Tag Archives: Sleep
Diagnosis: Combination of clinical features and imaging Genetics: Autosomal dominant Clinical features: Insomnia, sympathetic over activity, impaired attention Ataxia, dysarthria, Memory loss Hormone abnormalities: increased cortisol, Polysomnography: reduced total sleep time, absent REM sleep, absent deep nonREM sleep, Findings on Investigations: MRI: Normal or cerebral or cerebellar atrophy PET: Decreased metabolism in the thalami CSF: … Continue reading Fatal Familial Insomia
Congenital Central Hypoventilation Syndrome
Synonyms: Ondine’s curse Diagnosis: Adequate ventilation while awake +alveolar hypoventilation while asleep (normal rate +shallow breathing) +hypoxia +hypercarbia without arousal +Absence of cardiac, lung, neuromuscular, brain conditions In some: PHOX2B gene mutation, Investigations to consider: ECG, Holter CXR Fluoroscopy of the diaphragm Muscle biopsy MRI Blood tests: Carintine Urine: Carintine Sleep study: Hb O2 saturation, … Continue reading Congenital Central Hypoventilation Syndrome
Obstructive Sleep Apnea
Diagnosis: Confirmed by polysomnography Findings on Investigations: Polysomnography: The gold standard test =or>5 hypopnea or apneas per hour. +symptoms of hypersomnolence Hypopnea: 10 seconds of decrease in airflow for <10 secons by >50%. Or decrease in airflow <50% with arousal. Or decrease in airflow <50% with 3% desaturation. Apnea: decrease in airflow =or>80% for 10 … Continue reading Obstructive Sleep Apnea
Somnambulism
Synonyms: Sleep walking Diagnosis: A type of parasomnia. Suggested by clinical features and confirmed by polysomnography. Clinical features: Nonviolent activities, may be complex Findings on Investigations: Polysomnography: confirms the diagnosis Slow wave sleep (Non-REM sleep, stage 3 or 4) during the episode
REM Sleep Behaviour Disorder
Diagnosis: A type of parasomnia Clinical features: M>F, usually >50 year olds Vivid and often frightening dreams during REM sleep, but without muscle atonia i.e. act out the dream (behaviour). Recall of the dream is intact Finding on Investigations: Polysomnography: confirms the diagnosis RSWA: rim sleep without atonia REM sleep during the episode EEG: absence … Continue reading REM Sleep Behaviour Disorder
Nightmares
Diagnosis: Usually a clinical diagnosis Clinical features: Experiences/displays fear, vocalisation, motor activity and elaborate mental content Oriented on waking Easy to arouse Polysomnography: Occurs during REM sleep
Night Terrors
Synonyms: sleep terror Diagnosis: A type of parasomnia, diagnosed by clinical features supported by investigations Clinically features: Child appears to awake (vocalisations, fear motor activity) & is disoriented & goes back to sleep No recall of the episode usually Difficult to arouse during this Findings on Investigations: Polysomnography: confirms it Occurs during Slow wave sleep … Continue reading Night Terrors
Periodic Limb Movements of Sleep
Diagnosis: Is a polysomnographic diagnosis Polysomnography: =or > 15 episodes of periodic, stereotyped jerky movements of legs Each movement: lasts 0.5-5 seconds in duration Sequences of Movements are separated by 5-90 seconds. Measured from movement onset to movement onset. These may occur in normal people and are not significant unless associated with arousals Treatment: Ropinirole … Continue reading Periodic Limb Movements of Sleep
Advanced Sleep Phase Syndrome
Diagnosis: Clinical +sleep diary: patient feels sleepy in the evening and wakes up earlier than normal. i.e the sleep phase occurs earlier. Shift work can commonly cause this
Restless Leg Syndrome
Diagnosis: The 4 following are required: An urge to move the legs due to an unpleasant feeling in the legs. Begins or gets worse when at rest or not moving around frequently. Is partly or completely relieved by movement (such as walking or stretching) for as long as the movement continues. Is worse in the … Continue reading Restless Leg Syndrome
Kleine-Levin Syndrome
Diagnosis: This is a clinical diagnosis Clinical features: Young adults, M>F, recurrent periods of hypersomina, +another features: Binge eating, hypersexuality, irritability, aggression, other odd behaviors, or cognitive abnormalities such as a feeling of unreality, confusion, or hallucinations
Narcolepsy
Diagnosis: This is a clinical diagnosis supported by findings on polysomnogram Clinical features: Daytime hypersomnolance, wake up refreshed Cataplexy (sudden loss of muscle tone triggered by emotional situations) Hypnogogic & hypnopopic hallucinations Sleep paralysis (patient wakes from sleep but tone is still absent, last 10min) Findings on investigations: MSLT (multiple sleep latency test): decreased latency … Continue reading Narcolepsy
Delayed Sleep Phase Syndrome
Synonyms: sleep lag syndrome Diagnosis: Normal biological clock that is out of sync with the environment i.e. the sleep phase is delayed. Shift work can cause this
Insomnia
Diagnosis: Difficulty with sleep initiation or maintenance (staying asleep, waking early) inspite of adequate opportunity to sleep. Treatment: Non-pharmacological: Improve sleep hygiene: Maintain regular sleep-wake cycle: Set to bed time, mid-day Nap less than 1 hour, don’t oversleep in the weekend. Reduce stimulants: no caffiene afternoon, noneducational reading at bed, avoid exercise alcohol & heavy … Continue reading Insomnia