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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

sedative antidepressants

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


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


sudden loss of muscle tone

hypnagogoic (sleep onset) or
hypnopompic (upon awakening)

extremely vivid and frightening dreams > total body paralyis, and sensations of oppression and dread


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

>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


more common in children
confusional arousals
sleep terrors
bruxism (teeth grinding)
restless leg syndrome; periodic limb movmetns
sleep behavior disorder
catathrenia (breath holding)

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