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35 Cards in this Set
- Front
- Back
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RLS
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CLINICAL SYNDROME ( BASED ON HISTORY ONLY)
ARMS AND TRUNK CAN BE INVOLVED TOO STRONG URGE TO MOVE CREEPY CRAWLY FEELING RELIVED BY WALKING CAUSES DAYTIME FATIGUE SEEN IN WOMEN MORE@ANY AGE >50%OF PTS WITH RLS HAVE FAMILY TRAITE ASSOCIATED WITH (IRON DEFICIENCY) SEVERE KIDNEY FAILURE TX: MEDICATION (BENADRYL,ELAVIL,PROZAC,HALDOL) |
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PERIODIC LEG MOVEMENTS (PLMW)
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RECORDED DURING WAKE UP TO 10 SEC. MORE THEN 15 PLMW/HR OF WAKE SUPPORTS CLINICAL DIAGNOSIS OF RLS
TECH MOTES SHOULD DOCUMENT PT RESTLESSNESS AND SENSATIONS |
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PERIODIC LIMB MOVEMENTS DURING SLEEP (PLMS)
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MOVEMENTS OF LEGS OR ARMS &TRUNK
WORSENED BY DOPAMINE RECEPTOR BLOCKERS AND ANTIDEPRESSANT LOW FERRITIN LEVELS PLMS AND RLS ARE NOT SAME 80-90% OF PEOPLE WITH RLS HAVE PLMS BUT NOT EBERYONE WITH PLMS HAS RLS 70-75% WITH (REM SLEEP BEHAVIOR DISORDER) (RBD) PRESENT IN NREM & REM 45-65% WITH NARCOLEPSY MONITOR BOTH LEGS;EMG=50HZ TO150HZ RANGE HFF @100HZ SENSITIVITY TO RECORD TOE TWITCHES 0.5-10 SEC. DURATION AMPLITUDE 8uV IN BASELINE,SEPARATED BY 5-90SEC. LEG MOVEMENTS ON 2 DIFFERENT LEGS >5SEC BETWEEN MOVEMENTS ARE COUNTED AS ONE LEG MOVEMENT MUST BE 4 OR MORE IN SEQUENCE OTHERWISE NOT PERIODIC LIMB MOVEMENTS SEEN ON (N1) DECREASE (N3) ABSENT (REM) UNLESS (RBD) |
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PLMS INDEX
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# OF PLMS /HR OF TOTAL SLEEP TIME PER PSG
PLMS AROUSAL INDEX #IF PLMS ASSICUATED WUTG EEG AROUSALS/HR OF TOTAL SLEEP TIME PER PSG |
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PERIODIC LIMB MOVENENT DISORDER (PLMD)
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CHARACTERIZED BY PLMS
DISTURBANCE NOT DUE TO ANOTHER SLEEP DISORDER COMPLAINTS OF DIFFICULTY GETTING TO SLEEP OR STAYING ASLEEP PTS CAN BE UNAWARE BUT PT BED PARTNERS COMPLAIN >5/HR OF SLEEP CHILDREN >15/HR SLEEP ADULTS TX= MEDICATIONS FOR RLS ARE EFFECTIVE IN TX PLMD |
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SLEEP RELATED BRUXISM
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RHYTHMIC CONTRACTIONS OF JAW MUSCLES WITHOUT TOOTH GRINDING (THYTHMIC MASTIVATORY MUSCLE ACTIVITY OR RMMA)
STROMG MUSCLE CONTRACTIONS PRODUCE CLENCHING OF TEE AND TOOTH-GRINDING SOUNDS ARE SLEEP RELATED BRUXISM ABNORMAL WEAR OF TEETH,BROKEN TEETH,LOOSE TEETH,PAINFUL OR HYPERSENSITIVE TEETH , JAW PAIN,JAW LOCK ON WAKING OR HEADACHE BRIEF(PHASIC)OR (TONIC) ELEVATIONS OF CHIN EMG TWICE THE AMPLITUDE OF BACKGROUND EMG PT IS NOT AWARE OF BRUXISM OR AROUSALS OR COMPLAIN ABOUT POOR SLEEP QUALITY PARTNER DOES ABOUT NOISE , DENTAL EXAM SHOWS DESTRUCTION OF TEETH OCCURS ALL STAGES 80% IN (N1 & N2)EMG 0.25-2SEC. ARE SCORED IF >3 ELVATIONS IN CHIN EMG >3 SEC INTERVAL OF STABLE BACKGROUND BEFORE NEW EPISODE CAN BE SCORED.90% HAVE AROUSAL FOLLOWED BY ONSET OF JAW-MUSCLE CONTRACTIONS ASSOCIATED WITH TOOTH GRINDING (LOOKS LIKE CHEWING) CAN SCORE BY AUDIO IN COMBINATIONS WITH PSG MINUMUM OF 2 AUDIBLE TOOTH GRINDING ABSENT OF EPILEPSY ESSENTIAL FOR CORRECT INTERPRETATION OF SLEEP STUDY |
