not aware
  • Ex: sleep walking
• REM behavior disorder (RBD)
  
  • Dream enactment behavior 90+ min after the onset of sleep
  • Diminished atonia in rem sleep
  • May accidentally injure themselves or bed partner
  • May be an early symptom of synucleinopathy

Question 12

What medications can be used to treat insomnia?

Answer 12

• GABA_A agonists
  
  • -zazoles
  • Benzos (but not great for sleep)
• Orexin antagonists
• Melatonin

Remember, CBT is the most effective therapy for insomnia