Neurologic Sleep Disorders Flashcards Preview

Brain and Behavior Part 2 > Neurologic Sleep Disorders > Flashcards

Flashcards in Neurologic Sleep Disorders Deck (45)
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1
Q

3 broad categories of sleep disorders?

A

Excessive sleepiness
Insomnia
Abnormal behaviors during sleep

2
Q

4 conditions causing excessive sleepiness mentioned in lecture? (recall that this is a very incomplete list)

A

Narcolepsy
Sleep apnea
Insufficient sleep
Medication effects

3
Q

3 causes of insomnia mentioned in lecture?

A

Mood disturbance
Circadian rhythm disturbance
Restless leg syndrome

4
Q

3 conditions causing unusual movements or behaviors during sleep?

A

Parasomnias from non-REM or REM sleep
Nocturnal seizures
Movement disorders

5
Q

What’s an actigraph?

A

Wrist accelerometer that detects movements. It’s used to get an objective measure of when people are actually asleep.

6
Q

What is the narcolepsy tetrad + one other common symptom?

A
Hypersomnolence
Cataplexy
Hypnogogic/hypnopompic hallucinations (i.e. while falling asleep and waking up)
Sleep paralysis
\+ Impairment of sleep quality
7
Q

What is cataplexy?

A

Weakness / loss of muscle tone provoked by emotion.

8
Q

How do polysomnograms look in patients with narcolepsy?

A

“unremarkable except for frequent arousals”

9
Q

What is / what do you test for in multiple sleep latency tests?

A

Four or five 20 minute naps at 2 hour intervals.
Looking to see how quickly patient falls asleep / what stages of sleep they reach / anything unusual such as sleep paralysis.

10
Q

What will the results of a multiple sleep latency test on a patient with narcolepsy be?

A

Will fall asleep much more rapidly than normal.
Will enter REM sleep, which is not normal for a 20 minute nap.
May have sleep paralysis.

11
Q

What will be frequently seen on a electromyogram (EMG) of a patient with narcolepsy upon awakening?

A

Abrupt loss of muscle tone -> paralysis.

12
Q

Do people remain conscious during attacks of cataplexy?

A

Yes, but they often lack so much muscle tone that they are unresponsive.

13
Q

Most common age range for onset of narcolepsy?

A

“2nd to 4th decade” (…. does that mean age 10 - 39? a quick Google search makes me think so. It often presents in adolescence.)

14
Q

Is narcolepsy equally present in all parts of the world?

A

Nope. It’s more common in Japan and less common in Israel.

15
Q

What’s different about REM sleep in patients with narcolepsy?

A

The boundary between REM sleep and wakefulness is not as discreet as is normal.

16
Q

What kind of molcule is hypercretin? (What else is it called?) Where is it made?

A

Hypercretin aka. orexin is a neuropeptide made in the posterolateral nucleus of the hypothalamus. Hypercretinergic neurons project to areas controlling sleep/wake cycles.

17
Q

What’s hypercretin got to do with narcolepsy?

A

Patients with narcolepsy with cataplexy have markedly lower hypercretin levels.

18
Q

What does hypercretin do? What does it act on? (3 things)

A

Hypercretin promotes wakefulness by promoting the activity of the LC, TMN, and Raphe nuclei (which promote wakefulness and inhibit VLPO).

19
Q

What is the flip-flop model for wakefulness? How is hypercretin involved?

A

VLPO and eVLPO promote sleep, inhibit LC/TMN/Raphe nuclei, and inhibit hypercretin activity.
LC/TMN/Raphe nuclei promote wakefulness and inhibit VLPO/eVLPO.
Hypercretin promotes LC/TMN/Raphe nuclei activity, tipping the balance toward wakefulness.

20
Q

Treatment for somnolence in narcolepsy? (3 things, one is pretty obvious)

A

Conventional stimulants
Modafinil / armodafinil (new stimulants)
Naps.

21
Q

3 treatments for cataplexy?

A

Tricyclic antidepressants (suppress REM)
SSRIs (suppress REM)
Gamma hydroxybutarate aka. Xyrem (“produces consolidated sleep”)

22
Q

What are parasomnias? Are they necessarily pathological?