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SLEEP RELATED BRUXISM-RISK FACTORS OR TRIGGERS
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FAMILY HISTORY, OTHER MOVEMENTS DISORDERS
-PARKINSON'S DISEASE-TOURETTE'S SYNDROME,RLS,OSA,DEMENTIA,DEPRESSION,MENTAL RETARDATION,ALCOHOL,MEDICATIONS&DRUGS TX= NO SPECIFIC CURE MOUTH GUARD STABILIZATION BITE SPLINT REDUCE PAIN, MEDICATION FOR SHORT TERM USE OR IN MOST SEVERE CASES (KLONOPIN,FLEXERIL,MIRAPEX,INDERAL ,BOTOX |
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PARASOMNIAS
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UNDESIRABLE PHYSICAL EVENTS WHEN ONE IS GOING TO SLEEP,DURING SLEEP OR DURING AROUSAL FROM SLEEP
RESULT FROM (CNS)TRANSMITTED INTO SKELETAL MUSCLES AND/OR (FIGHT OR FIGHT) NERVOUS SYSTEM REM AND NREM |
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REM SLEEP BEHAVIOR DISORDER (RBD)
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CAUSE INJURY OR SLEEP DISRUPTION
DISAPPEARANCE OF NORMAL SKELETAL MUSCLE ATONIA(PARALYSIS DURING REM) SLEEP RELATED INJURY COMMON HSTY=VIOLENT,VIVID DREAMS WHICH PT BEING ATTACKED, PT RESPONDS BY ATTACKING BACK PT CAN REMEMBER DREAM ACTIONS EPISODES OCCUR DURING REM APPROXIMATELY 90 MINUTES AFTER SLEEP ONSET, EPISODES OCCUR MORE FREQUENTLY IN SECOND HALF OF NIGHT LONG HST OF DISRUPTIVE MOVEMENTS DURING SLEEP MORE COMMON IN MEN>50, UNDERLING NEUROLIGICAL DISORDER PARTICULARY IN PARKINSON'S DISEASE OR NARCOLEPSY,SEEN WITH ALCOHOL WITHDRAWAL WITH INTENSE REM SLEEP REBOUND, ANTIDEPRESSANTS CAN TRIGGER RBD (EFFEXOR,PROZAC,REMERON) |
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RBD & POLY SOMNOGRAPHY
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VIDEO RECORDINGS DURING PSG,MONITOR ALL FOUR LIMBS
EXCESSIVE SUSTAINED EMG ATONIA DURING REM SLEEP OLMS WITH FEW EEG AROUSAL DURING NREN SLEEP IN 70-75% RBD PTS. PLMS CAN BE PRESENT DURING REM SLEEP |
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SCORING RBD
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(TONIC) MUSCLE ACTIVITY IN REM IN CHIN EMG- AT 50% DURATION OF EPOCH HAS EMG AMPLITUDE>THEN MINIMUM AMPLITUDE SEEN IN NREM
EXVESSIVE TRANSIENT MUSCLE ACTIVITY DURING REM IN CHIN OR LIMB EMG - DIVIDE A 30 SEC EPOCH INTO 10 SEQUENTIAL 3 SECOND MINI EPOCHS @LEAST 5(50%) OF THE MINI EPOCHS CONTAIN BURST OF TRANSIENT MUSCLE ACTIVITY 0.1-5.0 SEC. IN DURATION AND @ LEAST 4 TIMES HIGH IN AMPLITUDE AS BACKGROUND EMG ACTIVITY. |
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NREM DISORDERS OF AROUSAL
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MENTAL CONFUSION OR CONFUSIONAL BEHAVIOR DURING OR AFTER AROUSAL FROM SLEEP
SLEEPWALKING SLEEP TERRORS =CRY OR SCREAM (FEAR) MORE COMMON IN CHILDREN THAN ADULTS |
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CONFUSIONAL AROUSALS
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OCCURE 1ST PART OF NIGHT BUT CAN OCCUR ON ATTEMPTED AWAKENING IN AM
MARKED MENTAL CONFUSION DURING AND AFTER AROUSAL FROM SLEEP, SLOW SPEECH AND DISORIENTATION TO TIME AND SPACE PT CAN HAVE AUTOMATIC BEHAVIOR SUCH AS PICKING AT BEDCLOTHES ,BECOMES AGITATED IF OUTSIDER TRIES TO HELP MAY NOT REMEMBER ANYTHING DURING AROUSAL COMMONLY OCCURS IN SLOW WAVE SLEEP CAN OCCURE IN (N2) PREDISPOSING FACTORS FAMILY HISTORY SHIFT WORK OTHER SLEEP DISORDERS, INSUFFICIENT SLEEP , ANXIETY AND DEPRESSION PRECIPITATION FACTORS RECOVERY FROM SLEEP DEPRIVATION,ALCOHOL,OSA,PLMD,DRUG ABUSE,FORED AWAKENING , PSYCHOTROPIC MEDICATION |
