DYSSOMNIA & PARASOMNIA
DYSSOMNIA & PARASOMNIA
I) Dysomnia
Introduction:
- Characterized by abnormality in duration or quality of sleep.
Subtypes:
- Insomnia.
- Hypersomnia.
1. Insomnia:
Features:
- Decreased sleep.
- Difficulty in initiation of sleep.
- Difficulty in maintenance of sleep.
- Frequent awakening during night.
- Early morning awakening.
- Nonrestorative sleep.
- Not feeling refreshed in morning due to poor quality of sleep.
Syndromes associated:
Periodic limb movement disorder:
- Non-restorative sleep and day time sleepiness.
Restless leg syndrome (Ekbom syndrome):
- Difficulty in initiation of sleep due to moving legs. Treated with ropinirole (dopamine agonist).
Treatment:
- Benzodiazepines, zolpidem & hypnotics.
2. Hypersomnia:
Features:
- Excessive sleepiness.
- Prolonged sleep episodes.
- Excessive day time sleep episodes.
Syndromes associated:
Narcolepsy:
- Reduced latency of REM sleep (reaching REM sleep earlier).
- Sleep attacks (irresistible urge for sleep at anytime of day) & sleep paralysis (Occurs in morning. patient awake but unable to move body).
Kleine-Levin syndrome:
- Characterized by episodes of hypersomnia, hyperphagia & hypersexuality (increased sexual activity).
II). PARASOMNIA:
Introduction:
- Disorders characterized by dysfunctional events associated with sleep.
Subtypes:
Stage 4, NREM sleep disorders:
- Occur during stage 4, NREM.
Events:
- Night terror or sleep terror (pavor nocturnus).
- Sleepwalking (somnambulism).
Sleep-related enuresis –
- Most common cause of bed wetting – Due to psychosocial (sibling rivalry).
- Treated by bed alarms, imipramine & intranasal desmopressin.
-
- Bruxism (teeth grinding).
- Sleep talking (somniloquy).
Other sleep disorders:
Nightmare:
- Occurs during REM sleep.
- Patient able to recall dream (contrast to night terror).
Exam Important
- Restless leg syndrome (Ekbom syndrome) is associated with sleep disturbances treated with ropinirole.
- Narcolepsy exhibits reduced latency of REM sleep.
- Kleine-Levin syndrome is characterized by episodes of hypersomnia, hyperphagia & hypersexuality.
- Night terror or sleep terror (pavor nocturnus), Sleepwalking (somnambulism), Sleep-related enuresis & Bruxism (teeth grinding) are all features of Stage 4, NREM sleep disorders.
- Sleep-related enuresis is most common cause of bed wetting.
- Nightmare occurs during REM sleep.
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