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Flashcards in 9. Sleep Medicine Deck (19)
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1
Q

sleep disorders

A

American academy of sleep medicine (1997)
common
- 1/3 more sleepy in the day than they would like
- 4-19% chronic insomnia
- 2-4% obstructive sleep apnoea (OSA; middle aged adults)
serious
- mortality (e.g. accidents) more likely = 1/6 sleep influenced (George, 1996)
- 100’000 crashed per anum
- 1500 fatalities per anum
- also links to obesity, depression, poor performance and relationships

2
Q

George (1996)

A
  • driving drunk is less likely to cause an accident compared to having OSA
  • more people drive tired too
3
Q

problem sleepiness

A
  • Selby train crash = 10 fatalities
  • Bhopal chemical disaster = >10’000 fatalities and 1/2 million exposed to chemicals
  • Chernobyl nuclear disaster = 125’000 deaths worldwide
  • Exxon oil spill = > 1000 sea otters, 300 harbour seals and 250’000 sea birds died costing $2.5 billion
4
Q

what is normal sleep

A

depends on the individual

  • we need to get a proper evaluation
  • its about how people feel
5
Q

Sleep disorders are under-diagnosed

A
  • 95% remain unidentified and undiagnosed
  • few health care professionals ask about sleep as they aren’t trained
  • medical students have approximately 5 minutes talking about sleep in 5 years of lectures
  • yet sleep disturbances are linked to the top 10 most diagnosed conditions
  • yearly cost of sleep deprivation is $16 billion direct and $50-100 billion indirect
6
Q

sleep disorders

A
  • insomnia (cant sleep)
  • hypersomnia (sleeps too much)
  • circadian rhythm disorders
  • parasomnias (sleep walking/talking)
  • movement disorders of sleep
7
Q

insomnia

A
  • 30-80% prevelance rate - Ohayon (2002)
  • evolutionarily we have evolved to have 7-9 hours sleep (seen in 1910) but nowadays we have on average 6.9h (2000)
  • treating insomnia also enhances the treatment of depression (Fava et al., 2007)
  • if you improve the sleep of individuals with mental disorders you also signficiantly improve their mental health as well (Morin et al., 1994 also below)
  • CBT is an influential therapy for insomnia
  • 30% of individuals improved just from talking about CBT
8
Q

CBT in insomnia sufferers

A
  • told if they wake up and cant sleep for 15-30 mins just to get up to reduce the fear of trying to sleep
  • slowly consolidating into a block of sleep

what time they need to wake up - how much sleep they need = bed time

  • extend this by 15 minutes each week but cant move on until they have mastered each block
  • reducing sleep onset latency
  • reducing wake after onset
  • 70-80% benefit
9
Q

sleep questionnaires and rating scales

A
  • Epworth sleepiness scale (0-3, how likely are you to fall asleep in these situations)
  • Restless leg rating scale (asks about how sleep disturbances are related to restless leg syndrome)
  • Parkinson’s disease sleep scale (how would you rate the following based on your experiences the previous week)
  • all based on subjective measures
10
Q

objective measures

A
  • multiple sleep latency test (MSLT)
  • maintenance of wakefulness test
  • vigilance test (Osler test)
  • outpatient neurophysiology studies = pulse oximetry, respiratory monitoring, ambulatory EEG (epilepsy)
  • can identify how successful therapies are through these sleep recording methods
  • can then have a sleep diary (subjective) to compare to
  • inpatient telemetry studies = polysomnography (EEG, respiratory monitoring, movement detection)
11
Q

hypersomnolance/excessive daytime somnolance

A
  • differential diagnosis - sleep disordered breathing hypersomnia of central origin, insufficient sleep syndrome, depression and anxiety syndromes
12
Q

sleep disordered breathing

A

increased thoracic and abdominal effort when airways are blocked (Vuzir et al., 2005)

  • measures of severity = Apnoea-hypoapnoea index (AHI) looks at the number of episodes each hour
  • children = 2-3%
  • middle age = 5-7%
  • CPAT treatment helps keep airways open throughout the night by forcing air through the airway
  • CPAT improves feelings of sleepiness, cognition, health status and blood pressure
  • controlled trial evidence that mandibular (jaw bone) advancement devices (MAD) and mandibular repositioning splints (MRS) (Mehta et al., 2001) but not as much as CPAP
  • mild evidence for surgery too
13
Q

narcolepsy features

A
  • Narcolepsy features = normal sleep quality is poor (lots of dreams, nighttime waking), hypnagogic (sleep onset) hallucinations, hypnopompic (awakening) hallucinations, sleep paralysis
  • 25-50 per 100’000 people (Billiard et al., 2003)
  • more common in younger and middle adolescents
  • diagnosis = 6 months duration without obvious cause, exclusions of other abnormalities, genetic associations (HLA on chromosome 6)
14
Q

cataplexy features

A
  • features = loss of muscle tone is triggered by emotions (mainly laughter), which worsens with poor sleep and fatigue
  • consciousness is retained
15
Q

narcolepsy/cataplexy physiology

A
  • pathophysiology (disease that impacts physiological processes)
  • intrusions of REM into wakefulness
  • diss-regulation of normal sleeping from an imbalance in adrenergic (decrease), serotonergic (decrease), hypocretin (decrease - mutation in gene coding) and Ach (increase)
16
Q

narcolepsy treatment

A
  • planned naps, using stimulants in the day like modaphinil (Neurology, 1998)
17
Q

cataplexy treatment

A
  • antidepressants (SSRI’s), sodium oxibate (the more you have, the less attacks you have; US Xyrem, 2002) with LT effects
18
Q

Parasomnia

A
  • non-REM = sleep terrors, sleep talking, common in childhood
  • can be triggered by stress or sleep deprivation
  • they are still asleep but do abnormal things
  • REM behaviour disorder = loss of atonia during REM which can result in acting out violent dreams as not paralysed
19
Q

movement disorders of sleep

A
  • restless leg syndrome, periodic limb movements, propriospinal myoclonus
  • sensorimotor disorder resulting in a feeling that you must move your legs
  • there seems to be a genetic predisposition
  • also related to iron deficiency, pregnancy or drugs

treatment = dopamine agonist (L-dopa, opiates)