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SLEEPWALKING
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CHILDREN WALK IN SLEEP
THEY APPEAR TO BE AWAKE BEHAVIORS ARE INAPPROPRIATE POTENTIALLY VIOLENT PT HARD TO AROUSE OR ARE CONFUSED IF AWAKENED DO NOT REMEMBER EPISODE IN AM SEEN IN FAMILY COMMON CHILDREN 8-12, USEALLY SPONTANEOUSLY STOPS AROUND PUBERTY ASSOCIATED WITH INJURY OR VIOLENCE IS COMMON IN ADULT MALES |
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SLEEPWALKING & PSG
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AFTER AROUSAL FROM (SWS) NEAR END OF FIRST OR SECOND EPISODE OF SWS
OCCASIONALLY ARISES OUT OF (N2) MULTIPLE AROUSAL FROM SWS WITHOUT SLEEPWALKING BEHAVIOR VIDEO,POST AROUSAL EEGEVENT SUCH AS OSA, NORMAL REM ATONIA AND EXCLUDE RBD EEG 16 CHANNELS SHOULD BE NORMAL TO EXCLUDE SEIZURES NOTE BEHAVIOV DURING AROUSALS |
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SLEEP TERRORS
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ABRUPT AWAKENING BEGIN TO CRY OR LOUD SCREAM, INTENSE FEAR SITS UP IN BED INCONSOLABLE POTENTIALLY DANGEROUS BEHAVIOR PT CAN NOT RECALL EVENT IN AM
OCCURS IN FAMILIES BEGINS CHILDHOOD CAN BEGIN IN ADULTHOOD INJURY OCCUR IF PT TRIES TO ESCAPE FROM BED OR FIGHT WITH OTHERS SUDDEN AROUSAL FROM SWS END OF 1ST OR 2ND EPISODE OF SWS |
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SLEEP TERRORS
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ABRUPT AWAKENING BEGIN TO CRY OR LOUD SCREAM, INTENSE FEAR SITS UP IN BED INCONSOLABLE POTENTIALLY DANGEROUS BEHAVIOR PT CAN NOT RECALL EVENT IN AM
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OTHER PARASOMNIAS
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SLEEP RELATED EATING DISORDER
SLEEP ENURESES(BED WETTING) SLEEP RELATED GROANING (CATATHRENIA) EXPLODING HEAD SYNDROME SLEEP RELATED HALLUCIANATIONS |
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SEIZURES
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UNCONTROLLED,ABNORMAL ELECTRICAL DISCHARGES IN BRAIN
CAUSE AWARENESS,MOVEMENT AND/OR SENSATION LAST A FEW MINUTES CAN OCCURE WAKING AND SLEEP WITH SLEEP MOST COMMONLY IN NREM |
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EPILEPSY
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NEUROLOGIC DISORDER IN WHICH A PERSON HAS TENDENCY TO HAVE SEIZURE
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ICTUS
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OLDER TERM FOR SEIZURE OCCURS
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ICTAL
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TIME IN WHICH A SEIZURE OCCURS
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PRE-ICTAL
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PERIOD BEFORE A SEIZURE
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POST-ICTAL
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PERIOD AFTER SEIZURE
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INTER-ICTAL
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BETWEEN 2 SEIZURES
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SEIZURES & THE SLEEP TECH
