Sleep-Wake Disorders => mood & anxiety d/o’s, morbidity & mortality from AMC, insomnia ↑ risks of dev

Mental d/o
Di#iculty initiation sleep = subjective sleep latency greater than 20- 30min.

Atonia on EMG
Memory consolidation

Sleep-wake Disorder Insomnia Disorder Hypersomnolence Disorder Narcolepsy Parasomnias Breathing related sleep d/o’s
*17-24y/o è Rem
*progressive onset è Non-rem
dx Sx’s: 1. Predominant complaint of dissatisfaction w/ sleep quality/ 1. Excessive sleepiness ≥3x/wk ≥3 mnth 1. Recurrent periods or irrepressible need to sleep/lapse Abnormal behavioural events occurring in ass. w/ sleep Obstructive Sleep Apnoea (OSA)
➢ Daytime Sleepiness quantity 2. ≥1: into sleep/napping w/in same day. 🔹 Dx Criteria (Polysomnography):
➢ Insomnia Ass. W/ ≥1: • Recurrent periods of sleep (e.g. within same day) 2. ≥3 nights/wk for ≥3 mnths Non-REM Sleep Arousal Disorders • ≥5 obstruct apneas / hypopneas per hr of sleep.
➢ Poor concentration • DiLiculty initiating sleep. 3. / ≥1: 🔹 Timing: 1st 1/3 of sleep. • With ass. Sx’s:
• Prolonges, non-restorative sleep episode
➢ Poor coordination • DiLiculty maintaining sleep, characterised by frequent
• Sleep inertia: diLiculty being fully awake, feeling groggy
• Episodes of cataplexy: few times month, after 🔹 Fts: Recurrent episodes of incomplete awakening, amnesia for the event & no o Nocturnal breathing disturbances: snoring, snorting, breathing
wakenings / problems returning to sleep after wakenings. laugh/joke you lose muscle tone on both sides dream recall. pauses during sleep.
➢ Irritability after waking.
• Early morning awakening w/ inability to return to sleep of body but remain conscious? 🔹 Types: o Daytime sleepiness, fatigue/unrefreshing sleep despite
➢ Mood sx’s 3. => distress
2. ≥3 nights/wk for ≥3 mnths • Hypocretin Deficiency: using CSF hypocretine- • Sleepwalking: Blank stare, unresponsive, may engage in activities adequate sleep opportunity.
3. => distress/fx 4. Not bc MMS
1 immunoreactivity values. like eating / sex.
4. Not bc MMS • Sleep Terrors: Sudden terror arousals w/ intense fear, screaming, OR simply the presence of ≥5 apneas/hypopneas regardless of sx’s.
• Nocturnal Sleep Polysomnography: showing
& autonomic activation.
REM sleep latency <15min / multiple sleep
🔹 Causes: Obstruction of the upper airway during sleep.
latency test showing mean sleep latency
Nightmare Disorder
<8min & >sleep onset REM periods.
🔹 Timing: 2nd 1/2 of sleep period (REM sleep). Central Sleep Apnoea (CSA)
🔹 Fts: Vivid, distressing dreams involving threats to survival, w/ full orientation upon 🔹 Dx Criteria (Polysomnography):
waking. • ≥ 5 central apneas per hr of sleep.
• Not better explained by another sleep disorder.
REM Sleep Behaviour Disorder (RBD)
🔹 Timing: Later pts of sleep period (REM sleep). 🔹 Types of CSA:
🔹 Fts: Complex motor behaviours, vocalizations, acting out dreams. • Idiopathic: Variability in respiratory eLort w/out airway obstruct.
🔹 Causes: • Cheyne-Stokes Breathing: Periodic ↑ & ↓ in tidal volume =>
• REM sleep w/out atonia (failure of normal muscle paralysis). central apnoea’s & hypopneas.
• Neurodegenerative disorders (e.g., Parkinson’s, Multiple • CSA w/ Opioid Use: Opioids aLect the respiratory rhythm in the
System Atrophy). medulla => to apnoea’s.

