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20 terms

Neuro Block 4 - CC Sleep disorders

STUDY
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idiopathic insomnia
insidious onset in childhood
unrelated to trauma or medical disorder
assoc w/ less emotional stress
classic insomnia - psychophysiological
conditioning of sleep preventing habits
internalization of psych conflicts & excessive worrying/apprehension about sleep
sleep-state misperception
meds used for insomnia
hypnotics
sedative antidepressants
antihistamines
obstructive sleep apnea syndrome
upper airway obstruction during sleep, loud snoring; frequent arousals
periodic limb movement disorder (PLMD)
episodes of limb mvmts that last from 0.5-5sec w/ 20-40sec btw
MOST COMMON in stage 2 sleep
tx - dopaminergic agents (like in parkinsons)
restless legs syndrome
disagreeable leg sensations, especially just before sleep onset, that cause an almost irresistable urge to move the legs
>occurs during daytime and at night in bed
>most often IDIOPATHIC
> tx - dopaminergic agents
narcolepsy
as frequent as parkinsons & MS
has the HIGHEST disease HLA linkage known
siblings of these pts ahve a 60x greater chance to develop the disease
onset is usually in the TEENS > stabilizes but rarely remits
-sometimes assoc w/ cataplexy; triggered by emotion
cataplexy
sudden loss of muscle tone
hypnagogoic (sleep onset) or
hypnopompic (upon awakening)
HALLUCINATIONS
extremely vivid and frightening dreams > total body paralyis, and sensations of oppression and dread
hypocretin/OREXIN
considered a regulator that integrates senosry inputs and orchestrates the AROUSAL THRESHOLD ( loss of these neurons may be trigger for narcolepsy)
rem suppressing agents
alcohol, cocaine, tricyclic antidepressants
EDS symptomatic treatment - effective at reducing symptoms of hypersomnolence
amphetamine
methylphenidate
mazindol
>they work via dopaminergic activation of the RAS
-others: modafinil, Haloperidol
treatment for cataplexy
TCAs - tricyclic antidepressants - imiprimamin, clomipramine, MAO inhibitors, SSRIs, clonidine
GHB - sodium oxybate aka gamma-hydroxybutyrate > anesthetic
idiopathic hypersomnia
excessive sleepiness consisting of prolonged 1-2 sleep episodes of NREM sleep
onset 15-30y/o
develops over weeks to months; pt remains symptomatic life long
post traumatic hypersomnia
onset w/in 18mo of head injury; sleepiness not accompanies by REM phenomena
recurrent hypersomnia
recurrent episodes over wks to months
1. monosymptomatic
2. kleine levin syndrome - onset in early adolesence, hypersexuality, disinhibited behaviors - more common in males, complete recovery
tx- lithium carbonate, B12, stimulants
menstrual assoc hypersomnia
oral contraceptives help
idiopathic recurring stupor
episodes of stupor or coma
fast 14-16hz background EEG; increased endozepine in CSF during episodes
tx flumazenil
chronic fatigue syndrome
chronic persistent fatigue that does not resolve w/ bedrest
pt complains of tiredness, fatige, reduction of activity by 50% of normal levels
2female:1 male ratio
age of onset 20-40
tx - exercise, sleep hygeine, diet
parasomnias
more common in children
NREM=
confusional arousals
sleepwalking
sleep terrors
bruxism (teeth grinding)
restless leg syndrome; periodic limb movmetns
REM=
sleep behavior disorder
catathrenia (breath holding)