Brian Chow Sleep Powerpoint Flashcards
(216 cards)
1
Q
what % of total nighttime sleep is NREM
A
75%
2
Q
what % of total sleep is REM
A
25%
3
Q
when does slow wave sleep/N3 occur in the night
A
in first half of the sleep period
4
Q
when does REM occur
A
more frequently during last THIRD of the sleep period
5
Q
what is another term for N3 sleep
A
slow wave sleep
6
Q
what does sleep architecture look like on a sleep histogram
A
7
Q
what % of sleep is stage 2 sleep
A
50%
8
Q
how many types of NREM sleep are there
A
W, N1, N2 and N3/SWS
9
Q
what % of sleep is N3/SWS
A
20%
10
Q
what % of sleep is N1
A
5%
11
Q
list the 8 elements included in polysomnography
A
EEG–> brainwaves (central and occipital leads)
EOG–> eye movements
EMG–> muscle tone (chin and legs)
ECG–> heart
breathing–> airflow (nose/mouth) and effort (thoracic, abdo)
SaO2
snore microphone
digital AV recording
12
Q
how do you conduct a multiple sleep latency test
A
do this after PSG
4-5 x 20 min naps at 2 hour intervals
check for average sleep onset latency
sleep onset REM periods
13
Q
what is considered “pathological sleepiness” on a MSLT
A
fall asleep in 8 min or less and 2 or more SOREMPs (sleep onset REM periods)
14
Q
what is the state of physiological arousal during NREM sleep
A
HYPOarousal –> low HR, low BP, low resting muscle tone
15
Q
what is N1 sleep
A
light sleep–> slow rolling eye movements (hypnic jerks)
16
Q
what stage of sleep is the most physically restorative
A
N3 (SWS)
physically restorative, consolidates declarative memory
are most difficult to rouse in this state
17
Q
what happens to N3 sleep as we age
A
decreases
18
Q
what waves are seen in EEG in the following phase? what frequency are these waves?
Awake
A
BETA waves
13-30 Hz
19
Q
what waves are seen in EEG in the following phase? what frequency are these waves?
Drowsy
A
ALPHA waves
8-12 Hx
20
Q
what waves are seen in EEG in the following phase? what frequency are these waves?
N1 sleep
A
THETA waves
3-7 Hz
21
Q
what waves are seen in EEG in the following phase? what frequency are these waves?
N2 sleep
A
SLEEP SPINDLES and K COMPLEXES
12-14 Hz
22
Q
what waves are seen in EEG in the following phase? what frequency are these waves?
N3 sleep
A
DELTA waves
0.5-2 Hz
23
Q
which stage of sleep shows the slowest frequency waves on EEG
A
N3/SWS
24
Q
which stage of sleep (NOT awake) shows the highest frequency waves on EEG
A
N2
25
which stage of sleep is associated with sleep spindels and K complexes
N2
26
with is a mnemonic to remember EEG waveform in various stages of sleep
BATS eat KD
beta, alpha, theta, sleep spindles and k complexes, delta
27
what type of waves are seen on EEG in REM sleep
SAWTOOTH waves
theta
slow alpha
28
why is REM called "paradoxical sleep"
because looks like awake on EEG
29
in what stage of sleep do you dream
REM
30
what is the physiological state of the body in REM sleep
HYPERarousal of autonomic state
HR, BP, RR show increased variability, can be irregular
brain--> increased glucose metabolism, blood flow, cerebral temp
poikilothermic condition prevails
penile erection
skeletal muscles are in NEAR TOTAL PARALYSIS
31
when do you have your first REM cycle
90 minutes after falling asleep
32
how long is your first REM cycle compared to later cycles
first is short (under 10 min) then later ones are longer (15-45 min)
have REM cycles every 90-100 minutes
33
in what stage of sleep are skeletal muscles in a state of near total paralysis
REM
34
what do the various brain waves look like in different stages of sleep (image)
35
in what stage of sleep do you see slow, rolling eye movements
N1
36
in what stage of sleep are there no eye movements
N2, N3
37
in what stage of sleep are there bursts of eye movements
REM
38
what brain areas are related to NREM sleep
anterior hypothalamus
thalamus
basal forebrain
nucleus tractus solitarius (medulla)
dorsal raphe nucleus (midbrain)
39
what brain areas are related to REM sleep
PONTINE RETICULAR FORMATION
midbrain
medulla
hypothalamus
40
what brain area controls the ONSET of sleep
hypothalamis
41
what brain area helps initiate REM sleep
pons
42
what brain area regulates the transition between sleep and wakefulness
reticular formation
43
what brain area is active during dreaming
hippocampus and amygdala
hippocampus=memory
amygdala=emotion
44
what brain area prevents sensory signals from reaching the cortex during sleep
thalamus
45
what neurotransmitter is associated with the pons
acetylcholine
46
what neurotransmitter is associated with the raphe nucleus
serotonin
47