Restless Leg Syndrome (RLS) Sleep-Related Hypoventilation

🔹 Fts: Uncontrollable urge to move legs, worsens at rest, relieved by movement. 🔹 Dx Criteria:
• Episodes of ↓ respiration => ↑ CO2 levels, measured on
Substance/Medication-Induced Sleep Disorder polysomnography.
🔹 Causes: Subst’s aLecting sleep (e.g., alcohol, caLeine, stimulants, ad’s, ap’s).
🔹 Dx: Sleep disturbance must coincide w/ substance use/intoxication/w/drawal & not 🔹 Types:
be better explained by another sleep disorder. • Idiopathic Hypoventilation: Unknown cause for ↓ ventilation.
🔹 EOects of Meds: • Congenital Central Alveolar Hypoventilation (Ondine’s Curse):
• Ap’s: Daytime sedation, worsens Periodic Limb Movement Genetic condition => to ↓ respiratory drive during 😴.
Disorder (PLMD) & RLS. • Comorbid Hypoventilation: Often seen w/ neuro d/o’s,
• SSRIs: Suppress REM sleep, ↑ REM latency. med/subst. use.

Spe ➢ Episodic: Sx last ≥1m <3 mnths. Course: Types:

cify ➢ Persistent: Sx last >3 mnths. ➢ Acute: duration <1m. - Narcolepsy w/out cataplexy, but w/ hypocretin deficiency.
➢ Recurrent: ≥2 episodes w/in 1 yr. ➢ Subacute: duration 1-3m. - Narcolepsy w/ cataplexy, but w/out hypocretin deficiency.
➢ Persistent: >3m. - Autosomal Dominant cerebellar ataxia, deafness & narcolepsy.
Types: - Autosomal Dominant narcolepsy, obesity, & T2DM.
- Narcolepsy secondary to AMC.
➢ Initial Insomnia: sleep onset insomnia. Grading:
➢ Middle Insomnia: sleep maintenance insomnia involves frequent / ➢ Mild: diLiculty maintaining daytime alertness 1-2 d/wk.
prolonged awakenings throughout the night. ➢ Mod: diLiculty maintaining daytime alertness 3-4 d/wk.
➢ Late/Terminal Insomnia: involves early morning awakening w/ an ➢ Severe: diLiculty maintaining daytime alertness 5-7 d/wk.
inability to return to sleep.
Extr (meds that aLect sleep: Diagnostic Markers: Nocturnal Polysomnography *Obese
a - Any that pass through BBB Hallucinations
- Benzos Hypersomnolence -> prolonged noct. Sleep -> diLiculty awakening Nightmares, vivid dreams
- Non-benzo-R agonists -> ↓ alert/memory/conc/distress/daytime sleepiness Sleep paralysis
- Anti-seizure drugs Nocturnal eating
- Antidepressants No reflexes
- Analgesics
- Stimulants
- Cardiac meds
- Pulm meds (theophyillines &
systemic glucocorticoids)
Mx ➢ Sleep Hygiene ➢ Sleep hygiene.
➢ Light Phase Shift Therapy ➢ CBT.
➢ Losing weight, CPAP: to alleviate sleep apnoea. ➢ Exercise.
➢ CBT ➢ Use of natural/simulated sunlight → simulating brain to prod. 5HT
➢ Relaxation therapy: muscle relaxation, biofeedback, imagery & Na, to promote + feelings & wakefulness.
training. ➢ Keep a to-do list to stay organised & busy.
➢ Exercise during day may promote better sleep. ➢ Support groups.
➢ Avoid alcohol, caLeine & nicotine. ➢ Stimulants:
➢ Software programs - Methylphenidate (Ritalin).
- Modafinil (Provigil).
• Pharms (Short term therapy preferred to restore - Atomoxetine.
normal sleep pattern → +/-2 2ks / less): ➢ Additional drug use may include clonidine, levodopa,
- Melatonin bromocriptine, AD
- Benzodiazepines ➢ Alternative therapies/adjuncts → meds, imagery, acupuncture.
- Non-benzo hypnotics (z drugs) ➢ Sleep log.
- Melatonin-R agonists
- Trazadone (AD) -> SE’s: Orthostatic hypotension, QT
prolongation, priapism, ↑ prolactin
- Anti-histamines: anti-cholinergic. - SE’s: dry mouth, blurred
vision, urinary retention, confusion in elderly. => daytime
consequences, tolerance/dependence.
Generally safe.
- Sedating Antipsychotics: Quetiopine.