Sleep Disorders

Question 1

DDx of daytime sleepiness?

Answer 1

Insomnia
Obstructive sleep apnoea.
Central sleep apnoea.
Night work
Drugs: hypnotics, β-blockers.
Parkinsonism
Hypothyroidism
Narcolepsy
Idiopathic hypersomnolence

Question 2

Normal sleep physiology:

Repeated cycles of 90-minute cycles of:
- Non-REM sleep then REM sleep.

What does REM stand for?

What happens to cycles through the night?

Which type does sleep occur in?

Answer 2

Non-REM (NREM)
REM

Rapid eye movement

Gets longer through the night

REM sleep

Question 3

Central sleep apnoea:

What is it also called?

Define?

Answer 3

Nocturnal hypoventilation

• An interruption of breathing during sleep, without an obstructive cause.
• Chest wall function leading to loss of respiratory effort

Question 4

Central sleep apnoea:

Causes mneumonic - APNO2EIC

Answer 4

Altitude

Primary central sleep apnoea (idiopathic)

Neuromuscular disease - muscular dystrophy, MND

Obesity hypoventilation syndrome (Pickwickian’s syndrome)
+ Opioids

Ejection fraction low - heart failure

Irregular spine - scoliosis

CNS disease - brainstem lesions from stroke

Question 5

Central sleep apnoea:

Presentation:

• How do they come on?
• Pattern
• What part of sleep is it worse in?
• Why do they get morning headaches?
• What does it lead to during the day?

Management - 1

Answer 5

Episodes of apnoea

Crescendo then decrescendo pattern

Worse during REM sleep

CO2 retention

NIV

Question 6

Insomnia:

What is it?

Management - sleep hygiene:

• What drinks should be avoided? - 2
• What should be avoided during the day?
• What should be added to their daily routine?
• What should be the only 2 things done in the bedroom?
• What stimulations should be avoided?

Answer 6

Difficulty initiating or maintaining sleep resulting in distress or impaired function

Caffeine after 12 pm
Alcohol just before sleep

Exercise

Sleep and sex

No bright screens, big meals or exercise

Question 7

Insomnia:

Management:
- Psych intervention

Pharmacological:

• What hormone can be given?
• What drugs can be given for short term severe and disabling crises?
• What antiemetic can also be used?

Answer 7

CBT

Melatonin for 3-10 wks

Benzodiazepines and Z-drugs

Sedating antihistamines

Question 8

Narcolepsy:

What is the pathophysiology?

Onset

How is it diagnosed?

What is polysomnography?

Why is an MRI and EEG done?

Answer 8

Loss of alerting neurons, that produce hypocretin (aka orexin)

Teens to 20s

A sleep study is a test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.

MRI = excludes space-occupying lesion 
EEG = excludes epilepsy

Question 9

Narcolepsy:

Management:

What should be done first?

2 stimulant meds used? - M, M

Who needs to be contacted?

Answer 9

Education, including sleep hygiene

Modafinil for daytime sleepiness - remember people on course using it for revision

Methylphenidate

DVLA

Question 10

NREM parasomnias:

What is it?

How may it present - just read

Answer 10

Abnormal behaviours associated with sleep - the patient is semi-awake but dissociated during slow-wave sleep.

Night terror
Sleepwalking
Sexsomnia
Sleep-related eating disorder

Question 11

REM behaviour disorder:

What is it?

What neuro diseases is it associated with?

What age and sex is commonly affected?

Answer 11

Loss of REM paralysis, leading to acting out dream content - a type of parasomnias.

PD and LBD

Middle age to elderly males