what neurotransmitter is associated with the locus ceruleus
norepinephrine
48
where is orexin released from
hypothalamus
49
where does orexin act
locus ceruleus--> wakefulnes pathway
raphe nuclei--> wakefulness pathway
ventral tegmental area--> reward pathway
nucleus accumbens --> reward pathway
50
what are the two primary factors that control the physiological need for sleep
homeostasis --> PROCESS S
circadian rhythm--> PROCESS C
51
what is process S
"sleep drive"
homeostatic control of physiological need for sleep
tendency to sleep increases the further from last sleep you are
52
what is process C
controlled by "biological clock"--> the circadian rhythm
53
what brain area controls the circadian rhythm
SUPRACHIASMATIC NUCLEUS in the anterior hypothalamus
receives PHOTIC and NON-PHOTIC inputs
synchronizes circadian rhythm to environmental cues
54
list the WAKE promoting neurotransmitters
norepinephrine
dopamine
orexin (hypocretin)
histamine
glutamate
55
list the SLEEP promoting neurotransmitters
acetylcholine--> REM
56
which neurotransmitter is both awake and sleep promoting
serotonin
57
what does the suprachiasmatic nucleus do
regulates the timing of nocturnal melatonin secretion from the pineal gland via the superior cervical ganglion
58
how does exposure to light during the biological night affect melatonin production
exposure to light SUPPRESSES melatonin production
59
when do melatonin levels peak
middle of the night--> decline to low daytime amounts
starts being produced in the evening
60
what produces melatonin
pineal gland
61
how does total sleep change across the lifespan
decreases
62
how does REM sleep change across the lifespan
wayyyy more in kids up until about age 2-4, then steadily decreases into old age
63
how does NREM sleep amount change over the lifespan
decreases (not as dramatically as REM)
64
does NEED for sleep change over the lifespan
no--> need for sleep stays the same
65
how does the following sleep parameter change (increased or decreased) as someone ages:
REM sleep
declines after age 65
66
how does the following sleep parameter change (increased or decreased) as someone ages:
sleep fragmentation
increases
67
how does the following sleep parameter change (increased or decreased) as someone ages:
total sleep time
decreases
68
how does the following sleep parameter change (increased or decreased) as someone ages:
ability to sleep
decreases
69
how does the following sleep parameter change as someone ages:
natural circadian rhythm
phase ADVANCE (earlier to sleep and wake)
70
how does the following sleep parameter change (increased or decreased) as someone ages:
sleep efficiency
decreased
71
how does the following sleep parameter change (increased or decreased) as someone ages:
SWS
decreased
72
how does the following sleep parameter change (increased or decreased) as someone ages:
sleep latency
increased
73
how does the following sleep parameter change (increased or decreased) as someone ages:
total sleep time
decreased
74
how much sleep is recommended for a newborn
14-17 hours
75
how much sleep is recommended for a school age child
9-11 hours
76
how much sleep is recommended for a teen
8-10 hours
77
how much sleep is recommended for adults
7-9 hours
78
how much sleep is recommended for an odler adult
7-8 hours
79
what factors, and their related etiologies, can result in excessive daytime sleepiness
1. lack of sleep (inadequate quantity)
--> insufficient time in bed
2. inadequate quality of sleep
--> sleep apnea, PLMS, environment
3. intrinsic sleepiness
--> narcolepsy, idiopathic hypersomnia
4. medical/psych disorder
--> mood disorder, medical, meds
5. circadian rhythm disturbance
--> shift work, delayed sleep phase etc
80
what factors, and their related etiologies, can result in nocturnal spells
1. NREM sleep arousal disorder (parasomnia)
--> night terror type, sleep walking type
2. REM sleep arousal disorder (parasomnia)
--> nightmares, REM sleep behaviour disorder
3. seizure disorder
4. psychiatric
--> panic attacks etc
81
how is cortisol release affected by insomnia
increased HPA activity with insomnia--> cortisol--> this normalizes with treatment of insomnia
82
why should you avoid excessive time in bed
can lead to sleep fragmentation
83
why should you not have a clock in your bedroom
watching clock leads to worry, rumination
84
why should you avoid caffeine, alcohol, nicotine
all can impact sleep and activate RLS
alcohol can worsen OSA
85
why should you reduce HS fluid intake
reduces nightime awakenings related to full bladder
