L9 Sleep Disorders Flashcards
(30 cards)
What can we say about sleep disorders?
Common Serious Treatable Under-diagnosed Costly
What is the prevalence of insomnia?
4-19%
What is the prevalence of OSA?
up to 4% of adults
What is the prevalence of narcolepsy?
1 in 2000 (0.03-0.16%) - many are not diagnosed
What are the consequences of poor sleep in relation to car accidents?
Car crashes are more common when sleep deprived
1 in 6 car crashes are related to fatigue and the cost is huge
53% of individuals have driven a vehicle whilst feeling drowsy
What are morbidities of poor sleep?
Obesity
Metabolic syndrome
Depression and suicide (relative risk for depression is 4x higher when SD and suicide risk is 7x higher)
What are the consequences for relationships with poor sleep?
Less enjoyment and a reduced QOL
What are some examples of problems caused by sleepiness?
Selby train crash - 10 fatalities, driver fell asleep and car went onto train line, now in prison
Bhopal chemical disaster - over 10,000 fatalities, plant blew up after worker fell asleep on night shift and toxic gases released
Chernobyl disaster - 56 fatalities and radiation, chief of plant fell asleep and reactor blew up
Challenger space shuttle disaster - put off take off for 10 days due to weather, made decision after SD which was more risky and fuel tank exploded
What are some treatment examples for sleep disorders?
Pharmacotherapy
Behavioural therapy
Continuous positive airway pressure (CPAP) for OSA
Surgical therapy
What are the rates of people being undiagnosed?
As many as 95% of people with a sleep problem remain undiagnosed
Lot of people think they’re not treatable so don’t bother seeing anyone about it
Few healthcare providers question patients about sleep and it is rarely taught in medical schools
If treat the sleep side effects of other disorders may be able to manage it more successfully
What is normal sleep?
Between 6-8 hours
Changes throughout life
If have a sleep partner it can impact quality of sleep
Context and locations of normal sleep can vary
How is sleep history relevant in diagnosing sleep disorders?
Have to go through a lot of the history and different aspects:
What happens at different times, look at physical and psychological aspects, are any drugs being taken? family history
Should evaluate the 24 hour sleep/wakefulness patterns
What is the Epworth Sleepiness Scale
Scale to measure quality of sleep
Good for seeing how a patient is responding to treatment
Not entirely accurate but best there is
What can be seen in outpatient neurophysiology studies?
The patient might be asked about something but they’re in a poor position to know about it as they might not know what they’re doing
Need to look at objective measures
Can assess breathing, EEG, PSG and movement of limbs which can give lots of data
What happens in inpatient telemetry studies?
Patients come into the hospital for objective measures and can also video what they do - providing comprehensive data
What are other objective measures?
Multiple Sleep Latency Test (MSLT)
Maintenance of wakefulness test
Vigilance tests - psychomotor vigilance test
What is the classification of insomnia?
Can be initial, middle of the night or terminal
Can involve hypnic phenomena such as falling off a cliff
Or people can sometimes experience hallucinations of pain such as a burning in the body as they’re falling asleep which can in turn cause insomnia or sleep phobia
What is treatment for insomnia and why is it important?
Can be treated through CBT
Can lead to more significant and more resistant depression so important to treat
TST isn’t actually that relevant, look at whether the patient feels refreshed and is effective during the day
What are some examples of disordered breathing hypersomnias?
OSA - an obstruction causing disordered breathing, narrow airways, too much tissue around the throat e.g. snoring
Central SA - dysfunction of the brain as it is an issue with control
What is narcolepsy?
An abnormality of REM sleep, intrusions into other stages and disrupts the quality of sleep rendering the individual very tired the next day
Can happen with or without cataplexy (about 3/4 have cataplexy)
Involves irresistible sleep attacks
Thought to be due to loss of hypocretin found in the hypothalamus
Memory can be pretty bad and can take a while to find the right medication
Need adult supervision sometimes
What is cataplexy?
A sudden drop/atonia due to intrusion of REM sleep into wakefulness but retain awareness
Can be triggered by emotions such as anger
What treatments are available for narcolepsy?
Planned naps, good sleep hygiene
Stimulants - modafinil, amphetamines, methylphenidate (is an amphetamine)
What treatments are available for cataplexy?
Antidepressants - the effect is immediate
Sodium oxybate - can improve narcolepsy and cataplexy
What are SWS parasomnias?
Sleep walking/talking
They are disorders of arousal which are common in childhood and usually get better with adulthood
Sleep terror treatment should also manage the parents as can be distressing and child has no recollection of them
Treatments include: reassurance, benzodiazepines and trazadone
