10.14 Sleep Disorders

Question 1

Obstructive sleep apnoea
General

Answer 1

• obstruction of upper airway
• no deep / slow wave sleep because they wake up all the time
• no REM
• Obese, short neck
• Snore
• Typical sleep pattern
  • Headaches
  • ⬇️ Concentration

Question 2

Clinical features of Obstructive sleep apnoea

Answer 2

• apnoea due to closure of the upper airway
• decline in oxygen saturation
• an arousal causing brief wakefulness and then return to a light stage of sleep

Question 3

Complications of OSA

Answer 3

• hypertention
• pulmonary hypertension (-> Right sided cardiac fail)
• cognitive decline (reversible)

Question 4

What controls if we are awake or asleep?

Answer 4

• brainstem reticulocytes (if “switched on” = awake) -> maintain REM sleep
• posterior hypothalamus (produce hypocretin = awake) {reinforces arousal neurons from the RAS}

Hypocretin keeps you out of REM sleep

Question 5

Narcolepsy
General
Clinical Features

Answer 5

• problem with the availability of hypocretin from hypothalamus
• go into REM sleep when you don’t want to
• mostly autoimmune disorder

Clinical features (features of normal REM sleep but during abnormal time)
- Excessive Sleepiness, dream-like activity during wakefulness: problem of REM intrusions
- Cataplexy (sudden loss of muscle tone typically with change in emotion)

Normal REM = decreased muscle tone

Question 6

REM sleep behaviour disorder

Answer 6

• A disorder of REM sleep, during which normal hypotonia does not occur: the patient is able to move, and can act out their dreams which may result in violent behaviour or shouting during sleep.
• when pt goes into REM; they can move (this is very abnormal)
• people can act out REM sleep

Question 7

Restless leg movements

Answer 7

• just an abnormal sensation
• kicking of legs as a way to reduced abnormal sensation
• circadian rhythm (not all day long; start at bedtime / late afternoon)
• Aching discomfort in calves
• Worse in evening
• Treatment of choice: Dopamine Agonists in low dose