86
why should you eat a light bedtime snack
promotes sleep by reducing hypoglycemia
87
list 7 strategies that fall under "sleep hygiene"
limit time in bed
regular sleep schedule--> esp. awakening time
no clock in bedroom
avoid caffeine, nicotine, alcohol
eat light bedtime snack
reduce HS fluid intake
dont try to fall asleep, or take worries to bed
88
why does having a regular sleep schedule help with sleep
strengthens homeostatic process and circadian synchrony
89
what is the goal of stimulus control in the treatment of insomnia
aim to re-associate sleep stimuli with falling asleep
90
what are elements of stimulus control in the treatment of insomnia
only go to bed when SLEEPY
only use BEDROOM for SLEEP
if unable to sleep, GET OUT OF BED
arise at SAME TIME every morning
DO NOT NAP during the day
91
why does sleep restriction work for insomnia
limits time in bed to ACTUAL sleep time
creates mild sleep deprivation and results in more consolidated and efficient sleep
92
how does sleep restriction work/how do you do it
maintain sleep log--> determine average total sleep time
decrease allowable time in bed to usual sleep time (NOT less than 5 hours)
change time in bed by 15 min increments weekly--> if sleep efficiency is above 85%, then increase by 15 min. If sleep efficiency below 85%, decrease by 15 min
wake time is kept constant and bedtimes are adjusted
93
what is the goal of CBT for insomnia
change the underlying beliefs that perpetuate insomnia that maintain maladaptive sleep behaviours
94
what are 6 basic cognitive strategies for insomnia
keep realistic expectations
do not blame insomnia for all impairments
do not give too much importance to sleep
do not catastrophize after a poor nights sleep
never TRY to fall asleep
develop tolerance to the effects of insomnia
95
list 3 first line NON pharmacological interventions for insomnia
sleep hygiene education
stimulus control therapy
sleep restriction therapy
96
list 2 second line NON pharmacological interventions for insomnia
cognitive training
relaxation training
97
when is pharmacological treatment appropriate for insomnia
SHORT term and TRANSIENT insomnia
NOT indicated for chronic insomnia
98
what are the prescribing principles when Rx for insomnia
lowest effective dose
intermittent dosing (2-4x per week)
short term prescribing (less than 4 weeks)
gradual discontinuation (reduce rebound insomnia)
meds with shorter half life--> minimize daytime sedation
99
how do you assess for hypersomnolence disorder
PSG--> rule out BRSD, PLMD, narcolepsy
use the epworth sleepiness scale
MSLT
100
what is the gold standard for testing daytime sleepiness
MSLT
101
what score on the epworth sleepiness test suggests hypersomnolence disorder
men are above 11
female are above 9
102
how do you treat hypersomnolence disorder
stimulants
modafinil--> less potential for abuse, no peripheral sympathomimetic action
ritalin, dexedrin--> abuse potential, can cause irritability, headaches, insomnia, excessive sweating
103
how many hours in bed is characteristic of someone with kleine-levin syndrome
18-20 hours in bed or asleep
104
list the characteristic features of kleine-levin syndrome
recurrent periods of SLEEPINESS
disinhibition
derealization
indiscriminate HYPERSEXUALITY
compulsive OVEREATING, acute weight gain
non specific neuro findings--> decreased deep tendon reflexes, nystagmus, dysarthria
105
is there any familial aggregation in kleine-levin syndrome
no
106
what is the course of kleine-levin syndrome
may continue with periodic course of decades
often resolves with middle age
107
are more men or women affected by kleine-levin syndrome
more men (3x)
108
what does the epworth sleepiness scale ask
how likely someone is to fall asleep doing various activities
109
what is the narcolepsy "pentad" (5 features)
1. excessive daytime SLEEPINESS
--> may fall asleep without warning, in unusual situations
2. cataplexy
3. hypnagogic/pompic hallucinations
4. sleep paralysis
5. disturbed nocturnal sleep
110
what % of those with narcolepsy have cataplexy
75%
111
what % of those with narcolepsy have hypnagogic/pompinc hallucinations
50-66%
112
what % of those with narcolepsy will have sleep paralysis
50-66%
113
list 3 non pharmacologic interventions for narcolepsy
scheduled napping
lifestyle adjustment
psychological counselling
114
what pharmacologic intervention can you use for the daytime sleepiness associated wtih narcolepsy
modafinil (could also consider ritalin or dexedrine)
115
