therapy III - melatonin, sleep disorders
moderate sleep apnea
15-30 per hour
timeline for narcolepsy
3x/week over 3 months
mild sleep apnea
5-15 per hour
cataplexy tx involves blocking what?
5-HT and NE reuptake in locus coeruleus and raphe
severe sleep apnea
>30 per hour
possible causes of CSA
ANS lesions, neurologic diseases, high altitudes, CHF
non-pharm for OSA
CPAP, BiPAP, weight reduction, surgery
absence of airflow out of mouth and nose with no activation of inspiratory muscles
CSA
type of apnea in which you do not need to be aroused to resume breathing
CSA
ADR modafinil
HA, N, nervousness, dizziness, bad taste, C
tasimelton ADR
HA, abnormal dreams, increased ALT, infection
armodafinil
Nuvigil
CSA treatment
PAP, optimize HF therapies
modafinil
Provigil
treatment for cataplexy
TCA, venlafaxine, fluoxetine, selegiline
treatment for jet lag
adjust sleep by 1-2 hours about 7 days before travel
pharm for OSA
avoid CNS depressants and meds promoting weight gain, modafinil and armodafinil in daytime
treatment for sleepwalking and NREM disorders
benzos, SSRIs, TCAs
brief episode of sudden loss of muscle tone
cataplexy
narcolepsy dx requires presence of one of:
cataplexy, hypocretin deficiency, REM sleep latency less than or equal to 15 min
DOC for REM disorder
clonazepam
___ travel has longer duration of jet lag
eastward
sleep apnea results in
fragmented sleep, poor sleep architecture, apnea, hypopnea
treatment for shift work sleep disorder
good sleep hygiene, extending daytime sleep, 2-3 hour nap on days off
tasimelteon
hetilox
result of stimulants
improve alertness, increase daytime performance, elevate mood, prevent sleep
ADR stimulants
insomnia, HTN, palpitations, irritability
melatonin is beneficial for whom?
low excretory, older age
can be beneficial for REM disorder
melatonin
tasimelteon MOA
melatonin receptor agonist
drugs that can help with jet lag
melatonin, short acting benzos
standard treatment for daytime sleepiness
modafinil
treatments for daytime sleepiness
modafinil, armodafinil, stimulants
medications that can be used for shift work sleep disorder
modafinil, short acting benzos, melatonin
irrepressible need to sleep
narcolepsy
causes of OSA
neck obesity, narrow airway, fixed upper airway lesions
s/sx of OSA
obesity, snoring, HTN, daytime sleepiness, FH
OSA
obstructive sleep apnea
three types of sleep apnea
obstructive sleep apnea, central sleep apnea, mixed sleep apnea
abnormal behaviors or physiologic events that occur during sleep
parasomnias
melatonin is produced by the
pineal gland
treatment for parasomnias
protect from harm
treatment for nightmares
reduce stress, anxiety, and sleep deprivation
cessation of breathing during sleep
sleep apnea
treatment for sleep paralysis, cataplexy, and hypnagogic hallucinations
sodium oxybate (REMS)
armodafinil DI
stimulants, MAOI
approved for non-24-h sleep wake disorder in the blind
tasimelteon
problem with stimulants
tolerance
hallmarks of OSA
witnessed apneas, gasping