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62 Cards in this Set
- Front
- Back
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Describe
Polysomnography |
Sleep monitoring in a sleep lab
Involves EEG (scalp-L hemi), EMG (muscle under chin), EOG (ocular), & respiration |
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T/F If a person has sleep apnea, a sedative can be a good idea.
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False. It could escalate the problem
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Describe
NREM Stage 1 Sleep |
Debatable existence
Time btwn deciding to fall asleep and disconnection of sensory awareness Can feel like you are "falling" |
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Describe
NREM Stage 2 Sleep |
Subjective sleep
Slower EEG w/ Theta spindles & K complexes NREM mentations |
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Describe
NREM Stage 3 Sleep |
-50% delta (slow wave)
-muscles relaxed but still tone -restorative w/ physical repair -proportional to exertion -no mentations |
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Describe
NREM Stage 4 Sleep |
50+% delta
-proportional to daily phys ed (like 3) -no mental activity |
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Which stages of sleep are assoc w/parasomnias and have EEG patterns similar to someone in a coma?
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Stages 3 & 4
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Describe
REM |
-90min after sleep onset
-dreaming -reflects cognitive activity of the day |
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Describe
Sleep-Onset Insomnia |
difficulty falling sleep
-common w/anxiety disorders -1+ hr to fall asleep 3+ days/wk |
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Describe
Sleep Maintenance Insomnia |
-trouble staying asleep
-racing thoughts Dx- think rumination and emotional turmoil |
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Describe
Early morning waking Insomnia |
wakes notably earlier than desired
Dx: depressive disorders |
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Describe
Idiopathic Insomnia (primary) |
unknown cause
-often onset-insomnia but can be a blend Dx: bio disturbance in either arousal system or sleep system |
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Describe
Subjective Insomnia |
-50% of all onset insomniacs
-person experiences insufficient sleep but shows normal sleep Dx: often emotional distress/overwhelmed Tx: education & relaxation |
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Describe
Alpha-Delta Sleep |
Sudden intrusions of alpha activity in delta sleep; "jolt"
-can occur during waking -assoc w/some stimulant meds or benzos Comorbid: CFS, Pain syndromes Dx: look at stressm meds, hormones |
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Describe
Restless-leg Syndrome |
-can be caused my anti-psychotics, SSRIs, alcohol w/drawal, neurosensory/pathy disorders
Tx: O-3 or 6 may help; warm baths, less caffeine; benzos, beta-blockers |
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Describe
Nocturnal Myoclonus |
periodic limb mvmnt disorder
-involuntary muscle contractions -often sx of other issue (apnea, neuromuscular, stress, shift work, caffeine, etc) Tx: tricyclics, dopamine agonists, benzos FULL WORKUP NECESSARY |
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Describe
Bruxism |
Grinding teeth/clamping jaw while asleep
-common & treatable by dentist + relaxation training |
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Describe
Narcolepsy |
-Charac by: sleep attacks, cataplexy, hypnogogic hallucinations, sleep paralysis
- triggered by strong emotions -Some consider cause to be dysreg of REM; think of as REM leaking into waking -reflects brain stem probs so need both neuro & psychiatric eval |
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What are the types of Apneas?
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Obstructive
Central Mixed |
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Describe
Obstructive Sleep Apnea |
The most common
-breathing passages collapses due to obesity, polyps, recessed jaw, allergies, etc -common in newborns -often assoc w/micro-arousals to resume breathing |
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Describe
Central Apnea |
-neurological condition in the medullary breathing nuclei
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Describe
Mixed Apnea |
Combo of obstructive & central
-freq assoc w/ Pickwickinian Syndrome (obstructive leads to central) |
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What are the greatest threats to sleep?
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age (@40 Stage 3-4 & REM decline)
Health Lifestyle Sleep Deprivation Drugs |
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Most OTC sleep inducers work primarily on the _____________ and __________ and produce general _____ depression
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On the brain stem & PFC
General CNS depression |
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Describe the effects of
Benzos |
Operate on the GABA system
-produce tolerance w/in 2 weeks -produce dependence & hangover -often used in combo w/barbituates/alcohol in suicide attempts -degrade sleep (suppress 5HT activity) |
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Describe the effects of
Antidepressants |
-not addicting
-block REM -can produce REM rebound if not tapered properly -sedating effect wears off -help early morning waking form of insomnia |
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What are some of the newer relatives of benzos?