what pharmacologic intervention can you use for the cataplexy associated wtih narcolepsy
sodium oxybate/GHB (also improved daytime sleepiness)
SSRIs, TCAs--> try SSRIs first before above as its safer
116
why might you use SSRIs to treat narcolepsy
are REM suppresants--> helps with sleep paralysis, hypnagogic/pompic hallucinations, cataplexy
117
list 4 physical exam findings common in OSA
often overweight
increased neck size
if normal weight, often have a structural abnormality like adenotonsillar enlargement
nasal airway obstruction even when awake (noisy breather)
118
are those with central sleep apnea likely to be overweight
less likely to be overweight
119
what are two sequelae of breathing related sleep disorders
HTN
can develop right heart failure/cor pulmonale
120
how do you assess breathing related sleep disorders
overnight PSG
121
how do you manage OSA
weight loss
avoid sleeping on back
tennis balls
nasal CPAP
nasal surgery
uvuloplasty
oral devices
122
what should you avoid in OSA
use of sedative meds and alcohol as can exacerbate OSA
123
what population is more likely to have non-24 hour circadian rhythm disorder
blind people
124
what population is more likely to have irregular sleep wake disorder
institutionalized or demented patients
125
what is the clinical presentation of irregular sleep wake disorder
chronic insomnia and excessive sleepiness and disorganzied sleep rhythm with 3+ sleep bouts in a 24 hour period--> total sleep time NORMAL for age
126
management of delayed sleep phase disorder
chronotherapy
melatonin in early evening (5-6 hours before sleep)
bright light in the MORNING
127
management of advanced sleep phase disorder
bright light in EARLY EVENING
128
management of non-24 hour sleep wake disorder
sleep wake scheduling
melatonin at bedtime
129
management of irregular sleep phase disorder
sleep wake scheduling
bright light exposure during the day and bright light therapy in the morning
130
what is the primary management of NREM sleep arousal disorders
educating and reassuring patients
maintain safety and avoid precipitates
131
when might you consider meds for NREM sleep disorders and what meds would you consider
in difficult cases
antidepressants--> SSRIs, TCAs
benzos--> historically, but now would avoid as can worsen symptoms (per brian chow sleep powerpoint)
132
what do you do to treat PTSD assoc nightmares
prazosin
can also do non pharm--> IRT, ERRT, EMDR, hypnosis
133
what types of psychotherapy might help in nightmare disorder
conflict resolution
image rehearsal therapy
progressive deep muscle relaxation
systematic desensitization
134
what is primary treatment for nightmare disorder
primarily nonpharm--> reassurance and psychotherapy
135
what meds can be used in nightmare disorder
in severe cases can use REM suppressant like SSRIs
136
how do you manage REM sleep behaviour disorder
1. ensure safety of patient and partner--> address sleep environment
2. CT/MRI head--> rule out lesions
3. PSG--> rule out sleep disordered breathing, confirm REM without atonia
4. pharmacological--> clonazepam, melatonin, dopamine agonists
137
what is the most commonly used pharmacological treatment for REM sleep behaviour disorder
clonazepam 0.5-2mg
BUT we recently read updated guidelines that said melatonin high dose (like up to 12mg) is as good if not better than clonazepam so would likely start with that
138
what 3 types of medication can be used to treat REM slepe behaviour disorder
clonazepam (increases threshhold for arousal)
melatonin
dopamine agonists
139
what do you expect to see on PSG in REM sleep behaviour disorder
REM without atonia
140
what is a mnemonia to remember the features of restless leg syndrome
URGE
Urge to move legs
Rest makes symptoms worse
Gets better with movement
Evening is time of worst symptoms
141
what is the prevalence of RLS
5-10%
142
what is the hypothesized mechanism behind RLS
brain DOPAMINE dysfunction
involves CIRCADIAN fluctuations in dopamine
deficiencies in other substances likely play a role
143
deficiency in what substance may play a role in RLS
iron
144
what neurotransmitter is hypothesized to be implicated in RLS
dopamine
145
list 6 factors that exacerbate RLS
caffeine
tobacco
alcohol
DA blockers
SSRIs
mirtazapine
146
do SSRIs help RLS or make it worse
make it worse
147
what is another term for periodic limb movement disorder
nocturnal myoclonus
148
what is periodic limb movement disorder
repetitive leg movements DURING SLEEP about which patient is usually unaware
20-40 sec apart
cause awakenings and fragmentation
