Sleep Disorders Flashcards
Genetic component of sleepwalking
HLA gene
3 step model for treating NREM parasomnias
- Modify predisposing factors – avoid sleep deprivation / stress
- Improve safety of sleeping environment
- Pharmacotherapy (benzos)
What parts of the brain are involved in REM sleep?
The critical structures for initiation of REM sleep are cholinergic neurons in the pons and midbrain.
Population for RBD
- Usualy occurs in elderly men. Risk of developing Parkinson’s or dementia.
- Associated w/ narcolepsy in young pxs.
Diagnosis and Tx for RBD (5 things)
•PSG is needed to confirm diagnosis. Look for elevated muscle tone.
Treatment
• Remove any causative drugs (antidepressants)
• Optimize safety of sleeping environment
• Benzos (but risky in elderly due to risk of falls)
• Melatonin
• Pramipexole (drug for PD)
5 cardinal sxs of narcolepsy
- Excessive daytime sleepiness (EDS)
- Sleep paralysis – mix of REM and wake
- Hypnogogic / hypnopompic imagery – often mixed w/ sleep paralysis
- Cataplexy – Highly specific for narcolepsy. Loss of muscle tone in response to emotional stimuli such as laughter
- Automatic behaviors – may not remember how you just drove somewhere
Cause of narcolepsy w/ cataplexy
Loss of hypocretin / orexin neurons in lateral hypothalamus. Most likely an autoimmune rxn due to association w/ HLA gene.
Diagnosis of narcolepsy (2)
- PSG
* Multiple sleep latency test (MSLT) – shows fast sleep onset and fast entry into REM, even during naps.
Treating narcolepsy (5)
- Avoid sleep deprivation
- Schedule naps – even 10-15 min work well
- Stimulants
- Antidepressants – tx cataplexy
- Sodium oxybate – tx EDS and cataplexy
Restless legs syndrome Population Criteria 2 types Tx (4)
- Most common in women, elderly, and northern European descent
- Criteria (URGE)
- Urge to move legs, usually with uncomfortable leg sensations (creepy-crawling, tingling, or itching)
- Rest – Onset or worsening of symptoms at rest or inactivity (lying or sitting)
- Gets better w/ movement
- Evening – Worsening of symptoms in the evening and at night
- 2 types
- Primary – caused by low iron stores in CNS
- Secondary – caused by iron deficiency anemia, renal failure, pregnancy, or meds (antidepressants, antiemetics, antispychotics, antihistamines)
- Treatment – iron replacement if ferritin is less than 50, behavioral strategies, DA agonists (pramipexole / ropinirole), or gabapentin
What parts of the brain control circadian rhythms?
Suprachiasmic nucleus of the hypothalamus. Melatonin release from the pineal gland also plays a role.
Risk factors for insomnia
Age (older), female (especially post-menopausal), divorce / widow, psychiatric illness (mood, anxiety, substance abuse), medical conditions, other sleep disorder, smoking, alcohol, coffee, meds
Meds that may cause insomnia
Antidepressants, stimulants, steroids, bronchodilators, decongestants, antihypertensives / diuretics, alcohol (wake up in middle of night to pee)
Psychiatric disorders that may cause insomnia (4)
MDD, bipolar, GAD, PTSD
Non-drug treatments for insomnia
Sleep hygiene
CBT - Challenge misconceptions about sleep, relaxation training, sleep restriction, stimulus control (get out of bed if can’t sleep)
