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173 Cards in this Set
- Front
- Back
About ? minutes after sleep onset, NREM yields to the first REM episode of the night.
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90
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shortening of REM latency frequently occurs with such disorders as ?
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depressive disorders and narcolepsy.
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For clinical and research applications, sleep is typically scored in epochs of 30 seconds, with stages of sleep defined by the visual scoring of three parameters:
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electroencephalogram (EEG), electrooculogram (EOG), and electromyogram (EMG) recorded beneath the chin
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NREM EEG pattern? EMG?
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EEG pattern consists of low-voltage, random, fast activity with sawtooth waves
EMG shows a marked reduction in muscle tone |
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The body musculature resting muscle potential is (greater or lower) in REM sleep than in a waking state.
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lower
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When persons are aroused ?hour after sleep onset—usually in slow-wave sleep—they are disoriented, and their thinking is disorganized
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30 minutes to 1
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Brief arousals from slow-wave sleep are also associated with ?
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amnesia for events that occur during the arousal
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The disorganization during arousal from stage 3 or stage 4 may result in specific problems, including ?
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enuresis,
somnambulism, and stage 4 nightmares or night terrors. |
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Polygraphic measures during ? sleep show irregular patterns, sometimes close to aroused waking patterns
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REM
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Pulse, respiration, and blood pressure in humans are all high during ? sleep—much higher than during ? sleep and often higher than during waking
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Pulse, respiration, and blood pressure in humans are all high during REM sleep—much higher than during NREM sleep and often higher than during waking
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Brain oxygen use ?(decreases or increases) during REM sleep
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increases
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The ventilatory response to increased levels of carbon dioxide (CO2) is (increased/depressed) during REM sleep
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depressed
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In contrast to the homoeothermic condition of temperature regulation during wakefulness or ? sleep, a poikilothermic condition (a state in which animal temperature varies with the changes in the temperature of the surrounding medium) prevails during ? sleep
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In contrast to the homoeothermic condition of temperature regulation during wakefulness or NREM sleep, a poikilothermic condition (a state in which animal temperature varies with the changes in the temperature of the surrounding medium) prevails during REM sleep
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Almost every ? period in men is accompanied by a partial or full penile erection
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REM
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A physiological change that occurs during ? sleep is the near-total paralysis of the skeletal (postural) muscles.
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REM
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Persons awakened during REM sleep frequently (? percent of the time) report that they had been dreaming
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60 to 90%
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The cyclical nature of sleep is regular and reliable; a REM period occurs about every ? minutes during the night
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90 to 100
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The first REM period tends to be the (longest/shortest),
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usually lasting less than 10 minutes; later REM periods may last 15 to 40 minutes each
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Most REM periods occur in what period of night?
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the last third of the night
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most stage ? sleep occurs in the first third of the night
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4
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In the neonatal period, REM sleep represents more than ? percent of total sleep time, and the EEG pattern moves from the alert state to ?
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In the neonatal period, REM sleep represents more than 50 percent of total sleep time, and the EEG pattern moves from the alert state directly to the REM state without going through stages 1 through 4
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By ? months of age, the pattern shifts so that the total percentage of REM sleep drops to less than ? percent, and entry into sleep occurs with ?
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By 4 months of age, the pattern shifts so that the total percentage of REM sleep drops to less than 40 percent, and entry into sleep occurs with an initial period of NREM sleep.
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Young adulthood sleep distrubtion %?
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NREM 75%
REM 75% NREM = Stage 1: 5 percent (3) Stage 2: 45 percent (1) Stage 3: 12 percent (2) Stage 4: 13 percent (2) |
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Most researchers think that there is not one simple sleep control center but a small number of interconnecting systems or centers that are located chiefly in the ? and that mutually activate and inhibit one another
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brainstem
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Prevention of serotonin synthesis or destruction of the dorsal raphe nucleus of the brainstem, which contains nearly all the brain's serotonergic cell bodies, (increases/descreases) sleep for a considerable time
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reduces
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Synthesis and release of serotonin by serotonergic neurons are influenced by the availability of amino acid precursors of this neurotransmitter, such as L-tryptophan. Ingestion of large amounts of L-tryptophan (1 to 15 g) reduces ?
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sleep latency and
nocturnal awakenings. |
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L-tryptophan deficiency is associated with ?
