Flashcards in Sleep disorders Deck (18):
What conditions must be ruled out with insomnia?
restless leg syndrome and disordered breathing
What do maintenance difficulties indicated?
intrinsic sleep disorder that requires sleep study
What causes psychophysiologic insomnia?
learned sleep-preventing associations
paradoxical improvement in sleeping lab
What causes fatal familial insomnia?
rare neurodegenerative process
What is the prevalence sleep apnea?
2-4% of population
rising due to rising obesity
What are some clinical aspects of obstructive sleep apnea?
17" neck circumfrence
excessive daytime sleepiness, pseudodepression
crowded oropharynx, nasal disorders
positionally worse, and aggravated by sedatives or alcohol
common in neuromuscular disorders
polychythemia (increased rbc) and hypothyroidism
Define apnea vs. hypopnea
Apnea: absent airflow for 10 seocnds
hypopnea: reduced airflow for 10 seconds
What are the types of apnea/hypopnea?
Mixed: starts central, becomes obstructive
What is the cutoff for apnea/hypopnea index/ Respiratory disturbance index?
<5 (events/hour sleep)
How is apnea/hypopnea treated?
conservative measures and cpap (contineous positive airway pressure), dental devices, sometimes surgery
What are possible causes of central apnea?
Lateral medullary syndrome
Define restless leg syndrome
urge to move
begins or worsens with rest
partially/totally relived by moving
worse at night/evening
What is the difference between restless leg syndrome and periodic limb movement disorder?
PLMD: manifestation 0.5-10 s, at 5-90 s intervals
90% of RLS have PLMD
50% of PLMD have RLS
What are common causes of RLP/PLMD?
Central (spastisity) or peripheral (radiculopathies, and neuropathies)
How is RLS/PLMD treated
underlying cause ex. iron folate def
Firs line role for dopaminergic agonists an hour or two before bed
Sinemet (carba-levo dopa)
clonazepam may cause tachyphylaxis (reduced response)
opioids in some circumstances
What is the classic tetrad for narcolepsy?
1- excessive daytime sleepiness
2- cataplexy (full muscle weakness while awake)
3- hypnagogic hallucinations
4- sleep paralysis
How is narcolepsy treated?
alerting agents: modafininl, methylphenidate, other amphetamines
anticataplectic: anticholinergic agents (TCA)