6.8:Neural Function Disorders — Sleep Disorders, Insomnia and Narcolepsy

What is insomnia?

The most common sleep disorder

How many symptoms are required to be considered insomnia?

At least 3 symptoms of the following: Difficulty initiating sleep, maintaining sleep, waking early, and poor sleep

What additional requirement is needed for insomnia diagnosis?

At least one daytime symptom

What are common daytime symptoms of insomnia?

• Daytime fatigue

• Impaired attention and/or concentration

• Impaired memory

• Poor performance socially, occupationally, and/or academically

• Irritability

• Tendency towards accidents (occupational or driving)

• Headaches

• GI distress

What is primary insomnia?

Insomnia with no other underlying cause

What is secondary (comorbid) insomnia?

Insomnia associated with other medical conditions

What conditions are linked to secondary insomnia?

Anxiety, depression, Alzheimer’s, Parkinson’s

Who is more affected by chronic insomnia?

Women and older adults

What is acute insomnia?

Short-term insomnia caused by emotional or physical stress

How does acute insomnia resolve?

When the stressor is removed or adjusted to

What is chronic insomnia?

Insomnia lasting 30 days or more

What commonly causes chronic insomnia?

Underlying health conditions or drug use

What substances can contribute to insomnia?

Caffeine, alcohol, nicotine, and drugs

What is needed to diagnose insomnia?

A thorough sleep history, daytime symptoms, drug use (caffeine, alcohol, nicotine, and/or prescription), and medical history

What is recommended for tracking sleep patterns?

A sleep diary for at least 2 weeks

Why should a sleep partner be interviewed?

To observe snoring or abnormal movements

What test may be ordered to evaluate insomnia?

A sleep study

What is the first step in treating insomnia?

Patient education on sleep hygiene

What is an example of consistent sleep hygiene?

Going to bed at the same time each night, creating a comfortable sleeping environment, avoidance of screens and excessive light right before bed, avoidance of stimulants several hours before bed

How long should a person sleep according to sleep hygiene guidelines?

Only as long as needed to feel refreshed

How should acute insomnia be treated?

Sleep hygiene and removal of the stressor

What is required to treat chronic insomnia?

A thorough assessment of the underlying cause

What non-drug therapies are used for chronic insomnia besides sleep hygeine?

Relaxation and cognitive therapy

Why should sedatives be used cautiously?

They lose effectiveness and can be habit forming

What is the most common class of sedatives prescribed for insomnia?

Benzodiazepines and benzodiazepine receptor agonists (BZDAs)

What are examples of BZDAs?

Ambien, Sonata, Lunesta

Why are BZDAs commonly used?

Rapid onset and short duration

What is Ramelton?

A long term sedative for sleep-onset insomnia

How does Ramelton work?

As a melatonin receptor agonist that is selective for the MT-1 and MT-2 receptors and does not have abuse potential.

Does Ramelton have abuse potential?

No

What OTC medications can be used for sleep?

Antihistamines (benadryl) and melatonin

What is an example of an antihistamine used as a sleep aid?

Benadryl

What are side effects of antihistamines?

Daytime drowsiness and feeling foggy

What is a commonly used sleep aid?

Natural or synthetic melatonin

What is narcolepsy?

A sleep disorder characterized by excessive daytime sleepiness not relieved by nighttime sleep

What nighttime symptoms are seen in narcolepsy?

Hypnagogic hallucinations, sleep paralysis, and cataplexy

What is cataplexy?

Brief periods of muscle weakness

What age group is most commonly affected by narcolepsy?

Ages 15–30

What sleep abnormality is seen in narcolepsy?

Entering REM sleep at onset or within 10–15 minutes

What does early REM onset indicate in narcolepsy?

Abnormal sleep-wake regulation

What neurotransmitter is linked to narcolepsy?

Hypocretin

What role does hypocretin play?

Regulates wakefulness

What change in hypocretin is associated with narcolepsy?

Decreased levels

What is usually the first symptom of narcolepsy?

Daytime sleepiness or falling asleep

When does daytime sleepiness typically occur in narcolepsy?

During sedentary or monotonous activity

What relieves daytime sleepiness in narcolepsy?

Movement

How long do daytime sleep episodes usually last?

Less than 30 minutes

What behaviors may occur during daytime sleep episodes?

Nonsensical talking and unusual behavior

What are hypnagogic hallucinations?

Vivid hallucinations at sleep onset

Why are hypnagogic hallucinations frightening?

They feel real because the person is not fully asleep

What is sleep paralysis?

Inability to move, speak, or breathe at sleep onset or awakening

What tests are used to diagnose narcolepsy?

Nighttime and daytime sleep studies

What is the purpose of a nighttime sleep study?

To rule out other sleep disorders or sleep apnea

What is done during the daytime sleep study?

Multiple nap opportunities

What is mean sleep latency?

Amount of time it takes to transition from full wakefulness to sleep

What is the criteria to diagnose narcolepsy?

Mean sleep latency time of less than 8 minutes and two or more episodes of sleep-onset REM

Is there a cure for narcolepsy?

No

What is the goal of narcolepsy treatment?

Symptom management

What lifestyle education is important for narcolepsy?

Sleep hygiene, avoiding sleep deprivation, and safety precautions during high risk activities

What non-drug treatment helps narcolepsy symptoms?

Short naps throughout the day

How long should naps be for narcolepsy to ease daytime sleepiness?

About 15 minutes

What type of medications are used to treat narcolepsy?

Stimulants

What are examples of stimulant medications for narcolepsy?

Ritalin and Adderall

What is Xyrem used for in narcolepsy?

Treat daytime sleepiness and cataplexy

What type of drug is Xyrem?

CNS depressant

What other medications can treat cataplexy?

SSRIs