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32 Cards in this Set
- Front
- Back
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What does REM sleep mean?
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rapid eye movement
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Stages of sleep distribution
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NREM Sleep 80%
• Stage 1 : 5% • Stage 2 : 55% • Stage 3 : 15% – REM Sleep 25% |
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When does the NREM sleep occur?
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NREM sleep occurs when a majority of the arousal areas have been inhibited.
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SSRI's do what to REM sleep
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cause REM sleep without atonia
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Processes of sleep?
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Process S denotes homeostatic factor(s) which accumulate during W and decline during sleep, eg adenosine
• Process C regulates the timing of W and REM. • Suprachiasmatic nucleus is the master clock |
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Most alert period?
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usually 6-9 pm
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Infants what age do they develope light/dark?
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3-5 months
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• Opiods
• Myorelaxants • Dopaminergic agents • Antihypertensives • Antidepressants • Antiepilepetics • Alcohol/illicit drug use |
medications for sleep disorders
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First sleep disorder recognized?
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narcolespy
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Narcolepsy defined
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Characterized by rapid transitions form W to REM
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four key points for narcolepsy
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1. • Sleepiness: naps are short and refreshing
2. • Sleep Paralysis: inability to move or speak during transitions from sleep to wake. May occur in normals 3. • Hypnogogic/Hypnopompic Hallucinations: dreamlike experiences at sleep onset/offset 4. • Cataplexy: sudden loss of muscle tone triggered by strong emotion, particularly laughter |
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What is pathognomonic for narcolepsy?
How do you diagnose? |
cataplexy
Diagnosis is made by PSG/ MSLT Polysomnogram/Multiple Sleep Latency Test |
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What is drug used for narcolepsy for cataplexy
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Sodium Oxybate and/or antidepressants for cataplexy
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hypopnea?
Sleep Apnea syndrome |
>50% reduction in airflow >10 sec
SAS- AHI of greater or equal to 5 and with symptoms |
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MC type of sleep disorder breathing (SDB)
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obstructive sleep apnea
Muscles that control the tongue and soft palate relax causing the airway to narrow and close • Patient tries to breathe but cannot due to airway obstruction • Patient stops breathing for more than 10 seconds |
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Cenrtral sleep apnea shows what type of wave pattern in nasal flow
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sigmoid
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Patient makes no effort to
breathe in thorax nor abdomen during apnea • Patient stops breathing for more than 10 seconds • Typical in severe heart failure patients • May be characterized by Cheyne‐ Stokes respiration (CSR) separated Normal breathing by periods of apnea or hypopnea |
central sleep apnea
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Sleep apnea and associated problems?
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1. diabetes
2. accidents 3. cognitive dysfunction 4. htn 5. stroke |
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How does CPAP work?
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CPAP treats OSA providing a pneumatic splint to
keep the upper airway open |
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Difficulty falling asleep
• Difficulty staying asleep • Early morning awakenings • Non‐restorative sleep • Daytime consequences |
insomnia must have daytime consequences
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Difference between primary insomnia and cormorbid insomnia
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Comorbid- associated with other issues (anxiety, depression, ADHD)
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Differential Diagnosis for insomnia
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• Circadian Rhythm Disorders
• Phase Delay • Phase Advance • Shift work sleep disorder • Non 24‐hour sleep/wake syndrome (blind people) • Irregular sleep/wake pattern |
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Sleep hygiene includes?
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• Avoid stimulants (e.g. caffeine, nicotine) for several hours before bedtime.
• Avoid alcohol around bedtime, as it fragments sleep. • Exercise regularly (especially in the late afternoon or early evening). • Allow at least a 1‐hour period to unwind before bedtime. • Keep the bedroom environment quiet, dark, and comfortable. • Maintain a regular sleep/wake schedule. |
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Stimulus control treatment
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Go to bed only when sleepy – not just fatigued, but sleepy.
• Get out of bed when unable to sleep (e.g. after 20 minutes), go to another room, and only return to bed when sleep is imminent. • Curtailing all sleep‐incompatible activities (over and covert); no eating, TV watching, radio listening, planning or problem solving in bed. • Arise at a regular time every morning regardless of the amount of sleep the night before. • Avoid daytime napping. |
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CBT for insomnia would include?
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• Keep realistic expectations.
• Do not blame insomnia for all daytime impairment. • Never try to sleep. • Do not give too much importance to sleep. • Do not catastrophize after a poor night’s sleep. • Develop some tolernace to the effects of insomnia |
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CIRCADIAN RHYTHM DISORDERS shows what?
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• Delayed Sleep Phase
• Misalignment between the endogenous and external clocks • Habitual sleep times are delayed ≥ 2 hours relative to conventional times • Subsequent sleep is normal • Often assoc with difficulty waking up at socially acceptable times |
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Tx of circadian rhythm disorders?
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timed bright light exposure, chronotherapy and try to reset clock foward or backward
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The free running rhythm of circadian rhythm disorders is seen mostly in who?
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Free Running Rhythm (most pts are blind)
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RESTLESS LEG SYNDROME dx
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Desire to move the legs, often assoc with abnormal leg sensations
Symptoms worsen at rest Partial of temporary relief with activity Worsening of sx later in the day or night • IRRLS 2 10 questions with sx rated from 0 to 4 |
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Tx RLS (restless leg syndrome)
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• Fe replacement for ferritin < 50
• Dopaminergic agents • Benzodiazepines • Gabapentin • Narcotics |
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What is periodic limb movements
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• Usually occur during sleep but may occur while awake
• Five or more movements lasting >o.5 sec to <10 sec, occurring at intervals of 5 to 90 seconds |
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co morbities and mortality with PLMS (periodic limb movement syndrome)
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1. cardiovascular disease
2. ESRD- survival of patients with an PLMI> 20 was 50% at 20 months vs 90% for those with PLMI 3. Systolic heart failure |