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less time spent in REM sleep
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Norepinephrine-containing neurons with cell bodies located in the ? play an important role in controlling normal sleep patterns.
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locus ceruleus
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most Brain serotonergic cell bodies?
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dorsal raphe nucleus of the brainstem
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Drugs and manipulations that increase the firing of these noradrenergic neurons result in?
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markedly reduced REM sleep (REM-off neurons) and
increase wakefulness. |
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In humans with implanted electrodes (for the control of spasticity), electrical stimulation of the locus ceruleus ?results in
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profoundly disrupts all sleep parameters
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Brain ? is also involved in sleep, particularly in the production of REM sleep
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Brain acetylcholine is also involved in sleep, particularly in the production of REM sleep
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In animal studies, the injection of cholinergic-muscarinic agonists into pontine reticular formation neurons (REM-on neurons) results in
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a shift from wakefulness to REM sleep
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Disturbances in central cholinergic activity are associated with
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the sleep changes observed in major depressive disorder
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Compared with healthy persons and nondepressed psychiatric controls, patients who are depressed have marked disruptions of ? sleep patterns
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REM
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Depression REM distruptions include?
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include shortened REM latency (60 minutes or less),
an increased percentage of REM sleep, and a shift in REM distribution from the last half to the first half of the night. |
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Administration of a muscarinic agonist, such as arecoline, to depressed patients during the first or second NREM period results in?
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n a rapid onset of REM sleep.
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Depression can be associated with an underlying supersensitivity to ?
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acetylcholine
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Drugs that ? REM sleep, such as antidepressants, produce beneficial effects in depression
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reduce
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about ? the patients with major depressive disorder experience temporary improvement when they are deprived of sleep or when sleep is restricte
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50%
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? one of the few drugs that increase REM sleep, also produces depression
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reserpine (Serpasil),
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Patients with ? have sleep disturbances characterized by reduced REM and slow-wave sleep.
Cause of that ? |
dementia of the Alzheimer's type.
The loss of cholinergic neurons in the basal forebrain has been implicated as the cause of these changes |
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Melatonin secretion from the pineal gland is (activated or inhibited) by bright light
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inhibited
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the lowest serum melatonin concentrations occur during the (day or night)
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day
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The (brain site) may act as the anatomical site of a circadian pacemaker that regulates melatonin secretion and the entrainment of the brain to a 24-hour sleep-wake cycle
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suprachiasmatic nucleus of the hypothalamus
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Drugs that increase dopamine concentrations in the brain tend to produce (sleepiness or arousal)?
dopamine blockers tend to? |
arousal and wakefulness.
In contrast, dopamine blockers, such as pimozide (Orap) and the phenothiazines, tend to increase sleep time |
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A hypothesized homeostatic drive to sleep, perhaps in the form of an endogenous substance—process S—may accumulate during wakefulness and act to ?(reduce or induce) sleep
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induce
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Another compound—process C—may act as ?
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a regulator of body temperature and sleep duration.
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As ? sleep increases after exercise and starvation, this stage may be associated with satisfying metabolic needs.
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NREM
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Most investigators conclude that sleep serves a (list 3 fxns)
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restorative, homeostatic function and appears to be crucial for normal thermoregulation and energy conservation.
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Prolonged periods of sleep deprivation sometimes lead to
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ego disorganization,
hallucinations, and delusions. |
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Depriving persons of REM sleep by awakening them at the beginning of REM cycles results in what when allowed to sleep without interruption?
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increases the number of REM periods and the amount of REM sleep (rebound increase) when they are allowed to sleep without interruption.
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REM-deprived patients may exhibit ?
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irritability and lethargy.
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Difference in REM between long (>9h) and short (6<) sleepers?
