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EEG-more active than NREM similar to wakefulness. EEG shows low voltage fast with ocular movement artifact
EMG is silent in REM sleep corresponding to flaccid muscles
Paradoxical to muscle tone, all other body activities are as active as the wakefulness state in REM sleep
Sleep patterns-two latencies of sleep-definitions
Sleep latency- the interval to fall asleep after retiring. Normal range is 10-20 minutes
REM latency- once asleep, normal individual enter NREM sleep and pass in succession through four stages. The interval from falling asleep to the first REM sleep is called REM latency. Normal range is 90-120 minutes
Changes in these two latencies are helpful in diagnosing many sleep disorders.
Also, the conditions affecting these two latencies are different for these two distinct latencies
DSM-IV recognizes three major categories of sleep disorders
A. Dyssomnias- Dyssomnias are a broad classification of sleeping disorder that make it difficult to get to sleep, or to stay sleeping.
B. Parasomnias:Parasomnia is a broad term used to describe various uncommon disruptive sleep-related disorders. They are intense, infrequent physical acts that occur during sleep. Some common Parasomnias include sleepwalking, sleep talking, sleep terrors, nightmares, and teeth grinding
Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors
In general, there are two broad classes of treatment, and the two may be combined: psychological (cognitive-behavioral) and pharmacologic. In situations of acute distress, such as a grief reaction, pharmacologic measures may be most appropriate. With primary insomnia, however, initial efforts should be psychologically based
Narcolepsy is a neurological condition most characterized by Excessive Daytime Sleepiness (EDS). A narcoleptic will most likely experience disturbed nocturnal sleep, confused with insomnia, and disorder of REM or rapid eye movement sleep.
The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places
Four other classic symptoms of narcolepsy, which may not occur in all patients, are cataplexy , sleep paralysis , hypnogogic hallucinations , and automatic behavior .
Treatment is individualized depending on the severity of the symptoms, and it may take weeks or months for an optimal regimen to be worked out. Complete control of sleepiness and cataplexy is rarely possible
Treatment is primarily by medications, but lifestyle changes are also important.
The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants . For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are prescribed.
Periodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus , is a sleep disorder where the patient moves involuntarily during sleep
It is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMD. However, most people with PLMD do not experience RLS
Nocturnal myoclonus is treated by medications aimed at reducing or eliminating the leg jerks or the arousals. Non- ergot derived dopaminergic drugs ( pramipexole and ropinirole ) are preferred. Other dopaminergic agents such as co-careldopa , co-beneldopa , pergolide , or lisuride may also be us
These medications are also successful for the treatment of RLS restless leg syndrome .
Primary RLS is considered idiopathic , or with no known cause.
Secondary RLS often had a sudden onset and may be daily from the very beginning
The most commonly associated medical condition is iron deficiency (medicine) , which accounts for just over 20% of all cases of RLS. The conditions include: pregnancy, varicose vein or venous reflux , folate deficiency , uremia , diabetes , thyroid problems, peripheral neuropathy, Parkinson's disease and certain auto-immune disorders such as Sjögren's syndrome , Celiac Disease , and rheumatoid arthritis . Treatment of the underlying condition often eliminates the RLS.
About 45% of patients with primary generalized epilepsy have seizures in the sleep
Sleep deprivation precipitates seizures in the susceptible patients. Obtaining an EEG after enforced sleep deprivation elicits variety of spike-and sharp activities in more than one third of epileptics
Anticonvulsants promote normal sleep
Anticonvulsants raise the efficiency of sleep
Even at therapeutic level, the anticonvulsants can lead to excessive daytime sleep (EDS)
some important systemic causes of sleep disturbances