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In this chapter, we will review sleep disorders that can involve difficulties related to sleeping, including difficulty falling or staying asleep or, falling asleep at inappropriate times, excessive sleep, or abnormal behaviors associated with sleep.
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Difficulty with sleep initiation, maintenance, and duration, or subjective quality
Can be primary (psychophysiological or behavioral) or secondary (med effect)
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SLEEP-RELATED BREATHING DISORDERS
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WARDS TIP
3 Cs of central sleep apnea—Congestive heart failure, CNS toxicity or trauma, Cheyne-Stokes breathing
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Daytime sleepiness not due to disturbed nocturnal sleep.
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Narcolepsy (with or without Cataplexy)
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Symptoms: Excessive daytime somnolence ≥3 months, sleep attacks, cataplexy (pathognomonic, abrupt onset of REM atonia triggered by strong emotional stimuli or physical exercise) varying severity, weakness most frequent at the knee, sleep paralysis.
May experience hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucination.
Onset at any age—usually second decade of life.
Diagnosis: Overnight polysomnogram and multiple sleep latency test.
Etiology:
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Sleep-Associated Movement Disorders
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Periodic Limb Movement Disorder (PLMD—Formerly Called Sleep Myoclonus or Nocturnal Myoclonus)
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Described as repetitive limb movements that occur during sleep and cause sleep disruption.
Usually involves the lower extremities, consisting of extension of the big toe and flexion of the ankle, the knee, and the hip.
Limb movements can occur in the upper extremities as well.
Observed in about 80% of patients with RLS.
PLMS can occur in over 30% of people aged 65 and older and can be asymptomatic.
Common in patients with narcolepsy and REM behavior disorder, and may be seen in patients with obstructive sleep apnea.
The limb movements occur most frequently in light non-REM sleep.
Dopamine agonists are considered first line of treatment.
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Undesirable phenomena that occur while falling asleep, during sleep, and while ...