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34 Cards in this Set

  • Front
  • Back
What are the 4 main sleep disorders discussed in this lecture?
1. Narcolepsy

2. Non-rem parasomnia: sleep walking

3. REM parasomnia: REM behavior disorder

4. Restless leg syndrome
What are the 4 main symptoms seen in narcolepsy?
1. Hypersomnolence - sleepiness

2. Cataplexy - Sudden loss of muscle tone

3. Hypnogogic/hypopompic hallucinations

4. Sleep parlysis

(sleep quality is also often impaired)
What is cataplexy?
Sudden loss of muscle tone

(partial tone loss common)
What is cataplexy triggered by?
Emotion, especially laughter
What are the 2 tenents of the pathophysiology of narcolepsy?
1. Normal sleep architecture is disrupted across the 24 hr period

2. Th boundries between wakefulness and REM sleep are not well maintained
What neuropeptide is diminished in narcolepsy with cataplexy?
Hypocretin (orexin)
Where is hypocretin produced?
Postero-lateral hypothalamus
What do hypocretinergic neurons do?
Project widely to areas of the brain involved in sleep-wake control
Hypocretin causes what in terms of awakeness/sleepiness?
Awake --> stimulates LC/TMN/RAPHE
What is state dissociation?
Overlap among sleep states
What are the 3 main treatments for hypersomnolence?
1. Conventiional Stimulants

2. Modafinil / armodafinil

3. Naps
What are the 3 main treatments for Cataplexy?
1. Tricyclic antidepressants

2. SSRIs

3. Gamma hydroxybutyrate (Xyrem)
What is parasomnia?
An undesirable behavioral, motor, or sensory phenomenon which occurs intermittently during sleep
Are all parasomnias abnormal?
No (ex: nightmares)
What are the 3 types of "Disorders of Arousal"?
1. Confusional arousals

2. Sleepwalking

3. Sleep Terrors
Disorders of arousal have their origin in which sleep?
Non-REM
When in life are disorders of arousal common?
Childhood
How can Non-REM parasomnias be understood?
As a form of state dissociation
What is the Tx for Non-REM parasomnias?
1. Reassurance/Secure Environment

2. Warning device

3. Medication: Benzodiazepines
What is a dissociated state characterized by violent dream enacting behavior?
REM sleep behavior disorder
Where are REM sleep generating neurons located?
PONS
Is it known what causes RBD?
Idiopthic

Nacrolepsy, non-REM parasomnia, neurogenerative disease, medications
What sex typically has RBD?
Males (87%)
What is the main treatment for RBD?
Clonazepam (90%) effective

(melatonin also shown to be effective)
What is an awake sensory phenomenon with a volitional motor response?
Restless Legs
What is the URGE criteria for restless legs syndrome?
1. Urge to move legs

2. onset with Rest or inactivity

3. Partial or total relief with movement (Getting up)

4. Symptoms worse in Evening and at night
What are for exacerbating factors for RLS?
1. Stress

2. Confinement

3. Caffeine

4. Poor sleep
What are the 3 associated conditions with secondary RLS?
1. Iron Deficiency anemia

2. Pregnancy

3. Chronic Renal Failure
In the pathophysiology of RLS, what may be impaired?
Central dopaminergic transmission
What might the dopaminergic transmission impairment be caused by in RLS?
Decreased availability of iron in the brain
What is the functional result of dopaminergic impairment in RLS?
Reduced supra-spinal inhibition (giving restless legs)
What does PLM represent?
Reduction of supra-spinal inhibition affecting MOTOR efferents
What does RLS represent?
Reduction of supra-spinal inhibition affection SENSORY afferents
What are 5 treatments of RLS?
1. Dopamine agonists

2. Opiates

3. Gabapentin

4. Iron

5. Benzodiazepines