MISC - Sleep disorders Flashcards

Question

(8) Non-pharmacological Rx of insomnia

Answer 1

* Treat Comorbid disorders * Stimulus Control Therapy * Sleep Restriction * Relaxation * Biofeedback * Paradoxical intention * Sleep Hygiene!! * Short term hypnotics

Answer 2

–Types »Benzodiazepines - temazepam »Non-benzodiazepines - zolpidem »Other - antidepressants, valerian, antihistamines –Hypnotic medications should NOT be the first choice of treatment –Short term management of idiopathic or psycho-physiological insomnia –Combined with non-pharmacological measures when tapering dose

Answer 3

* Delayed Sleep Phase Syndrome * Advanced Sleep Phase Syndrome * Non-24 hour circadian rhythm * Free-running rhythm * Jet Lag * Shift Work Disorder * Seasonal Affective Disorder

Answer 4

–Desire to move the extremities often associated with paresthesias or dysesthesias –Motor restlessness –Worsening of symptoms at rest with at least partial and temporary relief during activity –Worsening of symptoms in the evening or at night

Answer 5

- Primary - Secondary (Fe deficiency, renal failure, peripheral neuropathy, lumbosacral radiculopathy, pregnancy etc) - May be familial (AD)

Answer 6

* sleep disturbances * tiredness or fatigue during daytime * reduced emotional well-being/QOL * avoidance of social activities * possibly higher incidence of CVS risk factors/ CVS disease

Answer 7

Aka. Willis-Ekbom disease (WED) or Wittmaack-Ekbom syndrome = a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. - most commonly affects the legs, but can affect the arms, torso, head, and even phantom limbs - Moving the affected body part modulates the sensations, providing temporary relief. - RLS sensations range from pain or an aching in the muscles, to "an itch you can't scratch," an unpleasant "tickle that won't stop," or even a "crawling" feeling. - The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep. - Additionally, most individuals with RLS suffer from periodic limb movement disorder (limbs jerking during sleep) -> sleep disruption. - It can be caused by low iron levels. - Treatment is often with levodopa or a dopamine agonist such as pramipexole.

Answer 8

–Repetitive movements of the limbs (usually legs) that occur during sleep and may be associated with arousal –PLM index on polysomnography –Associated with RLS - 80% with RLS have PLM, >50% PLMS have RLS

Answer 9

–Non pharmacological •Fe replacement •Avoid aggravating factors –Pharmacological - opiods, benzodiazepines, dopamine agonists

Answer 10

–Disorder of sleep regulation •Intrusion of some REM sleep into wakefulness •Abnormal regulation sleep timing –Deficiency in the neurotransmitter OREXIN – F=M, begins in the teens and twenties, but can occur after forty –Autosomal dominant with incomplete penetrance –HLA DQB1*0602 positive

Answer 11

Excessive daytime sleepiness (100%) –“sleep attacks”, ESS>15, refreshed following nap –Abnormally timed REM sleep –Multiple Sleep Latency Test Manifestations related to REM sleep •Hypnagogic/Hypnopompic hallucinations (30%) •Sleep paralysis (25%): Complete inability to move for 1- 2 minutes after awakening •Cataplexy (60%)

Answer 12

``` General Measures •Avoid shifts in sleep schedule •Avoid heavy meals and alcohol intake •Regular timing of nocturnal sleep •Naps: Strategically timed naps, if possible (e.g., 15 min at lunchtime, 15 min at 5:30 PM) •Career counseling ``` ``` Pharmacological Mx: •Stimulants –Modafinil –Amphetamines: Dexamphetamine, methylphenidate •REM suppressing drugs –SSRI’s: Flouxetine, Venlafaxine –tricyclics ```

Answer 13

Diagnostic criteria –Complaint of EDS and prolonged, often unrefreshing naps –Difficulty waking up in the morning or after a nap (sleep drunkenness) –Insidious onset prior to age 30 –Duration of at least 6 months –Exclusion of conditions that may cause the same symptoms Unknown pathogenesis Diagnosis of exclusion Rx: stimulants. 1/4 spontaneously improve

Answer 14

Undesirable behaviour or experiences in sleep or in transition to or from sleep

Answer 15

* Arising from slow wave sleep * A mixed state between sleep and wakefulness * First third of night * Exacerbated by factors deepening sleep and also by factors disturbing sleep * Confused if woken, mentation slow but complex activity possible * Much commoner in childhood * Strong familial component * Main differential diagnosis is from seizure disorder

Answer 16

* Reassurance * Alter sleep environment for safety * Avoidance of Precipitants * Treat Stress * Sleep Extension * Scheduled Wakenings * Clonazepam/Tricyclics * L tryptophan for sleep terrors

Answer 17

* REM behaviour disorder * Frequent Nightmares * Isolated Sleep Paralysis

Answer 18

* Elderly men predominantly, 0.5 % prevalence * Dream enactment behaviour, violent * Failure of REM atonia / locomotor quiescence * Idiopathic/Secondary forms * Acute form precipitated by injury/CVA/SSRIs * Association with neurodegenerative disorders * Treat associated conditions/ stop meds * 80-90% response to clonazepam (benzodiazepine) * Also melatonin, others