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Flashcards in Sleep disorders and headaches Deck (14)
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-A physiologic state of relative unconsciousness, inaction of voluntary muscles, and the need for which recurs periodically
-Sleep stages: NREM (non-REM, delta) is 75% of sleep, the most restorative, and REM (25%) is associated w/ classical dreaming
-Sleep cycle: NREM and REM cycle (every 90 min NREM followed by about 20 min of REM)
-Over the night REM periods become longer and more intense
-Age related changes: decrease in amount of delta sleep, increase in awakenings during sleep


Causes of excessive daytime sleepiness

-Usually self-induced sleep deprivation
-Obstructive sleep apnea
-Movement disorders


Obstructive sleep apnea

-Respiration ceases for brief periods of time, followed by arousal from sleep
-Can be several hundred of the arousals resulting in fragmented sleep
-Obstructive: blockage of the airway
-Central: inability of central regulatory system to drive respiration
-Often accompanied by snoring
-Rx: obstruction removal via surgery, CPAP, pharmacological (avoid CNS depressants since they interfere w/ brain's ability to be aroused)



-Parts of the tetrad: excessive daytime sleepiness, cataplexy (sudden loss of muscle tone, preceded by emotionally charged stimulus), sleep paralysis (upon waking), hypnagogic hallucinations (dream-like fragments)
-Non-pharmacologic Rx: education, support, naps (10 min)
-Pharmacologic Rx: Antidepressents (SSRIs) can result in rebound cataplexy when discontinued abruptly, sodium oxybate (GHB), CNS stimulants



-Relative lack of sleep + impairment of function
-Can include: difficulty falling asleep/maintaining sleep, waking too early, poor quality
-Can be transit (days, due to stress), short-term (3 weeks)
-Rx with good sleep hygiene, relaxation, hypnotic drugs (BZDs)


Ideal hypnotic

-Rapid sleep induction
-Sufficient duration w/ no hangover
-Lack of habituation and tolerance
-Normal sleep pattern
-High therapeutic index
-Lack of drug interactions


Sleep hygiene

-Regular bedtime and wake up time
-Regular exercise early in day
-Avoid naps
-No heavy/spicy foods, or late meals/drinks
-Bedroom cool, dark, quiet
-Minimize caffeine, EtOH, stress


Different hypnotics

-Diphenhydramine: histamine (H1) antagonist and anticholinergic (gives sympathetic sx)
-Barbiturates (not used)
-Antidepressants: highly sedating, can also be anticholinergic
-Benzodiazepines: first line of Rx for insomnia
-Non-BZD BZD-receptor agonists: the Z drugs, not as widely used
-Melatonin-receptor agonists: short acting, reduces sleep latency (but inconsistent on total sleep time)


Severe headache differential

-Subarachnoid hemorrhage (SAH)
-Tests: CT head, LP (hb, bili), anteriogram


Sx for SAH

-Systemic: fever, weight loss
-Neurologic: confusion, seizures
-Onset: sudden
-Older: >50
-Previous health Hx: 1st headache?


Migraine Dx

-History: Past headache history, social, family Hx, headache impact
-Normal PE
-No imaging needed unless abnormal signs
-Criteria of migraine: any 2 Sx (unilateral, throbbing, worsened by movements, moderate or severe) plus any one Sx (nausea or vomiting, photo/phonophobia)
-Clinical course: prodrome (cause), aura (visual, sensory association), headache, postdrome


Pathogenesis of headache

-Generated in brainstem (pons), which stimulates CN V thus causing release of neuropeptides and constriction of blood vessels
-There is neuronal hyperexcitability (esp in occipital cortex)
-Rx: pharmacologic treatment of even mild pain, and within 15 min of onset


Cluster headache

-Starts same time same day each year (unique time pattern)
-Usually in males, onset 20-40 yo
-Severe, excruciating, lasts 15min - 3 hours
-Restless pt (as opposed to migraine: don't want to do anything)
-Starts in hypothalamus
-Rx: 100% O2, pharmacologic


Rebound headache

-Analgesic rebound: use of more than 10-15 pills of common NSAIDs per week
-Causes brain to sensitize to normal pain threshold, thus removing the drug increases pain perception

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