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27 Cards in this Set

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What is the prevalence of occasional and chronic insomina? just chronic insomnia?
Occasional and chronic insomnia - 45-55%

Chronic insomnia - 5-20%
What is the multiple sleep latency test?
Measures the time it takes for individuals to fall asleep in a sleep laboratory. It is administered during the waking hours. Usually 5 nap opportunities, each lasting approximately 20 minutes. Longer sleep latency implies lower levels of sleepiness.
What are the polysomnographic alterations in sleep found in the elderly?
Increased time spent in bed, increased awakenings and arousals, diminished total sleep time, diminished sleep efficiency, increased stage 1 sleep, decreased slow wave (delta) sleep, daytime somnolence and napping, and advance in the sleep/wake cycle.
For the following arotic arch state the postnatal derivative: 2nd
2nd

1. STAPEDIAL ARTERY
2. HYOID ARTERY

1st- part of MAXililary Artery (br. ext carotid)
What are the narcolepsy tetrad?
Excessive daytime somnolence, cataplexy, hypnagogic hallucinations, and sleep paralysis.
What is the prevalence of narcolepsy?
0.02 - 0.18% of the population
What is the biologic basis of narcolepsy?
Linked to dysfunction of hypocretin (HCRT) / orexin peptides
What is cataplexy?
Episodic weakness without altered consciousness lasting seconds to minutes and precipitated by excitement or emotion. Laughter is the most common precipitator.
What are hypnagogic hallucinations?
Vivid, "waking dreams" that occur during transitions between sleep and wakefulness. May accompany sleep paralysis or occur independently. May be tactile or auditory. Some awareness of surroundings is preserved.
What is a normal sleep latency? What is considered pathological sleepiness?
Normal: > 10 minutes
Pathologic: < 5 minutes
What are the pharmacological treatments for EDS?
Modafinil, dextroamphetamine, methylphenidate
What is the pharmacological treatment for REM symptoms of narcolepsy?
Antidepressants - Protriptyline (TCA), imipramine (TCA), clomipramine (TCA), desipramine (TCA), Fluoxetine (SSRI)
Obstructive sleep apnea syndrome symptoms
Unrefreshing sleep, daytime sleepiness, snoring, and weight gain
Obstructive sleep apnea syndrome risk factors
Middle-older age, male, obesity, use of CNS suppressants
Obstructive sleep apnea syndrome treatments
Weight loss (life style change?), avoidance of CNS depressants, continuous positive airway pressure (CPAP), dental devices, upper airway surgery, and medications
Adjustment sleep disorder
Usually short term; insomnia following stressor, which remits if stressor is removed or after adaptation.
Psychophysiologic insomnia
Sleep-preventing assocations and somatized tension perpetuate insomnia.
DSM IV classification of insomnia
Insomnia greater than 1 month with fatigue, distress, and/or impairment; no other primary disorders.

Includes psychophysiologic insomnia and adjustment sleep disorder.
Restless leg syndrome
Creepy, crawling sensations in legs that are relieved by movement. Generally idiopathic but can be secondary to uremia, anemia, and pregnancy. Often coexists with period limb movements in sleep (PLMS). Treatments include dopaminergic agents, benzodiazepines, opioids, anticonvulsants, vitamins, and iron.
Advanced sleep phase syndrome
Complaints of evening sleepiness, morning insomnia; normal sleep at early (advanced) hour; persistent and stable; responsive to AM phototherapy; more common in adolescents.
Delayed sleep phase syndrome
Complaints of evening insomnia, morning sleepiness; normal sleep at a delayed hour; responsive to AM phototherapy; more common in adolescents
Sleepwalking
Difficulty in arousal during episode; amnesia for the episode; usually occurs during the first third of night; usually in prepubertal children.

Sleepwalking occurs during delta sleep. Clonazepam is medical treatment.
What is clonazepam?
Benzodiazepine used for the treatment of absence seizures. And sleep walking, apparently.
Sleep terror
Sudden, intense scream during sleep. Evidence of intense fear occurs during delta sleep. Other features similar to sleepwalking.

Treatment includes stress reduction (beer), psychiatric evaluation for adults, and reassurance for parents.
Nightmares
Sudden awakening with intense fear. Tachycardia and tachypnea upon awakening. Usually occurs in the latter half of the night. Abrupt awakening from REM.

Treatment includes psychotherapy and hypnosis. Frequent nightmares can be indicative of psychiatric conditions.
REM sleep disorder
Movements, vocalizations ("I'd prefer not to be touched"), violent or injurious behavior secondary to dream enactment. Excessive EMG tone, body movements, vocalizations, or phasic twitching in REM.

Treatment is, you guessed it, clonazepam.
Sleep bruxism
Tooth grinding or clenching during sleep. Bursts of jaw EMG activity.