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Long sleepers have
more REM periods and more rapid eye movements within each period (known as REM density) than short sleepers |
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REM density
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# rapid eye movements during a Rem Period
|
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(Short or Long) sleepers are generally efficient, ambitious, socially adept, and content. (Short or Long) sleepers tend to be mildly depressed, anxious, and socially withdrawn
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Short sleepers are generally efficient, ambitious, socially adept, and content. Long sleepers tend to be mildly depressed, anxious, and socially withdrawn
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REM periods (decrease or increase) after strong psychological stimuli, such as difficult learning situations and stress, and after the use of chemicals or drugs that decrease brain catecholamine
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increase
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Low-voltage, mixed frequency activity
Alpha (8–13 cps) activity with eyes closed = ? |
wakefulness
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Low-voltage, mixed frequency activity
Theta (3–7 cps) activity, vertex sharp waves |
Stage 1
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Low-voltage, mixed frequency background with sleep spindles (12–14 cps bursts) and K complexes (negative sharp wave followed by positive slow wave)
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Stage 2
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High-amplitude (≥75 µV) slow waves (≤2 cps) occupying 20 to 50 percent of epoch
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Stage 3
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High-amplitude slow waves occupy >50% of epoch
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Stage 4
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Low-voltage, mixed frequency activity Saw-tooth waves, theta activity, and slow alpha activity
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REM
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EMG:
High tonic activity and voluntary movements |
Wakefulness
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Tonic activity slightly decreased from wakefulness
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Stage 1
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Low tonic activity
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Stages 2-4
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Tonic atonia with phasic twitches
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REM
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Without external clues, the natural body clock follows a ?-hour cycle
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25
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In a normal nighttime sleeper, a nap taken in the morning or at noon includes a (much, little) of REM sleep, whereas a nap taken in the afternoon or the early evening has (much or little) REM sleep
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In a normal nighttime sleeper, a nap taken in the morning or at noon includes a great deal of REM sleep, whereas a nap taken in the afternoon or the early evening has much less REM sleep
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DSM divides sleep ds into?
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DYS and PARA
somnias |
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DYS somnias divided into?
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insomnia and
hypersomnia |
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? are abnormal behaviors during sleep or the transition between sleep and wakefulness
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Parasomnias
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Often, they reflect the appearance of normal sleep processes at inappropriate times
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Parasomnias
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Period of time from turning out the lights until the appearance of stage II sleep
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Sleep Latency
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Number of apneas longer than 10 seconds per hour of sleep
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Apnea Index
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Number of periodic leg movements per hour
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Nocturnal Myoclonus Index
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Period of time from the onset of sleep until the first REM period of the night
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REM latency
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REM sleep within the first 10 minutes of sleep
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Sleep-onset REM period
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List common causes of initial insomnia?
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GMC: pain, cns lesions
Psychosocial: anxiety, muscular, environmental changes, circadian rhythm sleep ds |
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List common causes of difficulty maintaining sleep?
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GMC: slep apneas, nocturnal myoclonsus, restless legs, dietary factors, parasomnias, substance related, endocrine, metabolic, infectious, neoplastic, painful disease, brainstemhypothalamic lesions, aging
Psych: Depression, especially primary depression Environmental changes Circadian rhythm sleep disorder Posttraumatic stress disorder Schizophrenia |
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Most common sleep complaint?
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insomnia
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Excessive Sleep GMC's? Other
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Kleine-Levin syndrome
Menstrual-associated somnolence Metabolic or toxic conditions Encephalitic conditions Alcohol and depressant medications Withdrawal from stimulants Depression (some) Avoidance reactions |
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Excessive Daytime Sleepiness
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Narcolepsy and narcolepsy-like syndromes
Sleep apneas Hypoventilation syndrome Hyperthyroidism and other metabolic and toxic conditions Alcohol and depressant medications Withdrawal from stimulants Sleep deprivation or insufficient sleep Any condition producing serious insomnia Depression (some) Avoidance reactions Circadian rhythm sleep disorder |
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The term ? should be reserved for patients who complain of sleepiness and have a clearly demonstrable tendency to fall asleep suddenly in the waking state, who have sleep attacks, and who cannot remain awake; it should not be used for persons who are simply physically tired or weary.
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somnolence
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Parasomnia is an unusual or undesirable phenomenon that appears (when during sleep)
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suddenly during sleep or that occurs at the threshold between waking and sleeping.
