Sleep-Wake Disorders

Question 1

How to identify sleep complaint?

Answer 1

is it quality, daytime sleepiness, awakening, getting sleep??

Question 2

How does core body temp affect sleep?

Answer 2

• Sleep best as CBT drops (arousal system quiets)
• awake approximately 2 hrs after lowest CBT begins to rise
• Insomnia develops if we try to sleep before CBT begins to drop
• Excessive Daytime Sleepiness (EDS) develops when sleep period truncated before alerting rhythms begin to rise

Question 3

signs of Obstructive Sleep Apnea

Answer 3

Loud snoring, excessive daytime drowsiness, structural abnormality of upper airway

obesity strongest RF

Question 4

Insomnia disorder

Answer 4

• Daytime symptoms
• Symptoms of fatigue, sleepiness cognitive or mood disturbances, reduced social, academic and work effectiveness
• Usually coexists with other conditions (psych, sleep, medical)

Question 5

Complications of insomnia disorder

Answer 5

• Major depression risk if Insomnia > 1 year

- Suicide risk if insomnia + nightmares

Question 6

Most common form of insomnia disorder

Answer 6

transient (1-2 days to several weeks)

due to stress, excitement, high altitude, jet lag, shift work, menopause

Question 7

Treatment of Sleep Phase Delay (Circadian Rhythm Sleep-Wake Disorder)

Answer 7

Melatonin taken before lowest core body temp and light exposure after lowest core body temp resets alerting system to an earlier time. Light exposure before lowest CT and melatonin after resets alerting system to a later time

Question 8

Treatment insomnia

Answer 8

• Brief trial of med (upregulate inhibitory and/or downregulate activating systems)
• No hypnotics
• Consider behavioral treatments, circadian guidance
• Education about healthy sleep habits, cognitive distortions and catastrophizing, hyperarousal, feared illnesses
• Tx comorbid conditions (depression, anxiety)
• Lifestyle: relaxation techniques, exercise, diet
• If no response, refer

Question 9

Treatment to reset your alerting system to an EARLIER time

Answer 9

Melatonin before lowest core body temp

Light exposure after lowest core body temp

Question 10

Treatment to reset your alerting system to an LATER time

Answer 10

Light exposure before lowest core body temp

Melatonin after lowest core body temp

Question 11

Restless leg syndrome

Answer 11

urge to move legs and/or arms to relieve uncomfortable sensations

Question 12

RLS treatment

Answer 12

• Remove nicotine, alcohol, psychotropic meds
• Check serum ferritin levels (<50 ng/Ml)
• Massage, warm baths, relaxation, exercise, meditation
• If severe: possible opiates (methadone), anticonvulsants, benzos, dopamine agonists

Question 13

Signs of Non-REM sleep arousal disorders?

Answer 13

• sleep walking and subtypes, sleep terrors
• eyes are open
• first half of sleep

Question 14

Signs of REM sleep behavior disorder?

Answer 14

• failure of muscle inhibition during REM
• eyes are closed
• second half of sleep; act out dreams

Question 15

Tx of REM Sleep Disorder

Answer 15

REFER to sleep medicine

low-dose clonazepam, melatonin

Question 16

Onset of narcolepsy

Answer 16

adolescence

Question 17

Signs/sx’s of narcolepsy

Answer 17

• excessive daytime sleepiness usually first symptom

- strong emotion (like laughter) triggers sudden and short loss of muscle tone (seconds to 2 mins)