Our topic now brings
us to dyssomnias.
So primary sleep disorders producing
either difficulty initiating
and maintaining sleep or
excessive daytime somnolence.
Once again, keep separate
and how that then affects
you during the day
when you have sleep
deprivation at night.
obstructive sleep apnea,
restless leg syndrome,
and insomnia are conditions that will –
or dyssomnias that we
shall take a look at.
Narcolepsy, excessive daytime sleeping.
Think of it as being
Remember during the daytime.
And we have a term called cataplexy,
which is a brief
loss of muscle tone.
So at this point, during narcolepsy,
if there is an attack of cataplexy,
the muscle tone has been lost.
however, is preserved
and often triggered by emotion,
cataplexy as a symptom or
as a sign of narcolepsy,
First line treatment for narcolepsy is a stimulant called modafinil,
but some patients also take other stimulants.
Solriamfetol is a selective dopamine and norepinephrine reuptake inhibitor
that is a class of wake promoting agent that is sometime used.
And finally Pitolisant can be used for patients with cataplexy.
Another type of dyssomnia would
be obstructive sleep apnea,
excessive daytime sleepiness.
Repetitive episodes of upper
airway obstruction during sleep.
So in an adult,
you’ll have the pharyngeal folds
in which if they’re excessive,
may then cause actual obstruction
when trying to then breathe.
And so therefore, during
the period of sleep,
there might be apnea taking place and
therefore, awakening the patient.
That’s fragmented sleep and so therefore,
with that type of fragmented
sleep that’s taking place,
please understand that the daytime
somnolence is taking place
due to the lack of
proper sleep at night.
Risk factors for sleep apnea include obesity, male gender, age over 50,
craniofacial or upper airway abnormalities, and smoking.
Having sleep apnea is associated with an increased risk of stroke,
hypertension, and myocardial infarction.
You have an obese individual, makes it
more difficult to breathe at night.
Your excessive pharyngeal folds.
Your CPAP, continuous positive
airway pressure, or even BiPAP.
And posterior pharynx decompression
is important or is a possibility
if weight loss and the positive airway
pressures seem to be ineffective.
Here, we have restless
sleepiness here as well.
So all of these, these three conditions of
narcolepsy, but those are sleep attacks,
and that really doesn’t –
It’s not contingent upon not
having proper sleep at night
whereas obstructive sleep apnea.
And there are variants of it.
At this point, I just want you to be
introduced to a few things one at a time.
But here, in restless
excessive daytime sleepiness,
you have disagreeable, difficult to describe
sensation in the legs when recumbent.
And so therefore, your patient
is going to tell you that
on perhaps a long plane
ride, that all of a sudden,
they have these sensations in his legs
that are very difficult to describe,
that keeps them extremely awake.
urge to move those legs
and associated with iron deficiency,
uremia, and alcohol use.
So these are things that you are
going to check for, please,
if your patient is
presenting and describing
down in the legs,
they seem to have this –
They seem to motivate the patient to
have this irresistible urge to move.
Perhaps dopamine agonist.
And underlying condition
if identified such as –
Remember, if it’s a female
that is presenting as such,
well, one of the most common
causes of iron-deficiency anemia
in a female would be her
menstrual cycle, right?
So maybe you want to address
that so on and so forth.
Here, the topic is parasomnia.
Let me put this into perspective for you.
This particular topic is being covered
in behavioral science with parasomnias,
but I want to make sure that you’re
clear about the definitions.
What we’ve walked through
thus far has been dyssomnias
and, by dyssomnias, referring to the
narcolepsy, which were sleep attacks;
the obstructive sleep apnea that
I’ve gave an introduction to;
and your restless leg syndrome.
And these are conditions in which the
patient felt excessive sleep during the day
but for different reasons.
Those were known as dyssomnias.
Now, with the parasomnia, in other words,
think of this as being your paranormal.
You’ve heard of that before?
For example, here, parasomnia would
be during the event of sleep,
the patient has nightmares, night
terrors, or walks during the sleep.
And all of these, can be then referred to
in greater detail in behavioral science.
And here’s a list of this
Now, sleepwalking, the patient wakes
up and goes about their business,
meaning to say that they’re not awake, but
they’re walking down the hall
in their home.
Somnambulism or sleep walking.
And sleep terrors is
part of parasomnia.
Nightmares, you want to keep this
separate from your sleep terror.
You have something
called sleep bruxism.
And then you have sleep paralysis.
And this is a very good list
of high yield parasomnias.
Make sure that you’re able to
distinguish one from the other
and this can then be gotten
from your behavioral science.