A

Undesirable behavioral, motor, or sensory phenomena that happen during sleep. They’re not necessarily pathological, but some are. They range from nightmares to leg movement to sleepwalking.

23
Q

What are 3 steps on the continuum of severity of “Disorders of Arousal”?

A

Confusion arousal - appear to be awake and confused, but not actually.
Sleepwalking.
Night terrors = sleepwalking with sympathetic overdrive.

24
Q

From which phase of sleep to disorders of arousal originate?

A

non-REM (usually slow wave) sleep

25
Q

Do people usually remember having had an episode of sleepwalking / night terror?

A

No.

26
Q

Do disorders of arousal run in families?

A

Yes.

27
Q

When is the peak incidence of sleepwalking?

A

About age 12.

28
Q

What is the treatment for disorders of arousal? (5 things)

A

Reassurance that it’s probably not the sign of some serious problem.
Secure environment.
Warning device.
Avoid precipitating factors (EtOH, stress, insufficient sleep).
Medication, if severe: benzodiazepines.

29
Q

What will polysomnography of a person with REM sleep behavior disorder show?

A

Muscle tone during REM sleep where there shouldn’t be any.

and movements / behaviors…

30
Q

3 features of REM sleep behavior disorder? (2 positive, 1 negative)

A

Violent dream-enacting by history or polysomnography.
Increased tonic or phasic EMG recordings during REM sleep.
Absence of epileptiform activity (on EEG and otherwise, presumably).

31
Q

Where, anatomically, is REM sleep generated? What does it do to suppress movement during REM sleep?

A

The pons. Sends active inhibition to spinal nerves.

32
Q

What muscles aren’t paralyzed in REM sleep?

A

Occular muscles, the diaphragm

33
Q

6 causes of REM sleep behavior disorder?

A
Ideopathic.
Narcolepsy.
Overlap with non-REM parasomnias.
Neurodegenerative disease.
Medications, esp. SSRIs.
Disrupted REM sleep.
34
Q

What 3 neurodegenerative diseases are associated with REM sleep behavior disorder?

A

Parkinson’s disease
Dementia with Lewy Bodies
Multi-system Atrophy

35
Q

3 treatments for REM sleep behavior disorder?

A

Clonazepam (a benzodiazepine) - 90% effective
Melatonin - sometimes effective
Secure environment (comedian Mike Birbiglia sleeps in a sleeping bag and wears mittens so he can’t get out).

36
Q

How are “restless legs” defined?

A

An awake sensory phenomenon that is relieved by volitional motor activity.

37
Q

How are “periodic limb movements” defined (in the context of restless leg syndrome)?

A

An involuntary, sleep-related motor phenomenon. (remember that the arms can also be involved)

38
Q

What are the URGE criteria for restless leg syndrome (RLS)?

A

Urge to move legs, usually with dysthesias.
Rest or inactivity brings on these urges/dysthesias.
Getting up to walk around provides partial or total relief.
Evenings - in the evenings, symptoms are usually worse.

39
Q

3 (non-URGE) features that support a diagnosis of RLS?

A

Periodic limb movements - in 80-90% of patients with RLS, but not specific at all (lots of people have periodic limb movement).
Family history.
Response to dopaminergic therapy.

40
Q

4 exacerbating factors for RLS?

A

Psychological stress
Physical confinement (i.e. being in jail?)
Caffeine
Poor sleep

41
Q

What’s more likely to rapidly progress: Early or late onset RLS?

A

Late onset. - it’s more likely to be secondary to some other condition.

42
Q

3 conditions associated with secondary RLS?

A

Iron deficiency anemia.
Pregnancy.
Chronic Renal Failure.

43
Q

What’s thought be the pathophysiology of RLS?

A

Iron deficiency? -> impaired dopaminergic activity? -> reduced supra-spinal motor inhibition.
Maybe.

44
Q

What might be the RLS - Periodic Limb Movement link?

A

Both might be caused by loss of supraspinal inhibition:
RLS - suppression of afferent sensory info is lost
PLM - suppression of efferent motor activity is lost

45
Q

5 treatments of RLS?

A

Dopamine agonists
Opiates
Gabapentin
Iron (or tell them to stop donating blood so much)
Benzodiazepines (doesn’t actually treat the RLS part, though)