PHGD: Sleep Medicine PDF

CM101: Stand-alone Subject PHGD: Sleep Medicine Alex Dy, MD | September 11, 2024 TOPICS Melatonin (from pineal gland) - principal biomarker...

CM101: Stand-alone Subject PHGD: Sleep Medicine Alex Dy, MD | September 11, 2024 TOPICS Melatonin (from pineal gland) - principal biomarker Off release during daylight A. Introduction to Sleep On release when it is dark Definition and importance Sleep Propensity B. Sleep Regulation Varies across the day due to homeostatic sleep drive Two Process Model (Process S and and circadian rhythms C) Factors: quality and duration of sleep and the time Role of adenosine awake since the last sleep C. Sleep Architecture Stages of Sleep (NREM and REM) Levels of sleepiness and Alertness Ultradian Cycles Fluctuates within the day D. Developmental Sleep Patterns “Circadian Troughs” - maximum sleepiness Trends from infancy to adolescence ○ Later afternoon (3-5 pm) E. Sleep Disorders ○ Toward the end of the night (3-5 am) “Circadian Peaks” - maximum alertness Types of Sleep Problems ○ Mid-morning Specific Disorders (Insomnia, OSA, ○ Before sleep onset (second wind) Parasomnias, Hypersomnia) F.. Management Strategies Reference: Nelson (Textbook of Pediatrics) Healthy Sleep Practices Treatment Options ARCHITECTURE OF SLEEP G. Special Considerations “Sleep stages” Vulnerable Populations Non-Rapid Eye Movement (NREM) Disparities in Sleep Health ○ Low brain activity H.. Conclusion ○ Activities continue to be active (maintained Importance of sleep health awareness body movements, normal respiratory and cardiovascular indices) ○ Progressively deepens from light to restful SLEEP sleep (N1, N2, N3) Reduced motor activity N1 Decreased interaction with and responsivity to the ○ Lightest stage / wake-sleep transition environment ○ 30 seconds - 5 minutes Specific postures ○ Lowest arousal period (easily woke) Lying down is the standard position for sleeping ○ Drowsiness and decreased awareness of Easy reversibility surroundings Unlike difficult coma ○ Hypnagogic hallucination, hypnic jerks “Two process model” of sleep regulation: ○ Theta waves (EEG) ○ Process S ○ Process C N2 Process S ○ “True sleep” “Homeostatic process” or “sleep drive” ○ Last 5 - 25 minutes Sleep depth and duration based on adenosine build- ○ Memory consolidation (cognitive up performance) Promotes sleep onset and maintains sleep throughout ○ Sleep spindles - a burst of fast brain waves the night (after 4wks of age) Adenosine ○ K complexes - large slow waveforms (after 6 The neurotransmitter that accumulates when we are months of age) awake - build-up of adenosine makes us feel sleepy ○ Protects sleep Coffee contains caffeine which blocks the adenosine ○ Lowers arousal receptors in the brain that keep us awake Infants and toddlers rapidly generate sleep pressure, N3 limiting daytime awake and requiring daytime sleep ○ “Deep sleep” Process C ○ “Delta sleep” high voltage, low frequency Circadian Rhythm (15% in children aged 3-11 Treatment of OSA ○ Adenotonsillectomy ○ Other tx REM-Related Parasomnias REM-Sleep Behavior Disorder (RBD) Weight loss, positional therapy, ○ Act out in their dreams intranasal corticosteroids, ○ Loss of atonia positive airway pressure ○ Very rare in children (CPAP) ○ Late childhood or adolescence Drug-induced sleep endoscopy (DISE) - Often associated with advanced dx tool neurodevelopmental disorders: Neuromuscular reeducation or myofunctional Narcolepsy or therapy - improve oral and facial muscle function neurodegenerative Oral appliances and maxillofacial surgery for conditions specific cases Nightmares ○ Common in children Ages 3-8 (10-50%) PREPARED BY: GUERRERO, GUMBA, ILANO, LORILLA, MERCIALES, NARVAEZ, PAREJA, RAMIREZ, RODRIGUEZ, ROMABON, SIOSON, UBALDO, VILLAMOR (YL1-B6)  Sleep Medicine – Week 5 ○ Stress, anxiety, trauma, sleep ○ Video recording (5 movements/hour/ deprivation sleep) Sleep paralysis Rhythmic Movement