Parasomnia usually occurs in stages III and IV and, thus, is associated with poor recall of the disturbance. |
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narcolepsy,
breathing-related sleep disorder, circadian rhythm sleep disorder fit in under what category of sleep ds |
DYS somnias
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Parasomnias include
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nightmare disorder
sleep terror disorder sleepwalking disorder |
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Primary insomnia is often characterized both by
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difficulty falling asleep and by repeated awakening
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Tx of primary insomnia
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1. Sleep hygiene
2. 2 weeks benzo's, z drugs 3. Supplements: tryptophan, melatonin |
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Melatonin's precursor L-tryptophan was used previously with the same rationale; however, in addition to having uncertain efficacy, it was found to be contaminated with a substance causing
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eosinophilic myalgia, a possibly deadly dyscrasia
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? is characterized by a dissociation between the patient's experience of sleeping and the objective polygraphic measures of sleep
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Sleep state misperception (also known as subjective insomnia)
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? insomnia typically presents as a primary complaint of difficulty in going to sleep. A patient may describe this as having gone on for years and usually denies that it is associated with stressful periods in his or her life. Objects associated with sleep (e.g., the bed, the bedroom) likewise become conditioned stimuli that evoke insomnia
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Psychophysiological
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A common finding is that a patient's lifestyle leads to sleep disturbance. This is usually phrased as ?, referring to a problem in following generally accepted practices to aid sleep.
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inadequate sleep hygiene
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Primary Hypersomnia
According to DSM-IV-TR, the disorder should be coded as recurrent if patients have periods of excessive sleepiness lasting at least ? days and occurring several times a year for at least ? years |
According to DSM-IV-TR, the disorder should be coded as recurrent if patients have periods of excessive sleepiness lasting at least 3 days and occurring several times a year for at least 2 years
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Treatment of primary hypersomnia consists mainly of
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stimulant drugs, such as amphetamines, given in the morning or evening. Nonsedating antidepressant drugs, such as SSRIs, may be of value in some patients.
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Describe narcolepsy
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Narcolepsy is a condition characterized by excessive sleepiness, as well as auxiliary symptoms that represent the intrusion of aspects of REM sleep into the waking state
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In nacrolepsy, are sleep attacks refreshing?
Do sleep attacks occur at predictable times or more inappropriate times? |
yes
They can occur at inappropriate times (e.g., while eating, talking, or driving and during sex). |
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Narcolepsy:
The appearance of REM sleep within ? minutes of sleep onset (sleep-onset REM periods) is also considered evidence of narcolepsy. |
10
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Narcolepsy criteria:
Irresistible attacks of refreshing sleep that occur daily over at least ?months. |
3 months
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Criteria B for nacrolepsy:
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one of
1.cataplexy or 2. rem intrusion |
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Narcolepsy can occur at any age, but it most frequently begins in ?
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adolescence or young adulthood, generally before the age of 30
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Narcolepsy:
The most common symptom is |
sleep attacks:
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Often associated with nacrolepsy (close to ? percent of long-standing cases) is cataplexy, a sudden loss of muscle tone, such as jaw drop, head drop, weakness of the knees, or paralysis of all skeletal muscles with collapse.
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50%
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EEG signs of narcolepsy
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Patients often remain awake during brief cataplectic episodes; the long episodes usually merge with sleep and show the electroencephalographic (EEG) signs of REM sleep.
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Narcolepsy and associated biomarker?
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A type of human leukocyte antigen called HLA-DR2 is found in 90 to 100 percent of patients with narcolepsy and only 10 to 35 percent of unaffected persons
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One recent study showed that patients with narcolepsy are deficient in the neurotransmitter ?, which stimulates appetite and alertness.
Another study found that the number of ? neurons in narcoleptics is 85 to 95 percent lower than in nonnarcoleptic brains |
hypocretin
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Tx narcolepsy
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1. forced naps
2. stimulant, like modafinil 3. SSRI's to reduce cataplexy via REM suppression (e.g. fluoxetine) or TCA imipramine |
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Breathing related sleep ds more commonly are associated with insomnia or hypersomnia?
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Two disorders of the respiratory system that can produce hypersomnia are sleep apnea and central alveolar hypoventilation.
Both disorders can also cause insomnia, but more commonly produce hypersomnia. |
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Do most snorers have sleep apnea?
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NO
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Medical consequences of Obstructive sleep apnea?
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Medical consequences include cardiac arrhythmias, systemic and pulmonary hypertension, and decreased sexual drive or function.
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The polysomnogramic features of (Central or Obstructive Sleep Apnea) are similar to those of (CSA or OSA), except that, during the periods of apnea, a cessation of respiratory effort is seen in the abdominal and chest expansion leads with (CSA or OSA)
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The polysomnogramic features of CSA are similar to those of OSA, except that, during the periods of apnea, a cessation of respiratory effort is seen in the abdominal and chest expansion leads in CSA.