bed partner reports "kicking"
149
how do you manage RLS/periodic limb movement disorder--> first step
correct underlying deficiencies or stop causative agent
150
list nonpharmacological interventions for periodic limb movement disorder/RLS
decrease alcohol, nicotine, caffeine consumption
hot baths
applying hot/cold compresses
massage
keep the mind alert
good sleep hygiene
151
what are two first line pharmacologic agents for periodic limb movement disorder/RLS
ropinirole
pramipexole
both are dopamine agonists
(can also use levodopa but not first line)
152
list all medications that can be used to treat periodic limb movement disorder/RLS
dopamine agonists--> ropirinole, pramipexole = FIRST LINE, also levodopa
gapabentin (recent studies)
benzos
opioids (low dose oxycodone_)
153
how does alcohol affect sleep ACUTELY
decreases sleep latency
increases SWS initially, then decreased in second half of sleep
decreased REM in first 2-4 hours of sleep period
REM rebounds in 2nd half of sleep period
intense DREAMS, nightmares
sleep FRAGMENTATION
154
how does chronic alcohol use affect sleep
INCREASED sleep latency
decreased sleep efficiency
decreased SWS
decreased REM
decreased TOTAL sleep time
155
how does alcohol withdrawal affect sleep
disrupted continuity of sleep
increased REM assoc with vivid dreaming
after acute withdrawal, chronic users may experience LIGHT, FRAGMENTED sleep for WEEKS TO YEARS
assoc with PERSISTENT decrease in SWS
156
alcohol exacerbates which sleep disorders
OSA
PLMD
RLS
parasomnias
RBD
SWS
157
opioids cause what ACUTE sleep changes
decreased total sleep time
decreased REM
decreased SWS
158
how does chronic opioid use affect sleep
same as with acute changes but these changes are minimized
159
how does opioid withdrawal affect sleep
insomnia
decreased REM and SWS
160
which sleep disorders are exacerbated by opioids
OSA
CSA
161
how does acute cannabis use affect sleep
decreased sleep latency
decreased REM
increased SWS
162
how does chronic cannabis use affect sleep
TOLERANCE to sleep induction effects and to SWS effects
decrease total sleep time
decreased sleep efficiency
decreased REM sleep
163
how does cannabis withdrawal affect sleep
starts after 2-3 days and lasts 2-7 weeks
REM REBOUND with increased dreaming and nightmares
decreased SWS
164
how do sedative/hypnotic/anxiolytic drugs affect sleep acutely
increased sleepiness
decreased wakefulness
165
how does chronic use of sedative/hypnotic/anxiolytic drugs affect sleep
tolerance--> with subsequent return of insomnia
166
how does sedative/hypnotic/anxiolytic drug withdrawal affect sleep
withdrawal and rebound insomnia
167
what sleep disorder is associated with benzo receptor agonists
parasomnias
(also sedative/hypnotic/anxiolytic drugs increase frequency and severity of apneas)
168
how do stimulants affect sleep acutely
insomnia
decreased total sleep time, REM and SWS
increased sleep latency
increased sleep continuity disturbance
169
how does chronic stimulant use affect sleep
increased sleep latency
decreased total sleep time
decreased sleep efficiency, REM, SWS
170
how does stimulant withdrawal affect sleep
excessive sleepiness
171
how does depression affect the following sleep parameter:
REM sleep
SHORTENED REM latency (under 60 min until first REM cycle rather than 90 min)
more REM sleep, increased REM density
shift to predominance of REM in first half of sleep (rather than SWS in first half)
172
how does depression affect the following sleep parameter:
SWS
decreased SWS
173
how does depression affect the following sleep parameter:
sleep continuity
disturbed sleep continuity, early morning awakenings
174
what effect does one night of total sleep deprivation have on patients with depression
one night with total sleep deprivation can temporarily alleviate depression in 40-60% of patients
175
how does mania affect sleep
TRUE reduction in need for sleep
awakens refereshed after 2-4 hours
176
what two changes in sleep are noted in patients with GAD
increased sleep latency
increased sleep fragmentation
177
what % of patients with PTSD have nightmares
96%
nightmares may also occur in NREM sleep, especially N2
may have MOTOR ACTIVITY with nightmares
178
how does PTSD affect the following sleep parameter:
N1
increased
179
how does PTSD affect the following sleep parameter:
SWS
decreased
180
how does PTSD affect the following sleep parameter:
REM
higher REM density but disrupted REM continuity
181
how does PTSD affect the following sleep parameter:
movements in sleep
