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13 Cards in this Set

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What are differentials for excessive sleepiness?
Narcolepsy, Not sleeping enough, Apnea
What are differentials for not being able to sleep?
Medical (depression, anxiety), circadian rhythm disturbance, leg discomfort (restless leg)
What are differentials for unusual movements during sleep?
Night terrors, RBD, movement disorder, seizures
What are key diagnostic criteria for narcolepsy?
Hypersomnolence (stimulants), vivid dreams, episodic paralysis (cataplexy), fragmented sleep --> treat with GBH.

DECREASED HYPOCRETIN

Younger people, 20's and 30's.

The boundaries between REM and awake are NOT WELL MAINTAINED.
How many minutes of sleep latency indicates sleep deprivation?
Less than 8 minutes!
What is sleep dissociation?
OVERLAP AMONG SLEEP STATES. normally the progression of sleep states (normal sleep architecture) is very set...however, in state dissociation there's problems with overlap of these distinct states.
What is parasomnia?
Undesirable motion, behavior, sensory phenomena occurring intermittently during sleep.
Disorders of arousal?
Continuum...lack of recall. Night terrors, sleepwalking. ~1-2% of adults.

Treat with reassurance, warning devices, BENZO's to consolidate sleep and prevent waking breakthroughs
REM Sleep Behavior disorder?
OLDER MEN.

VIOLENT DREAM ENACTING. Kicking, screaming, punching. Increased tonic/phasic EMG in REM. YOU ARE NOT PARALYZED AS IS TYPICAL IN REM. NO EPILEPSY
What are factors for RBD?

(REM-Sleep Behavior disorder)
PRIMARY: Narcolepsy, idiopathic, EPS (note resting tremors, etc), overlap with non-rem parasomnia.

SECONDARY: SSRI. Intoxication, withdrawal

TREAT w/ BENZO's, which suppresses behaviors; atonia not restored.
What are diagnostic criteria for Restless leg syndrome
Urge to move. Onset at rest. Relieved with movement. Symptoms worse at night.
What's the difference between Restless Leg and Period limb movements?
Restless leg is volitional. Period legs are involuntary movements during sleep.
What are factors for RLS?
Primary...familial when young. If onset is later, look at medical causes...renal problems, iron insufficiency.

SSRI use, other problems