Sleep Disorder

Question 1

Sleep

Answer 1

Sleep is an active, multiphase process that provides restorative functions and promotes memory consolidation.

Question 2

Stages of Sleep

Answer 2

1. Awake
2. Non-Rapid Eye Movement-N1(NREM): Lightest sleep
3. Non-Rapid Eye Movement-N2: Light sleep
   4.Non-Rapid Eye Movement-N3: Deep sleep
4. Rapid-Eye Movement (REM): Time of most movement
   New Cycle, beginning with N2 follows each REM stage

Question 3

Dyssomnias

Answer 3

Disorders of initiating and maintaining sleep and disorders of excessive sleepiness

Question 4

Insomnias

Answer 4

Inability to fall or stay asleep.
-Primary (Treatable): Related to travel across time zones or caused by acute stress
-Secondary (Caused by other conditions): Related to drugs or alcohol abuse, chronic pain, depression, obesity, aging, etc.

Question 5

Insomnia Epidemiology

Answer 5

-33% prevalence
-Female
-Older population
-Unemployment
-Marital status (separated/widowed)
-Lower socioeconomic status
-Poor sleep hygiene

Question 6

Insomnia Etiology (SLEEP GAP)

Answer 6

-Snoring (Respiratory issues)
-Lamenting (mood disorders)
-Endocrine (Hypothyroidism)
-Excruciating (chronic pain)
-Pregnancy
-Gastroesophageal (GERD)
-Arrythmia, Anxiety, and Abuse
-Parkinson’s (Neurologic conditions)

Question 7

What are the Clinical manifestation of insomnia?

Answer 7

Acute or short-term and Chronic

Question 8

Insomnia Pathophysiology

Answer 8

High level of Cortisol which is responsible of activating the arousal system.

Question 9

Insomnia Diagnostic

Answer 9

-≥ 1 of the following symptoms:
-Difficulty initiating sleep
-Difficulty maintaining
sleep, characterized by
frequent awakenings or
problems returning to
sleep afterward.
-Early-morning
awakening with inability
to return to sleep.
-The sleep difficulty occurs at least 3 nights per week.
-Episodic
-The sleep difficulty is present for at least 3 months.
-Chronic (Persistent ≥ 3
months, Recurrent ≥ 2
episodes within a year)

Question 10

Obstructive Sleep Apnea Syndrome (OSAS)

Answer 10

Characterized by repetitive episodes of cessation of breathing during sleep
-Followed by blood
oxygen desaturation and
brief arousal from sleep
to restart breathing

Question 11

OSAS Risk Factors

Answer 11

-Male
-Older Population
-Large Neck circumference
-Obesity
-Afro desendientes o hispanos
-Excessive use of alcohol and sedative

Question 12

OSAS Clinical Presentation

Answer 12

-Symptoms
-Snoring
-Sleep Interruption
-Excessive daytime
sleepiness
-Obstructive Sleep Apnea
-Central Sleep Apnea

Question 13

OSAS Diagnostic

Answer 13

-Evidence by polysomnography of at least 5 obstructive apneas or hypopneas
-15 or more obstructive apneas and/or hypopneas per hour of sleep

Question 14

Restless Leg Syndrome (RLS)

Answer 14

Sensorimotor disorder that is associated with unpleasant sensations usually in the calf muscle and compelling urge to move the legs for relief.

Question 15

RLS Risk Factors

Answer 15

-Female
-Older Population
-Northern Europeans
-5-15% prevalence

Question 16

RLS Clinical Presentation

Answer 16

-Unpleasant sensation in lower limbs
-Symptoms lead to insomnia and affect quality of life
-Aches, itching, pulling, crawling, tingling, tightness

Question 17

RLS Pathophysiology

Answer 17

Nigrostriatal Pathway
-Deficiency of
dopaminergic activity in
the striatum and
substantia nigra
Iron Deficiency
-Low iron stores in the
striatum, thalamus, and
red nucleus
-Iron is a co-factor in
dopamine production

Question 18

RLS Diagnostic

Answer 18

An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs.
-Three time a week for
three months
-Not attributed for SUD
or medication

Question 19

Narcolepsy

Answer 19

Characterized by excessive daytime sleepiness with loss of muscle tone (cataplexy) and sleep paralysis.

Question 20

Narcolepsy Risk Factors

Answer 20

-Male
-0.06% prevalence
-10% of patients have a close relative with similar symptoms
-Prevalencia en hombres y afecta a los 20 o 30 años

Question 21

Narcolepsy Clinical Presentation

Answer 21

Narcolepsy Type 2
-EDS (Hypersomnia)
-Hallucinations
-Sleep Paralysis
Narcolepsy Type 1
-Cataplexy
-Type 1 presents all of
the symptoms of type 2
in addition to cataplexy

Question 22

Narcolepsy Pathophysiology

Answer 22

Type 1
-Hypocretin (orexin)
deficiency
-Believed to be and
immune-mediated
destruction of
hypocretin-producing
neurons in the
hypothalamus
-A strong association
exists between
narcolepsy and HLA-
DQB1*06:02
Type 2
-Normal levels of
hypocretin
-Pathophysiology poorly
understood

Question 23

Narcolepsy Diagnostic

Answer 23

At least 3 times/week ≥ 3 months.
One of the following:
-Cataplexy
-Hypocretin deficiency, as
measured using
cerebrospinal fluid (CSF)
hypocretin-1
immunoreactivity values
(≤ to 110 pg/mL).

Normal CSF Hypocretin-1: > 200 pg/ml

Question 24

Circadian Rhythm Sleep Disorders (CRSD)

Answer 24

-A common disorder where a desynchronization between an individual’s biological clock and external demands on the sleep cycle occurs.
-Typically symptoms include insomnia and hypersomnia

Question 25

CRSD Clinical Presentation

Answer 25

Shift-Work Type - Overnight workers
-Directly related to
working night shifts or
outside the conventional
9 a.m.–5 p.m. window.
Jet Lag
-Results from traveling
across multiple time
zones, causing temporary
misalignment of the
internal clock.

Question 26

CRSD Severity

Answer 26

-Episodic: Symptoms last at least 1 month but less than 3 months.
-Persistent: Symptoms last 3 months or longer.
-Recurrent: Two or more episodes occur within the space of 1 year.