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Psychiatry > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What are some potential causes of sleep disorders?

A
  • Medical conditions
  • Physical conditions
  • Sedative withdrawal
  • Use of stimulants
  • Major depression
  • Mania or anxiety
  • Neurotransmitter abnormalities
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2
Q

How do the following neurotransmitter abnormalities affect sleep?

  • Elevated dopamine or NE:
  • Elevated acetylcholine:
  • Elevated serotonin:
A
  • Elevated dopamine or NE:
    • Decreased total sleep time
  • Elevated acetylcholine:
    • Increased total sleep time and increased proportion of REM sleep
  • Elevated serotonin:
    • Increased total sleep time and increased proportion of delta wave sleep
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3
Q

What are the two types of primary sleep disorders?

A
  • Dyssomnias: disturbances in the amount, quality, or timing of sleep
  • Parasomnias: abnormal events in behavior or physiology during sleep
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4
Q

What types of waves and percentage of sleep are associated with the following…

  1. Non-REM sleep:
    1. Stage 1 sleep:
    2. Stage 2 sleep:
    3. Stage 3-4 sleep:
  2. REM sleep
A
  1. Non-REM sleep: 75% of sleep
    1. Stage 1 sleep: Decreased alpha waves; 5%
    2. Stage 2 sleep: Sleep spindles and k-complexes; 45%
    3. Stage 3-4 sleep: Delta waves; 25%
  2. REM sleep: Sawtooth waves; 25%
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5
Q

What is required for a diagnosis of insomnia?

A

Difficulty initiating or maintaining sleep, resulting in daytime drowsiness or difficulty fulfilling tasks

Disturbance occurs three or more times per week for at least 1 month

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6
Q

What percentage of the population is affected by insomnia?

A

30%

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7
Q

What sleep hygeine measures are used to treat insomnia (1st line treatment)

A
  • Maintain regular sleep schedule
  • LImit caffeine intake
  • Avoid daytime naps
  • Exercise early in day
  • Soak in hot tub prior to bedtime
  • Avoid large meals near bedtime
  • Remove disturbances such as TV and telephone from bedroom
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8
Q

What pharmacotherapy is used to treat insomnia?

A
  • Benadryl, Ambien (zolpidem), Xonata (zaleplon), Desyrel (trazodone)
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9
Q

How is primary hypersomnia diagnosed?

A
  • At least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition, medications, poor sleep hygeine, insufficient sleep, or narcolepsy
  • Usually begins in adolescence
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10
Q

How is hypersomnia treated?

A

Stimulant drugs (amphetamines) are first line

SSRIs may be useful in some patients

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11
Q

How is Narcolepsy diagnosed?

A

Repeated sudden attacks of sleep in the daytime for at least 3 months, associated with:

  • Cataplexy - collapse due to sudden loss of muscle tone; associated with emotion, particularly laughter
  • Short REM latency
  • Sleep paralysis - brief paralysis upon awakening (50%)
  • Hypnagogic (patient falls asleep or is falling asleep) or hypnopompic (as patient wakes up; dream persists) hallucinations (30% of patients)
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12
Q

Narcolepsy is more common in ______ (males/females)

A

equal in both (gotcha!)

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13
Q

What is the treatment for narcolepsy?

A

Timed daily naps plus stimulant drugs (amphetamines adn methylphenidate)

SSRIs

Sodium oxalate for cataplexy

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14
Q

How are breathing-related disorders (OSA, CSA) diagnosed?

A

Sleep disruption and excessive daytime sleepiness (EDS) caused by abnormal sleep ventilation from either obstructive or central sleep apnea

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15
Q

What other symptoms are correlated with…

Obstructive sleep apnea:

Central sleep apnea:

A

OSA: strong correlation with snoring

CSA: correlated with heart failure

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16
Q

What are some risk factors for OSA?

A
  • Male gender
  • Obesity
  • Shirt collar size >17
  • Prior upper airway surgeries
  • Deviated nasal septum
  • “kissing” tonsils
  • Large uvula, tongue
  • Retrognathia
17
Q

How is OSA treated?

A

Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery, or uvulopalatoplasty

18
Q

How is CSA treated?

A

Mechanical ventilation (such as b-PAP) with a backup rate

19
Q

What is the difference between excessive daytime sleepiness (EDS) and fatigue?

A

EDS is falling asleep when you don’t want to

Fatigue is being too tired to complete activities

20
Q

What is the difference between OSA and CSA?

A

OSA: respiratory effort is present, but ventilation is disrupted by physical obstruction of airflow

CSA: periodic cessation of respiratory efort

21
Q

What is Circadian Rhythm Sleep Disorder?

What are the subtypes?

A

Disturbance of sleep due to mismatch between circadian sleep-wake cycle and environmental sleep demands

Subtypes include jet lag type, shift work type, and delayed sleep or advanced sleep phase type

22
Q

How do you treat the following subtypes of circadian rhythm sleep disorder…

  • Jet lag type:
  • Shift work type:
  • Delayed sleep/advanced sleep phase type:
A
  • Jet lag type: Usually remits untreated after 2-7 days
  • Shift work type: Light therapy may be useful
  • Delayed sleep/advanced sleep phase type: Melatonin can be given 5.5 hours before desired bedtime
23
Q

What is nightmare disorder and during which phase of sleep does it occur?

A

Repeated awakenings with recall of extremely frightening dreams

Occurs during REM sleep and causes significant distress

24
Q

When is the onset of nightmare disorder?

A

Onset most often in childhood

25
Q

What are treatment options for nightmare disorder?

A

Usually nothing, but TCA or other agents that suppress total REM sleep may be used

26
Q

What findings are often observed in the diagnosis of Night terror disorder?

A
  • Repeated episodes of apparent fearfulness during sleep
  • Usually begins with a scream and associated with intense anxiety
  • Episodes usually occur during the first third of the night during stage 3 or 4 sleep
  • Patients are not awake and do not remember the episodes
27
Q

Night Terror disorder is more common in ____ (boys/girls)

A

boys

28
Q

Night terror disorder has a high association with what other sleep disorder?

A

Sleepwalking disorder

29
Q

What treatment options are available for patients with night terror disorder?

A

Usually nothing, but small doses of diazepam at bedtime may be effective if necessary

30
Q

What is Somnambulism (sleep walking disorder)?

A

Repeated episodes of getting out of bed and walking associated with blank stare and difficulty being awakened

31
Q

How does sleepwalking usually terminate?

A

Usually terminates with patient returning to bed, but patient may awaken with confusion for several minutes

32
Q

During which part of the night does sleepwalking disorder occur?

A

Episodes occur during the first 3rd of the night during stages 3 and 4 sleep and are never remembered

33
Q

When is the usual onset for somnambulism? When is the peak prevalence

A

Onset usually between ages 4 and 8; peak prevalence at age 12

34
Q

How is Somnambulism treated?

A

Measures to prevent injury in surrounding environment

Psychiatry (18 decks)

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