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WHEN HOW LAST SEIZURE WHAT HAPPEN! DID PT TAKE MEDICATIONS
KNOW PROTOCOL FOR PT IF SEIZURE AND WHAT TO DO AND WHO TO CALL |
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INTERICTAL DISCHARGES
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SINGLE SPIKES OR SHARP WAVE OR COMPLEXES WITH SPIKES FOLLOWED BY SLOW WAVES
WITHOUT CLINICAL EVENT NREM SLEEP INTERICTAL DISCHARGES SPREAD MORE EASILY AND LEAD TO CLINICALLY EVIDENT SEIZURES REM RELATIVELY ANTIEPILEPTIC STATE INTERICTAL DISCHARGES DO NOT SPREAD EASILY AS IN NREM AND SEIZURES ARE GENERALLY NOT CLINICALLY EVIDENT |
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ICTAL EVENTS
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CONTAINING SPIKES AND SHARP WAVES LAST FOR SEVERAL SECONDS OR MINUTES
USUALLY ASSOCIATED WITH CLINICAL MANIFESTATIONS OF A SEIZURE |
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GENERAL SEIZURES
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DISCHARGES AFFECT BOTH SIDES OF BRAIN SIMULTANEOUSLY
1.) LOSS OF CONSCIOUSNESS 2.) GENERALIZED TONIC CLONIC SEIZURE 3.) ABSENCE SEIZURES |
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PARTIAL SEIZURES
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DISCHARGES ORIGINATE IN ONE PART OF THE BRAIN
1.) PARTIAL COMPLEX SEIZURE= PRODUCES IMPAIRMENT IN CONSCIOUSNESS 2.) PARTIAL SIMPLE SEIZURE - CONSCIOUSNESS IS RETAINED |
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PARTIAL SEIZURE WITH SECONDARY GENERALIZATION
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PARTIAL SEIZURES WHICH SPREAD TO INCLUDE BOTH CEREBRAL HEMISPHERES, CAUSING GENERALIZED SEIAURE
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GENERALIZED TONIC CLONIC SEIZURES
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1.) LIMBS STIFFEN AND RIGID (TONIC)
2.) LIMBS AND FACE BEGIN TO JERK RHYTHMICALLY(CLONIC PHASE) 3.)LOOS OF BOWEL OR BLADDER CONTROL 4.) LAST FEW MINUTES 5.) CONFUSED AFTERWARD, FATIGUE AND HEADACHE 6.) MAY NOT BREATH DURING (TONIC PHASE) CAN BE LABORED DURING (CLONIC PHASE AND AFTER SEIZUREIS OVER 7.)START CPR IMMEDIATELY AND CALL 911 |
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ABSENCE SEIZURES / PETIT MAL
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SEIZURE BEGIN AND ENDS ABRUPTLY
BEGINS WITH BLANK STARE, LAST FEW SECONDS MAY BE ACCOMPANIEW BY RAPID EYE BLINKING PT RETURNS TO FULL CONSCIOUSNESS AFTER AND IS UNAWARE THAT SEIZURE OCCURRED ABSENCE SEIZURES CAN BE TRIGGERED BY COUNTING OR REPEATING THE ALPHABER ABSENCE SEIZURES ARE MORE COMMON IN CHILDRE THAN ADULTS |
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SIMPLE PARTIAL SEIZURES
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NO LOSS CONSCIOUSNESS
SOMETIMES PT CAN NOT TALK CAN SFFECT MOVEMENT= TWITCHING OF FACE RAPID EYE BLINKING EMOTIONS = PT SUDDENLY FEELS AFRAID ANGRY OR HAPPY MAY HAVE UNCONTROLLABLE CRYING SENSATIONS= ODD SMELL DISTORTION OF VISION PECULIAR SOUND BAD TASTE BURNING SKIN DEJA VU= FEEL AS THOUGH THEY HAVE HAPPENED BEFORE JAMAIS VU= FAMILIAR SURROUNDINGS APPEAR UNFAMILIAR |
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STATUS EPILEPTICUS
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REPEATED SEIZURES OCCURING FREQUENTLY PT DOEN NOT RECOVER FOR ONE SEIZURE BEFORE THE ONE STARTS
CALL MEDICAL EMERGENCY CALL YOUR MEDICAL DR |
