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Sleep Disorders :bed: (Narcolepsy (CSA (OSA (Path: Excessive tissue (fat…
Sleep Disorders :bed:
Narcolepsy
CSA
OSA
Path: Excessive tissue (fat neck)
Pt: wakes up startled (apnic) at night, but won't know it
- daytime somnolence
- obese
- Snoring
- may see: large tongue, short neck (part of obese picture)
Dx: Sleep study (Polysomnography)
- ≥15 sleeping spells/ hr
or
- combo of: ≥5 apneas & snoring
Tx: CPAP
(same as PEEP)
-
BIPAP
- obese = weight loss
-
Path: "forgetting" to breathe
Pt:
- Opiates
- over oxygenation in COPD
- Idiopathic (#1 common)
- stroke
-
Path: Startle causes immediate/instantaneous sleep :sleeping:
Pt: Immediate REM sleep (decr. sleep latency)
- must: 3x/week for 3 mo
- Waking Refreshed (most important)
go right into REM
- Cataplexy (loss of tone: may wake up paralyzed)
- Hypnogogic (hallucinations going to sleep)
- Hypnopomic (hallucinations waking)
Dx: Sleep study (polysomnography)
- can get CSF Hypocretin-1 labs
Tx: Train pt to schedule naps (LSM)
- if fail, use stimulants (amphetamines)
Insomnia
Path: Trouble sleeping
Usually 2/2 another disorder
- Trouble falling asleep :tired_face:
or
- Reawakening
Someone with a mood disorder, must be treated for that 1st! Insomnia alone is just a sleep cycle issue.
Pt: 3x/ week for 3 mo
Dx:
- determine sleep duration. 6hr is normal
`>6hr sleep
- either normal sleep :+1::skin-tone-4:
- jet lag :airplane:
Tx:
- reorient them (stay awake until dark then sleep)
or
- Phototherapy :flashlight: (in Alaska, use lights on when awake)
Assess Sleep hygiene
- giving Rx for sleep is usually the wrong answer at this step (1º insomnia)
:check:Good sleep hygiene & 1º Insomnia
- not a product of another disorder
Tx:
- Diphenhydramine
- Trazodone (sleep AE,
depression)
- Quetiapine (sleep AE)
- BZD1 (zolpidem, last resort) : AE's of sleep walking, sleep talking
-
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