PLMs occur frequently
182
what two changes are seen in sleep in those with panic disorder
paroxysmal AWAKENINGS upon entering N3/SWS
nocturnal panic attacks
183
how does SCZ affect the following sleep parameter:
REM
short REM latency
decreased REM sleep early during exacerbations
184
how does SCZ affect the following sleep parameter:
total sleep
decreased
185
how does SCZ affect the following sleep parameter:
NREM
decreased NREM during EXACERBATIONS
186
what is the most consistently found sleep abnormality in SCZ
short REM latency
187
name 3 changes to sleep seen in dementia
decreased REM sleep
decreased SWS
decreased melatonin
188
name Freuds 4 "distorting operations" in dream interpretation
condensation
displacement
visualization
symbolism
189
in Freud's dream interpretation, what is the following operation:
condensation
one dream object stands for several ideas
190
in Freud's dream interpretation, what is the following operation:
displacement
a dream objects emotional significance is separate from its real object or content, and attached to an entirely different one that does not raise the censors suspicions
191
in Freud's dream interpretation, what is the following operation:
visualization
a thought is translated into visual images
192
in Freud's dream interpretation, what is the following operation:
symbolism
a symbol replaces an action, person or idea
193
what stage of sleep is most likely affected in the following disorder:
sleep terror
1st third of the night, during SWS--> N3
194
what stage of sleep is most likely affected in the following disorder:
nightmare disorder
2nd half of night, during REM sleep
(less commonly can have during NREM)
195
what stage of sleep is most likely affected in the following disorder:
sleepwalking disorder
1st third of night, during SWS--> N3
196
what stage of sleep is most likely affected in the following disorder:
REM sleep behaviour disorder
REM sleep
197
is there often a family history of sleep terror or sleepwalking?
yes
198
what is the typical duration for a sleep terror
1-10 min
199
what is the typical duration for a sleepwalking episode
5-10 min (above 30 min is rare)
200
what is the typical duration for a nightmare (in nightmare disorder)
5-15 min
201
what is the typical duration for an episode of REM sleep behaviour disorder
seconds to 20 min
202
what are the symptoms of nightmare disorder
ABRUPT arousal with PANICKY scream/cry
autonomic and behavioural manifestations of intense fear
NO clear dream recall
203
what are the symptoms of sleepwalking disorder
automatisms
getting out of bed
walking
204
what are the symptoms of nightmare disorder
SUDDEN awakening with anxiety and VIVID DREAM RECALL
on awakening, QUICKLY become ALERT AND ORIENTED
205
what are the symptoms of REM sleep behaviour disorder
limb movements, kicking, punching, talking
potential for injury of self/bed partner
on awakening, QUICKLY become ALERT and ORIENTED
206
are there any symptoms post-episode in nightmare disorder or sleepwalking disorder
if are awakened during the spell, are CONFUSED and DISORIENTED for SEVERAL MINUTES
NO clear dream recall
usually does NOT awaken fully
AMNESIA of episode in the morning
207
are there any symptoms post-episode in nightmare disorder
VIVID recall of dream
anxiety may interfere with falling back asleep
208
are there any symptoms post-episode in REM sleep behaviour disorder
vivid recall of dream with theme of VIOLENCE
209
what are some possible pathophysiologies for nightmare disorder and sleepwalking disorder
alcohol, sedatives
sleep deprivation
emotional stress
sleep-wake schedule disruptions
predisposing psychopathology
210
what are some possible pathophysiologies for nightmare disorder
medications
daytime stress
predisposing psychopathology
211
what are some possible pathophysiologies for REM sleep behaviour disorder
PONTINE lesions
synucleinopathies
drug induced (i.e SSRIs, TCA, MAOI)
alcohol withdrawal
paraneoplastic syndrome
212
treatment for nightmare disorder and sleepwalking disorder
reassurance, ensure safety
avoidance of precipitants
psychotherapy
in difficult cases, consider SSRI, TCA
213
treatment for nightmare disorder
avoid stress
sleep hygiene
tx psych illnesses
prazosin, REM suppresant
IRT
214
name 3 antidepressants that have been known to cause nightmares
venlafaxine
duloxetine
buproprion
215
what effect do SSRIs have on REM sleep behaviour disorder and PLMs/RLS
can induce REM sleep behaviour disorder and PLMD/RLS
216
which antidepressant does not cause RLS/PLMD
buproprion