Disorder ○ Adolescence (5-28%) ○ Head rolling/ banging ○ Sleep deprivation, irregular sleep ○ Common in children patterns, narcolepsy ○ Self Limiting Other Parasomnia Etiology ○ Sleep-related eating disorder (SRED) Genetic (RLS and PLMD) Eating while sleeping without Low Serum Fe memory Associated Cond: Diabetes, Renal Disease, and May eat inedible or high-calorie certain medication food > Adolescents and adults Differential Diagnosis (RLS and PLMD) ○ Exploding Head syndrome (EHS) Growing pains Experiences of loud noise or Leg cramps explosion-like sensation Neuropathy Fear or confusion without Arthritis external stimulus Myalgias > Adolescents Nerve compression TREATMENT Dopamine Antagonist - associated akathisia 1. Parental education and reassurance Diagnostic 2. Healthy sleep practices, avoiding sleep Management restrictions and caffeine Avoidance of exacerbating substance 3. Safety precaution during sleepwalking Iron Supplement for Low Serum FE 4. Scheduled awakening for frequent episodes ○ Ind. if Serum ferritin 10hrs “BEARS” sleep screening algorithm And severe sleep inertia Direct questioning of older children and Confusion, sleep drunkenness adolescents Sleep paralysis Hypnagogic hallucination Recognizing Sleep Problems Long >1hr unrefreshing naps Association between sleep disturbances and No known cause Daytime Consequences ○ Potential autoimmune process Knowledge of risk factors and developmental appropriate differential diagnosis DIAGNOSIS Assessment of sleep patterns in children Clinical History Polysomnography Preventive Measures for Sleep Health Multiple Sleep Latency Test Educating parents of newborns about normal Hypocretin Level measurement nt level for sleep patterns narcolepsy type 1 Recommendations for 2-5 month-old infants to foster self-soothing MANAGEMENT Importance of regular bedtimes, bedtime Medications: Stimulants, wake promoting routines, and transitional objects agents, sodium oxybate Lifestyle modifications: regular sleep schedule, Cultural and Family Context scheduled naps Consideration of cultural practices in sleep health Delayed Sleep-Wake Phase Disorder Bed-sharing practices in various racial/ethnic Evening Chronotypes groups Persistent in sleep-wake schedule The balance between cultural awareness and Common in adolescence (7-16%) safe sleep conditions Etiology: SIDS (Sudden Infant Death Syndrome) Eveningness chronotype Night owls Evaluation of Pediatric Sleep Problems Possible Intrinsic abnormality in circadian Importance of a careful medical history Oscillators Assessment for potential medical causes of Secondary psychophysiology sleep disturbances Importance of developmental history Assess current level of functions Clinical Manifestation ○ Evaluating functions at school and home Sleep Initiation Insomnia at desired bedtime ○ Identify mood, behavioral and Delayed sleep onset (often after 1-2 am) neurocognitive sequelae of sleep Daytime sleepiness problems Pronounced sleep inertia Sleep diaries (1-2 weeks) Difficulty arising in the morning Review sleep habits and environment School tardiness and absenteeism ○ Bedtime routines Decline in academic performance ○ Daily caffeine intake ○ Sleeping environment (temperature, TREATMENT noise level) Schedule Shifting (Chronotherapy) ○ Advancement of rise and bedtimes “Prescriptions without cost” 15-30 increments/day Sleep ○ Delaying of rise and bedtimes for Exercise significant phase delays (Circadian Love rhythm is more adapted to delays than Forgiveness advancement) 2-3 hours increments per day Step 2: Light Exposure ○ Morning light exposure. Natural light or light box 10k lux PREPARED BY: GUERRERO, GUMBA, ILANO, LORILLA, MERCIALES, NARVAEZ, PAREJA, RAMIREZ, RODRIGUEZ, ROMABON, SIOSON, UBALDO, VILLAMOR (YL1-B6)  Sleep Medicine – Week 5 PREPARED BY: GUERRERO, GUMBA, ILANO, LORILLA, MERCIALES, NARVAEZ, PAREJA, RAMIREZ, RODRIGUEZ, ROMABON, SIOSON, UBALDO, VILLAMOR (YL1-B6)