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Sleep Medicine - Coggle Diagram

- - - - N1: lightest Stage of Sleep (hypnic jerks, dozing)
      - N2: Sleep spindles and K complexes
      - N3: Deepest most restorative stage of sleep
    - - Increases as night progresses
      - Muslce atonia (Paralysis, dream recall, 90 minute latency, paradoxical sleep, braething irregular)
- - - - Psycholophysiologic Insomnia, Narcolepsy, Obstructive sleep apnea, Restless Legs syndrome
    - - Inadequate sleep hygiene, adjustment sleep disorder, insufficienct sleep syndrome, Limit-setting sleep disorder
    - - Changes in time zone, irregular sleep pattern, advanced sleep phase, non 24-hr sleep-wake disorder
    - - Mood disorders, Sleep-related epilepsy, Associated with other medical disorders
- - - - Sleepwalking
        
        Arousal in SWS, dissociation between cortical state of sleep and very elaborated motor activity
        
        Occurs in N3 (Slow wave)
        
        Do not awaken
        
        Aggravated by sleep deprivtation, stress, alcohol, +ve FHx
        
        Treatment
        
        No treatment, secure environment, and rarely benzodiazepines
        
        Typically in children without dream recall
      - Night Terrors
        
        Arousal from slow wave sleep (N3)
        
        Treatment
        
        No treatment, environment secured, and Benzodiazepines
    - - REM behaviour disorder
      - Lack of muscle atonia during REM sleep leading to ability to act out complex dream behaviour
      - Associated with Parkinsonism, Lewy Body Dementia
      - Treatmetn
        
        Full EEG montage, CT scan/MRI, secure environemnt
        
        Meidcation: Clonazepam, Melatonin
      - Typically adults and will have dream recall
- - - - Recurrent periods of irrepressible need to sleep >3x/wk >3 months, Cataplexy, Hypocredit deficiency, PSG-REM latency <15 min or MSLT with SL <8 min
    - - Genetic or Sporadic Cases (abrnoaml hypocretin receptor, precipitating factors
      - Symtpomtic Cases: Demyelinating disease, tumors, Post traumatic
    - - Hypocretin deficiency, HLADQB1
    - - Excessive daytime sleepiness, Cataplexs, Hypnagogic/Pompic hallucinations, Sleep Paralysis, Disturbed nocturnal sleeps
    - - Multiple Sleep Latency Test
        
        Calculate: Averate onset latency, Sleep onset periods (15 minutes) >2 is positive
        
        Sleep onsetlatenscy (how long to fall asleep) less than 8 minutes, with 2 SOREMPeriods
    - - Education -> Not their fault, prophylactic naps, avoid activities/jobs where sleeping is an issue
      - CNS Stimulates for EDS (Methylphenidate, Amphetamines)
      - CNS alerting Drugs (Modafinil)
      - REM Suppressants: Tricyclics (domipramine, desipramine, imipramine), SSRIs, MAOi
      - Sodium Oxybate
        
        Used for sleepiness and cataplexy, Side-effects: dizziness, nausea, sleepwalking, confusion, resp depression
        
        (do not use with CNS depressants, untreated OSA, COPD, Obesity hypoventilation syndrome