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34 Cards in this Set
- Front
- Back
What are the 4 main sleep disorders discussed in this lecture?
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1. Narcolepsy
2. Non-rem parasomnia: sleep walking 3. REM parasomnia: REM behavior disorder 4. Restless leg syndrome |
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What are the 4 main symptoms seen in narcolepsy?
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1. Hypersomnolence - sleepiness
2. Cataplexy - Sudden loss of muscle tone 3. Hypnogogic/hypopompic hallucinations 4. Sleep parlysis (sleep quality is also often impaired) |
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What is cataplexy?
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Sudden loss of muscle tone
(partial tone loss common) |
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What is cataplexy triggered by?
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Emotion, especially laughter
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What are the 2 tenents of the pathophysiology of narcolepsy?
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1. Normal sleep architecture is disrupted across the 24 hr period
2. Th boundries between wakefulness and REM sleep are not well maintained |
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What neuropeptide is diminished in narcolepsy with cataplexy?
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Hypocretin (orexin)
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Where is hypocretin produced?
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Postero-lateral hypothalamus
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What do hypocretinergic neurons do?
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Project widely to areas of the brain involved in sleep-wake control
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Hypocretin causes what in terms of awakeness/sleepiness?
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Awake --> stimulates LC/TMN/RAPHE
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What is state dissociation?
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Overlap among sleep states
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What are the 3 main treatments for hypersomnolence?
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1. Conventiional Stimulants
2. Modafinil / armodafinil 3. Naps |
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What are the 3 main treatments for Cataplexy?
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1. Tricyclic antidepressants
2. SSRIs 3. Gamma hydroxybutyrate (Xyrem) |
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What is parasomnia?
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An undesirable behavioral, motor, or sensory phenomenon which occurs intermittently during sleep
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Are all parasomnias abnormal?
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No (ex: nightmares)
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What are the 3 types of "Disorders of Arousal"?
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1. Confusional arousals
2. Sleepwalking 3. Sleep Terrors |
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Disorders of arousal have their origin in which sleep?
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Non-REM
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When in life are disorders of arousal common?
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Childhood
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How can Non-REM parasomnias be understood?
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As a form of state dissociation
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What is the Tx for Non-REM parasomnias?
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1. Reassurance/Secure Environment
2. Warning device 3. Medication: Benzodiazepines |
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What is a dissociated state characterized by violent dream enacting behavior?
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REM sleep behavior disorder
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Where are REM sleep generating neurons located?
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PONS
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Is it known what causes RBD?
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Idiopthic
Nacrolepsy, non-REM parasomnia, neurogenerative disease, medications |
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What sex typically has RBD?
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Males (87%)
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What is the main treatment for RBD?
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Clonazepam (90%) effective
(melatonin also shown to be effective) |
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What is an awake sensory phenomenon with a volitional motor response?
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Restless Legs
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What is the URGE criteria for restless legs syndrome?
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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 |
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What are for exacerbating factors for RLS?
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1. Stress
2. Confinement 3. Caffeine 4. Poor sleep |
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What are the 3 associated conditions with secondary RLS?
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1. Iron Deficiency anemia
2. Pregnancy 3. Chronic Renal Failure |
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In the pathophysiology of RLS, what may be impaired?
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Central dopaminergic transmission
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What might the dopaminergic transmission impairment be caused by in RLS?
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Decreased availability of iron in the brain
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What is the functional result of dopaminergic impairment in RLS?
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Reduced supra-spinal inhibition (giving restless legs)
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What does PLM represent?
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Reduction of supra-spinal inhibition affecting MOTOR efferents
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What does RLS represent?
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Reduction of supra-spinal inhibition affection SENSORY afferents
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What are 5 treatments of RLS?
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1. Dopamine agonists
2. Opiates 3. Gabapentin 4. Iron 5. Benzodiazepines |