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  • 1. Sleep disorders
  • 2. Main Topics
    • Insomnia
    • Obstructive sleep apnea
    • Central sleep apnea
    • Periodic limb movement
    • Narcolepsy
  • 3. Secondary causes of insomnia
    • Depression
    • Anxiety
    • Pain
    • GORD
    • Dyspnea
    • Hyperthyroidism
    • Drugs
    • Environmental factors-”learned insomnia”
  • 4. Drugs that can cause insomnia
    • Theophylline
    • Beta blockers
    • Caffeine
    • Amphetamine
    • Dopamine agonist
    • Nasal decongestant
    • Anti-depressants.
    • Corticosteroids
  • 5. Management of insomnia
    • Cognitive behavioural therapy .
    • Types of CBT:
    • Stimulus control
    • Sleep restriction
    • Sleep habits and education
    • Relaxation techniques
    • Bright light therapy
    • Cognitive therapy
  • 6. Drugs that causes reduce REM sleep
    • Amitriptylline (TCA)
    • Moclobemide (MAOI)
    • Citalopram (SSRI)
    • Venlafaxine (Selective serotonin and NorAd reuptake inhibitor)
    • Antipsychotics
  • 7. Drugs that increase REM sleep
    • Bupropion (NorAd and dopamine reuptake inhibitor)
    • Trazodone (Serotonin antagonist and reuptake inhibitor)
  • 8. Obstructive sleep apnea
    • Increasing prevalence with obesity .
    • Factors leading to increased airway narrowing:
    • Obesity
    • Genetics-micrognathia, retrognathia
    • Alcohol
  • 9. Signs of OSA
    • Sleepiness
    • Obesity
    • Crowded pharynx
    • Retrognathia
    • Congested nose
    • HT
  • 10. Associated conditions with OSA
    • Hypothyroidism
    • Acromegaly
    • Marfan’s syndrome
    • Cor Pulmonale
  • 11. The reason why a person would be compliant with his CPAP for OSA
    • Daytime sleepiness
    • Quality of life
  • 12. Other consequences of OSA
    • HT
    • Cardiovascular disease
    • Road trauma
    • Cognitive function
  • 13. Management of OSA
    • Weight loss
    • CPAP (mainstay of Rx)
    • Upper airway surgery-does not work for adults.
    • Mandibular advancement splint-must have own teeth.
  • 14. Central sleep Apnea
    • Associated with LVF
    • Treat CSA by treating the LVF
  • 15. Periodic limb movement
    • Sudden jerking leg movements that commonly accompany RLS.
    • The patient is usually unaware of these movements.
    • Associated with iron deficiency and renal failure .
    • ALWAYS Check ferritin!!
    • Start oral iron therapy if ferritin levels are low.
  • 16. Polysomnography in PLM
    • repetitive, highly stereotyped limb movements.
    • 0.5 to 5 seconds in duration.
    • amplitude >25% of toe dorsiflexion during calibration
    • in a sequence of four or more movements
    • separated by an interval of 5-90 secs.
  • 17. Levodopa in PLM
    • Reduces PLMs, Excess Daytime Sleepiness (EDS) and improves QOL but…
    • Issues with Levodopa: (If used continuously)
    • Augmentation . Worsening of RLS symptoms earlier in the day after an evening dose of medication, including earlier onset of symptoms, increased intensity of symptoms, or spread of symptoms to the arms.
    • Rebound is the recurrence of RLS early in the morning
    • Recurrence of symptoms in the second half of the night may occur.
  • 18. Levodopa in PLM
    • How to avoid this effect?
    • Don’t use it everyday, only use it intermittently. (“Drug holiday”)
    • Beware of retroperitoneal, mediastinal and pulmonary fibrosis.
  • 19. Narcolepsy
    • Pathology: loss of hypocretin producing cells.
    • Very low prevalence 0.03%.
    • Characterized by:
    • Excessive daytime sleepiness
    • Cataplexy
    • Sleep paralysis
    • Hypnogogic and hypnapompic hallucinations.
    • 100% will have HLA DQB1*0602 (HLA DR2)
  • 20. Management of narcolepsy
    • Scheduled naps
    • Reduce heavy carbo meals
    • Good night’s sleep
    • Psychosocial support
    • Avoid prazosin- may induce cataplexy.
    • Drugs to use: dexamphetamine, methylphenidate, caffeine, antidepressants.
  • 21. Drop in SaO2 with attempt to breath “ Breathing-not breathing-breathing”
  • 22. Drop in Sats but NO attempt to breath
  • 23. Low sats, High CO2.
  • 24. Repetitive leg movement No change in respiratory signals