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OSA/CSA psychiatric features?
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These include decreased ability to concentrate, decreased libido, memory complaints, and deficits in neuropsychological testing. Many or even most patients have dysthymic features and, although many patients manifest OSA and major depression,
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Patients sometimes awaken from apneas with a sensation of being unable to breathe, and these episodes need to be distinguished from nocturnal ?
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panic attacks.
but it is rare to have panic attacks purely at night |
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Tx of OSA?
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nasal CPAP
weight loss surgery rx: decrease period most associated with apneas -- REM, with SSRI's |
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? refers to several conditions marked by impaired ventilation in which the respiratory abnormality appears or greatly worsens only during sleep and in which no significant apneic episodes are present. The ventilatory dysfunction is characterized by inadequate tidal volume or respiratory rate during sleep. Death may occur during sleep (Ondine's curse). ? is treated with some form of mechanical ventilation (e.g., nasal ventilation).
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Central alveolar hypoventilation
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The patients' major complaint is often the difficulty of falling asleep at a desired conventional time, and their disorder may appear to be similar to sleep onset insomnia. Daytime sleepiness often occurs secondary to sleep loss.
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Circadian rhythm sleep disorder
Delayed Sleep Phase type |
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The first major therapy for delayed sleep-phase syndrome is chronotherapy, in which the patient is instructed to shift his or her hours of sleep and waking progressively (earlier or later) each night ...
until traditional bedtime Alternate approach? |
later
AM bright light tx |
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Depending on the length of the east-to-west trip and individual sensitivity, jet lag sleep disorder usually disappears spontaneously in ? days; no specific treatment is required. Some
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2 to 7
|
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Which Circadian Ds type associated with
gastrointestinal (GI) and cardiovascular disorders |
Shift Work Type
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In shift work type, what tx better melatonin or bright light?
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Treatment with melatonin has been found to be less successful than timed bright light exposure in aiding adjustment to shift work.
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? syndrome is characterized by sleep onsets and wake times that are intractably earlier than desired, actual sleep times at virtually the same daily clock hour, no reported difficulty in maintaining sleep once begun, and an inability to delay the sleep phase by enforcing conventional sleep and wake times
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The advanced sleep phase
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Which condtion interferes more with work or school day:
advanced sleep phase or delayed? |
delayed ...
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It is particularly common in the elderly, who have a phase advance of approximately 1 hour in terms of their temperature and melatonin rhythms
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Advanced Sleep Phase Syndrome
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Tx of advanced sleep phase syndrome
|
This condition can be treated by administering bright light in the early evening, resulting in a phase delay of the pacemaker, such that the sleep-wake signal is in closer concert with traditional hours for bedtime and arising.
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? pattern is defined as irregular, variable sleep and waking behavior that disrupts the regular sleep-wake pattern.
The condition is associated with frequent daytime naps at irregular times and excessive bed rest. Sleep at night is not adequately long, and the condition may seem to be insomnia, although the total amount of sleep in 24 hours is normal for the patient's age. |
Disorganized sleep-wake
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? consists of highly stereotyped abrupt contractions of certain leg muscles during sleep
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Periodic limb movement syndrome (PLMS) (also known as nocturnal myoclonus)
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PLM:
associated with extension or flexion of: toes, ankles, knees |
These movements include extension of the toes, as well as flexion of the ankle and knee.
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PLM associated with what GMCs?
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The condition is associated with renal disease, as well as iron and vitamin B12 anemia
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What part of sleep are periodic limb movements seen?
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On the polysomnogram, periodic limb movements are 0.5 to 5.0 seconds in duration and occur every 20 to 40 seconds (Fig. 24.2-4) during periods of NREM sleep.
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PLM EEG findings?
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Often, they are accompanied by a K-complex or brief arousal signal in the EEG
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A diagnosis of PLMS requires a PLM index of at least ? per hour
|
5
|
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PLM Tx?
|
Treatments that may be useful include benzodiazepines,
levodopa (Larodopa), quinine, and, in rare cases, opioids. |
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DDX of PLMs?
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he major differential diagnoses include medication-induced akathisia, peripheral neuropathy, and nocturnal leg cramps.
