Sleep Disorders Board and Resident Review Points
1. Insomnia
- Types: Primary, secondary (due to medical/psychiatric conditions)
- Diagnosis: Clinical history, sleep diary, polysomnography (if needed)
- Treatment: Cognitive-behavioral therapy for insomnia (CBT-I), medications (e.g., benzodiazepines, non-benzodiazepine hypnotics)
2. Sleep-Related Breathing Disorders
Obstructive Sleep Apnea (OSA):
- Symptoms: Snoring, witnessed apneas, daytime sleepiness
- Diagnosis: Polysomnography
- Treatment: CPAP, weight loss, surgery
Central Sleep Apnea:
- Symptoms: Cheyne-Stokes respiration, heart failure association
- Diagnosis: Polysomnography
- Treatment: Treat underlying condition, adaptive servo-ventilation
3. Hypersomnolence Disorders
Narcolepsy:
- Symptoms: Excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations
- Diagnosis: Multiple sleep latency test (MSLT), CSF hypocretin-1 levels
- Treatment: Stimulants (e.g., modafinil), sodium oxybate
Idiopathic Hypersomnia:
- Symptoms: Excessive daytime sleepiness without cataplexy
- Diagnosis: Exclusion of other causes, MSLT
- Treatment: Stimulants, lifestyle modifications
4. Circadian Rhythm Sleep-Wake Disorders
- Types: Delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, shift work disorder, jet lag disorder
- Diagnosis: Clinical history, actigraphy
- Treatment: Light therapy, melatonin, sleep hygiene
5. Parasomnias
Non-REM Parasomnias: Sleepwalking, sleep terrors
REM Parasomnias: REM sleep behavior disorder (RBD)
- Diagnosis: Clinical history, polysomnography (for RBD)
- Treatment: Safety measures, medications (e.g., clonazepam for RBD)
6. Movement Disorders
Restless Legs Syndrome (RLS):
- Symptoms: Urge to move legs, worse at rest, relieved by movement
- Diagnosis: Clinical criteria
- Treatment: Dopaminergic agents, iron supplementation
Periodic Limb Movement Disorder (PLMD):
- Symptoms: Repetitive limb movements during sleep
- Diagnosis: Polysomnography
- Treatment: Similar to RLS
Sleep apnea complications:
- Daytime Fatigue: Due to interrupted sleep, individuals often experience excessive daytime sleepiness and fatigue.
- Cardiovascular Problems: Sleep apnea can increase the risk of high blood pressure, heart attacks, stroke, and arrhythmias.
- Type 2 Diabetes: There’s a higher risk of developing insulin resistance and type 2 diabetes.
- Metabolic Syndrome: This includes a combination of high blood pressure, abnormal cholesterol levels, high blood sugar, and increased waist circumference.
- Liver Problems: Sleep apnea can lead to abnormal liver function and scarring (nonalcoholic fatty liver disease).
- Mental issues including anxiety, depression and memory loss.
- Complications with Medications and Surgery: Sleep apnea can interfere with the use of certain medications and anesthesia, increasing the risk of complications during surgery.
For further reading try this sleep disorders textbook.
Mnemonic for Sleep Disorders:
I SLEEP
Insomnia
Sleep-related breathing disorders
Limb movement disorders
Excessive daytime sleepiness (Hypersomnolence)
Extrinsic circadian rhythm disorders
Parasomnias
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.