Tag: Dyssomnia & Parasomnia

Dyssomnia & Parasomnia

DYSSOMNIA & PARASOMNIA

Q. 1

Which of the following clinical finding is seen in parasomnia?

 A

Nocturnal enuresis

 B

Night terror

 C

Nightmare

 D

All of the above

Q. 1

Which of the following clinical finding is seen in parasomnia?

 A

Nocturnal enuresis

 B

Night terror

 C

Nightmare

 D

All of the above

Ans. D

Explanation:

Parasomnias include sleep terror, nightmares, sleepwalking, and enuresis) are fairly common in children and less so in adults.

Sleep terror (pavor nocturnus) is an abrupt, terrifying arousal from sleep, usually in preadolescent boys although it may occur in adults as well.
Nightmares occur during REM sleep; sleep terrors in stage 3 or stage 4 sleep.
 
Enuresis is involuntary micturition during sleep in a person who usually has voluntary control. Like other parasomnias, it is more common in children, usually in the 3–4 hours after bedtime, but is not limited to a specific stage of sleep. 
 
Sleepwalking (somnambulism) includes ambulation or other intricate behaviors while still asleep, with amnesia for the event. It affects mostly children aged 6–12 years, and episodes occur during stage 3 or stage 4 sleep in the first third of the night and in REM sleep in the later sleep hours. 
 
Ref: Eisendrath S.J., Lichtmacher J.E. (2013). Chapter 25. Psychiatric Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014.

 


Q. 2

Drug of choice for restless leg syndrome ‑

 A

Ropinirole

 B

Chlorpromezine

 C

Haloperidol

 D

Bupripione

Q. 2

Drug of choice for restless leg syndrome ‑

 A

Ropinirole

 B

Chlorpromezine

 C

Haloperidol

 D

Bupripione

Ans. A

Explanation:

Ans. is’a’i.e., Ropinirole [Ref. Clinical Pharmacol Glt 3d/e p. 482]

  • Drugs of choice for Restless leg syndrome are dopamine agonists like ropinirole or promipole or rotigotine.
  • Levodopa can also be used.

Q. 3

All are true about narcolepsy except:

 A

Day dreaming

 B

Hypnagogic hallucinations

 C

Cataplexy

 D

Sudden sleep

Q. 3

All are true about narcolepsy except:

 A

Day dreaming

 B

Hypnagogic hallucinations

 C

Cataplexy

 D

Sudden sleep

Ans. A

Explanation:

Ans. (A) Day dreaming

[Ref Neeraj Ahuja 7th/ I j8-39; Kaplan & Sailockls Textbook of psychiatry 11th/547-50; Harrison 19th/189, t7th/172- ZB; CMDT 2016/1072]

Narcolepsy:

  • Disorder characterized by excessive daytime sleepiness often dkturbetl night time sleep and disturbances in REM sleep.
  • Hallmark of this disorder is decreased REM latency, I.e. decreased latent period before the first REM period occurs.
  • Normal REM latency is 90- 100 minutes, in narcolepsy, REM sleep occurs within 10 minutes of the onset of sleep.

Classical tetrad of symptoms:

  • Sleep attacks (MC)
  • Cataplexy
  • Hallucinations at sleep onset (Hypnagogic) and upon waking (Hypnopompic)
  • Sleep paralysis.

Quiz In Between



Dyssomnia & Parasomnia

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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