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Ambien
Prosom Doral Lunesta -fewer side effects & can reduce problems w/all 3 types of insomnias but NOT for ppl w/apneas |
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Describe
REM Sleep Bx Disorder |
-can "act out" while dreaming
-often have recall of intense/violent dreams -usually in older ppl -assoc w/ Ambien use |
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T/F All sedative hypnotics interact w/each other
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True
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T/F Using sedative hypnotics together can produce cross tolerance, cross dependence, & synergistic action.
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TRUE
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What is unique about Rozerem?
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It can be used for months w/o tolerance and doesn't develop any appreciable dependence
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T/F All "real" pain has a source
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False
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T/F Patients with potential secondary gain hurt more
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True; regardless of whether they are aware of it
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T/F The longer, more chronic the pain, the more it hurts.
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True
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T/F Pain is largely an emotional or psychological problem
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False
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T/F Providers personal values/intuitions about a pt's pain are useful tools
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False
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T/F Malingering of pain is actually uncommon
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True
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What is the #1 complain in the medical industry?
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complaints of acute & chronic pain
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What is the role of pain?
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To alert us that something has happened that we need to attend to immediately
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_______ pain is not something that ppl regularly seek out Tx for. ______ pain is the type that ppl seek Tx for regularly
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Acute- don't; take care of it on their own
Chronic- seek heavier meds or pain management |
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What are some cultural aspects of pain?
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-more common for women of all cultures to present
-More common for Asians to present w/pain instead of emotional problems -African American males may actually have more of an affective/psych issue at core of their complaints |
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What are some other Dxs we should consider in terms of ppl presenting w/pain?
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Somatization Disorder
Malingering Factitious Disorder Conversion Disorder Hypochondriasis Body Dysmorphic Disorder Pain Disorder |
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What is pain?
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-a perception. An interpretation of a sensation
-activates sympathetic NS -attentional & perceptual -is detected by "pain receptors" |
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What are the 2 types of pain fibers?
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A-deltas- faster; acute pains, hard to over-ride
C-deltas- conduct slower, duller pains; responsive to pain management |
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What makes the treatment of pain so empirically based?
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If what you do works, results appear almost immediately
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T/F A "charley horse" or gastric contractions are examples of dissonance induced pain
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True
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What are the Nociceptors?
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Delta-type neural fibers that carry most forms of pain info
A-deltas = acute, mylinated, not easily gated C-deltas = chronic; can be gated; thinner & slower |
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Which type of pain is harder to manage psychologically?
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Acute; goes directly to the thalamus
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Describe C-delta pain
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very vulnerable to distraction, gating, emotion
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What are
Kappa receptors? |
Opioid receptors that are more common in women; make women more responsive to pain meds that are opioid analgesics
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What is
Substance P? |
- assoc w/the conduction & perception of pain
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What do Cox-1 & Cox-2 enzymes do?
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increase in areas of inflammation --> trigger release of prostaglandins --> produce vasodilation to facilitate healing & produce inflammation
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Differential Dx:
someone presents with 4+ medically unexplained symptoms that are vaguely described (nausea, sexual problems, etc) & want a medical intervention |
Somatization Disorder
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Differential Dx:
A person presents with intense leg pain but appears to have no trouble walking normally. |
Malingering
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Differential Dx:
A person presents with a disorder that they appear to know an abnormal amount of info about. |
Factitious Disorder
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Differential Dx:
A person in their 20s presents with sudden blindness and reports having just experienced great stress. |
Conversion disorder
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Differential Dx:
You really want to hit them. Their MMPI-2 is high 1 & 3, low 2. |
Hypochondriac; "neurotic"
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Psych Tx for Pain:
Objectifying the Pain |
Have them keep pain diaries w/ratings of pain
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Psych Tx for Pain:
Evaluate the Pain |
After objectifying pain, have them look at the patterns, benefits, etc
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Psych Tx for Pain:
Don't suppress other feelings |
Holding in feelings aggravates stress, depression, and pain.
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Psych Tx for Pain:
Take charge of thoughts about pain |
after pt has objectified pain, discussed their feelings about them, ID'd benefits, encourage them to take charge (internal LOC)
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T/F Pain and cold exist on the same pathways
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True
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