Sleep
Sleep Hygiene (prevention)
Sleep Study (polysomnography)
Infant sleep eLearning
Awake for 8 hours as infant
Asleep for 8 hours in adulthood
You need a regular sleep time to avoid "jet lag"
Hx/Ex: pain, allergies, medications, development
Sleep diary including schedule and durations
bedtime routine
sleep environment (temp, noise)
loud snoring, choking or gasping, sweating
caffine
Sleep study if ?OSA or PLM
Sleep disorders
Inappropriate sleep association: needing to feed to sleep ?not insomnia unless impairs daytime function
Short sleep time - linked with alz dis, insulin resistances
PSG most sensitive screen for resp failure in neuromuscular disorders (PFT will pick up deterioration first but failure of gas exchange on PSG than early morning VBG)
BPAP best for muscular disorders
Sleep Study (polysomnography)
Infant sleep eLearning
Awake for 8 hours as infant
Asleep for 8 hours in adulthood
You need a regular sleep time to avoid "jet lag"
Hx/Ex: pain, allergies, medications, development
Sleep diary including schedule and durations
bedtime routine
sleep environment (temp, noise)
loud snoring, choking or gasping, sweating
caffine
Sleep study if ?OSA or PLM
Sleep disorders
- Insomnia of childhood
- Difficulty initiating or maintaining sleep despite age appropriate time and opportunity
- Must impair day functioning
- Behavioral insomnia of childhood, sleep onset association type
- learned to fall asleep only under certain circumstances, unable to self settle post arousal
- Behavioral insomnia of childhood, limit setting type
- Behavioral insomnia of childhood, sleep onset association type
- Sleep disordered breathing
- Primary snoring upper airway resistance syndrome
- Apnoea of prematurity
- Central apnoea (no respiratory effort)
- Obstructive sleep apnoea (Resp effort no flow)
- Apneoa hypopnea index >5/hr = OSA 1-5 borderline <1 neg
- Parasomnias (typically 1-2 / night, if more ?nocturnal seizures)
- NREM (partial arousal parasomnias) SWS
- Night terrors (stage3 or 4): terrified, dilated pupils, ↑HR/RR, agitation, and thrashing, unresponsiveness
- Somnambulism (walking, talking)
- Confusional arousals (in stage 4) chewing, sitting up, and mumbling to agitated sleep walking, and usually last for 10-15 min)
- REM
- Nightmares
- Sleep paralysis
- NREM (partial arousal parasomnias) SWS
- Sleep related movement disorders
- Restless legs syndrome (uncomfortable sensation causing urge to move legs) ?Fe deficient, ?Rx levodopa/AED gabapentin
- Periodic limb movement disorder (periodic, repetitive, sterotyped jerks)
- Rhythmic movement disorder (Sleep Transition Disorders) (head banging (jactatio capitis nocturna), head rolling, body rocking)
- Rx none, self remit by 5yo
- Hypersomnia (excessive daytime sleepiness, reduced baseline alertness, and/or prolonged nighttime sleep periods that interfere with daytime functioning
- Extrinsic (not enough sleep)
- Insufficient sleep
- Fragmented sleep
- Intrinsic (increased need for sleep)
- Nacrolepsy-cataplexy syndrome (lifelong CNS, presents in adolescence)
- intrusion of REM sleep into waking state
- cataplexy (sudden loss of tone)
- hypnogogic/hypnopompic hallucinations
- sleep paralysis
- disturbed nighttime sleep
- HLA DQB1*0602 in 90%
- Selective loss of hypocretin-secreting neurons in the hypothalamus
- Ix Multiple sleep latency
- Rx scheduled naps, amphetamines, methylphenidate, tricyclic antidepressants, and counseling about precautions in work and driving
- intrusion of REM sleep into waking state
- Nacrolepsy-cataplexy syndrome (lifelong CNS, presents in adolescence)
- Extrinsic (not enough sleep)
- Delayed sleep phase disorder
- predisposition or circadian preference for staying up late at night and sleeping late in the morning
- ?an intrinsic abnormality in the circadian oscillators that govern the timing of the sleep period
- ~10% adolescence
- No insomnia if go to bed at preferred time, no sleep maintenance issue, but tardiness and sleepiness in day
- Rx
- shift bed time and wake time by 15min / day
- Sun or light box in morning
- Avoiding evening sun, lights at home
- Melatonin
- large dose at bed (5mg)
- or physiologic dose (0.5mg) 5 hours before sleep
Inappropriate sleep association: needing to feed to sleep ?not insomnia unless impairs daytime function
Short sleep time - linked with alz dis, insulin resistances
PSG most sensitive screen for resp failure in neuromuscular disorders (PFT will pick up deterioration first but failure of gas exchange on PSG than early morning VBG)
BPAP best for muscular disorders