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Worsening at night and periodic limb movements are more common in ? than in ?
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Worsening at night and periodic limb movements are more common in restless legs syndrome than in medication-induced akathisia or peripheral neuropathy
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present with the desire to move the limbs
frequent limb movements Restless legs or nocturnal leg cramps? |
Unlike restless legs syndrome, nocturnal leg cramps do not present with the desire to move the limbs nor are there frequent limb movements.
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Periodic limb movments can occur with restless legs syndrome but also?
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Individuals with normal pregnancy or with conditions such as renal failure, congestive heart failure, and posttraumatic stress disorder may also develop periodic limb movements
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patient presented with complaints of uncomfortable, crawling sensations in the legs when trying to fall asleep. Patients commonly report an urge to move the leg to dispel the sensation. This
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Restless legs syndrome
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? is an uncomfortable, subjective sensation of the limbs, usually the legs, sometimes described as a “creepy crawly” feeling or as the sensation of ants walking on the skin. It tends to be worse at night, and is relieved by walking or moving about
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Restless limbs syndrome (RLS) (also known as Ekbom syndrome)
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Restless legs syndrome often appears in what GMC's?
|
pregnancy, iron or vitamin B12 deficiency anemia, and renal disease
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Tx of restless legs syndrome?
|
Dopamine agonist agents
NOT benzo's The first step in treatment is looking for anemia and treating it, if found. Benzodiazepines are relatively ineffective. The off-label use of L-dopa and carbidopa (Sinemet), bromocriptine (Parlodel), and pergolide (Permax) is often helpful. In rare patients who are severely affected, the off-label use of narcotic analgesics can help when other treatments have been tried and have failed. Ropinirole (Requip), a dopamine agonist already available for treatment of Parkinson's disease, is now the first drug approved by the FDA for treatment of moderate to severe RLS. |
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? is a relatively rare condition consisting of recurrent periods of prolonged sleep (from which patients may be aroused) with intervening periods of normal sleep and alert waking. During the hypersomniac episodes, wakeful periods are usually marked by withdrawal from social contacts and return to bed at the first opportunity; patients may also display apathy, irritability, confusion, voracious eating, loss of sexual inhibitions, delusions, hallucinations, frank disorientation, memory impairment, incoherent speech, excitation or depression, and truculence. Unexplained fevers have occurred in a few such patients.
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Kleine-Levin syndrome
|
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Kleine-Levin syndrome associated with what age?
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With few exceptions, the first attack occurs between the ages of 10 and 21 years. Rare instances of onset in the fourth and fifth decades of life have been reported. The syndrome appears to be almost invariably self-limited, and enduring remission occurs spontaneously before age 40 in early-onset cases.
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Some women experience intermittent marked hypersomnia, altered behavioral patterns, and voracious eating at, or shortly before, ?
|
the onset of their menses
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Nightmare disorder associated with what period of night
|
later in night
As with other dreams, nightmares almost always occur during REM sleep and usually after a long REM period late in the night. |
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Tx of nightmares
|
No specific treatment is usually required for nightmare disorder. Agents that suppress REM sleep, such as tricyclic drugs, may reduce the frequency of nightmares, and benzodiazepines have also been used. Contrary to popular belief, no harm results from awakening a person who is having a nightmare.
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Sleep terror disorder is an arousal in the (part) of the night during ?
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Sleep terror disorder is an arousal in the first third of the night during deep NREM (stages III and IV) sleep. It
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A night terror episode after the original scream frequently develops into a ?
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sleepwalking episode.
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Polygraphic recordings of night terrors are somewhat like those of ?; in fact, the two conditions appear to be closely related.
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sleepwalking
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Night terrors
percent of children >in boys or girls? |
About 1 to 6 percent of children have the disorder, which is more common in boys than in girls and which tends to run in families.
|
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When night terrors begin in teens consider?
|
Temporal Lobe epilepsy
|
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Tx of night terrors?
|
Specific treatment for night terror disorder is seldom required. Investigation of stressful family situations may be important, and individual or family therapy is sometimes useful. In the rare cases when medication is required, diazepam (Valium) in small doses at bedtime improves the condition and sometimes completely eliminates the attacks
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Sleepwalking, also known as ?, consists of a sequence of complex behaviors that are initiated in the (part) of the night during ? sleep and frequently, although not always, progress—without full consciousness or later memory of the episode—to leaving bed and walking about
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Sleepwalking, also known as somnambulism, consists of a sequence of complex behaviors that are initiated in the first third of the night during deep NREM (stage III and IV) sleep and frequently, although not always, progress—without full consciousness or later memory of the episode—to leaving bed and walking about
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Can sleepwalking be induced?
