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This Concept Map, created with IHMC CmapTools, has information related to: Sleep Disorders, Sleep Disorders Insomnia Tx: both BZDs and CBT effective -CBT more effective in long term -CBT more effective for long & short in elderly, Sleep Disorders Circadian Rhythm Disorders DELAYED SLEEP PHASE SYNDROME -teens -bright light BEFORE temp nadir, Sleep Disorders Sleep Loss Epworth Sleepiness Scale ᡂ pathological 20-narcoleptics, Sleep Disorders NARCOLEPSY Pathophys: -due to SLEEP-ONSET REM ->intrusion of REM atonia Primary: impaired sleep/wake regulation -7/10 pts deficient in HYPOCRETIN -from lateral hypothalamus -loss of NEURONS-neuroexcitatory (dogs w/ deficient receptor) -genetics - HLA-DQB1-0602 -99% narcoleptics, 50% NL -but lots of ppl w/ this -children of narcoleptics w/ 1% risk, RESTLESS LEG SYNDROME -a SYMPTOM 1. paresthesias 2. worse in evening-circadian 3. worse w/ inactivity, better w/ activity 4. ass'd motor hyperactivity Other Ass'd conditions: Pregnancy Neuropathies Anemia (Fe, B12, folate def) Chronic renal failure Medications (SSRIs, TCAs) Obesity Hypothyroid Caffeine Benadryl makes worse!, Sleep Disorders Moving while sleeping -often overlap RESTLESS LEG SYNDROME -a SYMPTOM 1. paresthesias 2. worse in evening-circadian 3. worse w/ inactivity, better w/ activity 4. ass'd motor hyperactivity, Sleep Disorders Circadian Rhythm Disorders Night shift workers do NOT adjust to day sleep, Sleep Disorders NARCOLEPSY Dx: ɭ SOREM w/ a few naps ɝ min MSLT, Sleep Disorders NARCOLEPSY M=F Rare More prev in JAPAN RARER in ISRAEL Sx appear in 10s-20s -Dx made midlife, Sleep Disorders Insomnia Psychophysiological Insomnia -10-25% insomnia pts, Sleep Disorders Moving while sleeping -often overlap PERIODIC LIMB MOVEMENT D/O -and EMG finding 1. stereotypic, repetitive mvmts 2. during sleep/inactivity 3. every 20-40s 4. may->arousal from sleep -can->insomnia 5. minimum clusters of 4, Sleep Disorders NARCOLEPSY Tx: GHB: Sodium Oxybate (Xyrem) -for bedtime and 4 hrs later -fast, but short acting -reduce sleepiness, cataplexy -consolidate sleep -efficacy improves over time TCAs, SSRIs-REM sleep suppression -reduce cataplexy Methylphenidate-ritalin-stimulants Modafinil-provigil-like ritalin, but ADRs not as bad, qd, RESTLESS LEG SYNDROME -a SYMPTOM 1. paresthesias 2. worse in evening-circadian 3. worse w/ inactivity, better w/ activity 4. ass'd motor hyperactivity Other Tx: NSAIDs if mild Dopaminergics -L-dopa-longterm bad -augmentation -Pergolide -PRAMIPEXOLE -ROPINIROLE (REQUIP) Narcotics if severe -tramadol -subQ apomorphine -levo-dromoran, Sleep Disorders Parasomnias REM Sleep Beh D/o -loss fo REM atonia ->motor activity w/ REM -middle-age, older MEN -neuro d/os in half -PD, dementia, multiple system atrophy -Tx: Clonazepam, perhaps melatonin, RESTLESS LEG SYNDROME -a SYMPTOM 1. paresthesias 2. worse in evening-circadian 3. worse w/ inactivity, better w/ activity 4. ass'd motor hyperactivity Other Complaints: Sleep disturbances Diff to fall asleep/stay asleep Nightwalkers, elvis legs Daytime sleepiness, Sleep Disorders Parasomnias SLEEP-WALKING -common in kids -worse w/ sleep loss, noisy, EtOH, stress -STAGE 4 SLEEP -EtOH->inc'd deep sleep ->inc'd sleep walking -gently guide back to bed -BZDs in severe cases ->dec'd deep sleep, Sleep Disorders Circadian Rhythm Disorders ADVANCED SLEEP PHASE SYNDROME -old ppl -bright light AFTER temp nadir, Sleep Disorders NARCOLEPSY Sx (tetrad): EXCESSIVE DAYTIME SLEEPINESS -even if they get enough sleep Cataplexy-drop attack-lasts sec-min -ppt'd by excitement, LAUGHTER, JOKE-TELLING -develops mos-yrs after EDS Hypnagogic hallucinations -vivid dreams at sleep onset -maybe w/ paralysis -tactile or auditory -some awareness of surroundings Sleep paralysis during onset/offset -can be in NL ppl (so can HHs) (Disrupted nocturnal sleep) BUT NL #hrs of sleep total, Sleep Disorders Insomnia Endocrine: HYPERTHYROIDISM -one of earliest signs Hypothyroid-inc'd tongue size DM-if glucose not controlled Cushing Acromegaly (GH excess), Sleep Disorders Sleep Loss No sleep for 24 hrs = 0.10 BAC 17 hrs = 0.05 BAC Take nap at 2pm! College students more sleepy than elderly Sleep latency -pathologic if ɝmin