Sleep Test
MWT is
Maintenance of wakeful test
try to stay awake while sitting in a chair
low lighting
daytime clothing
Insomnia
Hyperarousal
Narcolepsy
Central sleep apnea
sleep related hypoventilation
Circadian Rhythm sleep wake disorder(shift work specifier)
NonRem Sleep Arousal Disorder(sleep walking & sleep terrors
nightmare
REM sleep behavior
RLS
Sxm of OSA?
excessive sleepiness
difficulty maintaining sleep
obstructed breathing
awakening with h/a
awakening with dry mouth
Parasomnias occur during _______ & _______ sleep
REM & NonREM
Name the nonREM parasomnia
Intensive fear, screaming, crying, appears scared with physiological response
Sleep terrors
(more common in children and tend to reslove by adulthood)
MSLT
Multiple Sleep Latency
dark cool room
instructed to go to sleep
if not sleep in 20 mins test terminated
DSM 5 TR Criteria for Insomnia
A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
1.Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
2.Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
3.Early-morning awakening with inability to return to sleep.
B.The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
C.The sleep difficulty occurs at least 3 nights per week.
D.The sleep difficulty is present for at least 3 months.
E.The sleep difficulty occurs despite adequate opportunity for sleep.
F.The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
G .The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
With mental disorder, including substance use disordersWith medical condition
ALL of the following are linked to?
nonrestorative sleep
depression
anxiety
increased of sudden death
worsening performances
delayed rxn time
OSA
Sleep walking, Sleep terrors, confusion on arousal, sleep related eating disorders, and sexomnias are considered _________ Parasomnias
Non REM
****** involve incomplete awakening and pt do not recall the event
Name the nonREM parasomnia
disorientation and robotic behavior more common in children
Confusion on arousing
Epworth Sleepiness scale
copyright by Dr. Jones
self report the likeliness of falling asleep during several activities
0-never
1-slight chance
2- moderate chance
3 high chance
DSM 5 TR Criteria for Hypersomnolence
A.Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:
1.Recurrent periods of sleep or lapses into sleep within the same day.
2.A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).
3.Difficulty being fully awake after abrupt awakening.
B.The hypersomnolence occurs at least three times per week, for at least 3 months.
C.The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.
D.The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia).
E. The hypersomnolence is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence.
OSA is broken down into different types of _________ , measured by type of apnea, and amt of apneic periods
Apnea
Sleep behavior disorder, nightmare, and recurrent sleep paralysis are considered _________ parasomnias
REM
More common in won=men
binge earing during partial wakening-usually high carbohydrate or inedible food
variant of sleep walking with no recollection
Sleep elated eating Disorder
**** Ambien common cause
What is sleep Health by Dr. Daniel Buysse?
( sleep is personalized prmotes quality of health and ability to be productive and fxn
"Sleep health is a multidimensional pattern of sleep-wake-fulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being. Good sleep health is characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours".
DSM 5 TR Criteria for Narcolepsy
disorder order of spontaneous sleeping
A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months.
B.The presence of at least one of the following:
Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
a.In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw- opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.
Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.
Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods.
Dx OSA is done via___________
The values indicated are
PSG
decreased o2 SA
Decreased airflow
increased respiratory rate
increased arousal
tachycardia
occurs during REM sleep
Name the other sleep disorders
Enuresis
Sleep related hallucinations
exploding head disorders
Name the nonREM parasomnia
Engaged in sexual activity while slightly awaked during sleep
could be r/t seizures
Sexomnia
common in young men
(mirapex & SSRIs can be correlated with this
Sleep health Index is
12 item tool
developed by National Sleep foundation
measures quality of sleep, sleep disorders, and sleep duration
depicts an overall score
exclusive rights(proprietary)
Risk factors for OSA
High BMI, large neck circumference, male, upper airway obstruction
DSM 5 TR Criteria for Circadian Rhythm Disorder
(Shift work Disorder)
A. A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B. The sleep disruption leads to excessive sleepiness or insomnia, or both.
C.T he sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.
Name the nonREM parasomnia
aimless walking to more complicated behaviors such as driving, leaving home etc.
What is contraindicated with this disorder?
Sleep walking
Benzos & SSRIs
DSM % TR criteria for RLS
A.An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by all of the following:
1.The urge to move the legs begins or worsens during periods of rest or inactivity.
2.The urge to move the legs is partially or totally relieved by movement.
3.The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night.
B.T he symptoms in Criterion A occur at least three times per week and have persisted for at least 3 months.
C.The symptoms in Criterion A are accompanied by significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
D.The symptoms in Criterion A are not attributable to another mental disorder or medical condition (e.g., arthritis, leg edema, peripheral ischemia, leg cramps) and are not better explained by a behavioral condition (e.g., positional discomfort, habitual foot tapping).
E.The symptoms are not attributable to the physiological effects of a drug of abuse or medication (e.g., akathisia).