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An artificially induced arousal from stage IV sleep can sometimes produce the condition. For instance, in children, especially those with a history of sleepwalking, an attack can sometimes be provoked by standing them on their feet and thus producing a partial arousal during stage IV sleep.
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Sleepwalking usually begins between ages ? and ? and tends to dissipate in adolescence. Peak prevalence is at about ? years of age.
> in boys or girls |
Sleepwalking usually begins between ages 4 and 8 and tends to dissipate in adolescence. Peak prevalence is at about 12 years of age
The disorder is more common in boys than in girls, and about 15 percent of children have an occasional episode |
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Does sleep walking tend to run in families
|
yes
|
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What can worsen attack?
|
Extreme tiredness or previous sleep deprivation exacerbates attacks
|
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Tx of sleep walking?
|
Treatment consists primarily of educating and reassuring the parents. Although it can be exacerbated by periods of stress or sleep deprivation, in childhood, it is not associated with psychiatric illness
Rx: In difficult cases, some clinicians try the off-label use of benzodiazepines, which decrease slow-wave sleep. Recent reports of sleepwalking associated with the use of the sedative Zolpidem (Ambien) require further study. |
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Bruxism, tooth grinding, occurs throughout the night, most prominently in stage ?
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stage II sleep
|
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? disorder is characterized by episodes of complex, often violent, behavior and is thought to represent a patient acting out his or her dreams
|
REM behavior
|
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REM sleep behav ds
- age - associated with? - Polygraph finding? |
It is more common in older men, and often a history exists of a small stroke or other CNS insult in the last months or year. It can also appear as an early event in the evolution of Parkinson's disease. If an episode is captured on the polygraph, it shows motor artifact appearing out of REM sleep.
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REM sleep behav ds
its prevalence in the elderly and in patients with Parkinson's disease has suggested a more complex etiology involving alteration of function in brain area?, where integration of sleep-wake regulation with locomotor systems takes place |
pontine areas, including the nucleus pedunculopontine
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The most widely used treatment for REM behavior disorder is
2nd choice |
the off-label administration of clonazepam (Klonopin), 0.5 to 2.0 mg a day. Carbamazepine, 100 mg three times a day, is also effective in controlling the disorder.
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The insomnia associated with major depressive disorder involves relatively normal sleep onset, but ?
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repeated awakenings during the second half of the night and
premature morning awakenin |
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MDD polysomnography?
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Polysomnography shows
reduced stage III and IV sleep, often a short REM latency, and a long first REM period. |
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Panic disorder may be associated with paroxysmal awakenings or with entering stage?
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III and IV sleep
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In schizophrenia, total sleep time and slow-wave sleep are ?increased or decreased
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reduced
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Axis I/II ds associated with hypersomnia?
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Depressed phase Bipolar 1
uncomplicated grief pesronality ds dissociative ds somatoform ds amnestic ds |
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Seizures, in turn, can disrupt sleep structure, particularly ? sleep
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REM
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? is a rare, acquired, chronic hemolytic anemia in which intravascular hemolysis results in hemoglobinemia and hemoglobinuria. The hemolysis and consequent hemoglobinuria are accelerated during sleep, and the morning urine is brownish red. Hemolysis is linked to the sleep period, even when the period is shifted.
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Paroxysmal nocturnal hemoglobinuria
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Somnolence related to tolerance or withdrawal from a ? type of substance
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CNS stimulant is common in persons withdrawing from amphetamines, cocaine, caffeine, and related substances
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Sustained use of a CNS depressant, such as alcohol, can cause
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somnolence
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Insomnia is associated with tolerance or withdrawal from?
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tolerance to, or withdrawal from, sedative-hypnotic drugs, such as benzodiazepines, barbiturates, and chloral hydrate
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Long term use of hypnotics assciated with what changes in sleep architecture?
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Recordings show a disruption of sleep architecture, reduced stage III and IV sleep, increased stage I and II sleep, and fragmentation of sleep throughout the night.
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