Rpsgt: A-Step Module- Sleep Deprivation, Sleep Hygiene, Insomnia, And Medications

Front 1

What is sleep deprivation?

Back 1

Not getting enough sleep

Front 2

What is considered short term sleep deprivation?

Back 2

more than 16 hrs without sleep

Front 3

What is considered long term sleep deprivation?

Back 3

Less than 7-8 hrs/ 24 hrs on a regular basis

Front 4

What are factors that may contribute to sleep deprivation?

Back 4

Poor sleep hygiene
Multiple responsibilities
Circadian rhythm alterations

Front 5

What is Sleep Deprivation or Behaviorally Induced Insufficient Sleep Syndrome as defined by the ICSD-2?

Back 5

Behaviorally induced insufficient syndrome occurs when an individual persistently fails to obtain the amt of sleep required to maintain normal levels of alertness and wakefulness. The individual engages in voluntary, albeit unintentional, chronic sleep deprivation

Front 6

How is Sleep Deprivation or Behaviorally Induced Insufficient Sleep Syndrome treated?

Back 6

1) Understand that sleep is not negotiable
2)Schedule enough time in bed per 24 hrs to get adequate sleep
3) Learn about good sleep hygiene and apply to life

Front 7

What is sleep hygiene?

Back 7

Behaviors that promote good sleep

Front 8

What behaviors are considered to be part of having good sleep hygiene?

Back 8

1) maintain regular bed and wake time
2) use bed for only sleeping and sex
3) give yourself an hr to unwind before bed
4) go to sleep when feel drowsy
5) make bedroom as comfortable as possible
6) Exercise regularly
7) Avoid heavy exercise 6 hrs before bed
8) Avoid stimulants 6 hrs before bed
9) Avoid alcohol at bedtime

Front 9

What is insomnia as defined by the ICSD-2?

Back 9

1) complaint not a diagnosis
2) difficulty getting to sleep
3) difficulty staying asleep
4) poor sleep quality
5) inadequate amt of sleep despite adequate opportunity
6) daytime impairment due to poor sleep

Front 10

What percent of the population complains of sleep disturbance?

Back 10

30%

Front 11

What is considered to be transient or short term insomnia?

Back 11

1) less than 1 week or month
2) precipitated by some event
3) resolves when event is over

Front 12

What is considered to be chronic insomnia?

Back 12

last more than one month

Front 13

What psychological or behavioral treatments are available for treating insomnia?

Back 13

1) Stimulus control therapy
2) Sleep restriction therapy
3) Relaxation therapy
4) Cognitive therapy
5) Sleep hygiene education

Front 14

What is Stimulus Control Therapy?

Back 14

Helps a person to re-learn to associate bed with sleep and to establish a consistent sleep-wake schedule

Front 15

What is Sleep Restriction Therapy?

Back 15

Reduce time in bed to the amt of time pt estimates he/she is sleeping but not less than 5 hrs/night

Front 16

What is Relaxation Therapy?

Back 16

Techniques used to reduce body tension or intrusive thoughts that interfere with sleep

Front 17

How is Cognitive Therapy used to treat insomnia?

Back 17

Used to change mistaken beliefs and attitudes about sleep, insomnia, and consequences of not getting enough sleep

Front 18

What prescription medications are used to keep people awake?

Back 18

Used to treat narcolepsy
1) Modafinil (Provigil)
2) methylphenidate (Ritalin, Concerta)
3) dextroamphetamine (Dexedrine)
4) combo amphetamine salts (Adderall)

Front 19

What is Modafinil (Provigil) useful in treating?

Back 19

1) persistent daytime sleepiness in pts on CPAP with OSA
2) Circadian rhythm sleep disorders and shift work type

Front 20

What are the side affects of prescription medications used to keep people awake?

Back 20

Appetite suppression
Insomnia if taken too close to bed time.

Front 21

What drugs are available to keep people awake without a prescription?

Back 21

Caffeine
Nicotine

Front 22

How does caffeine affect sleep?

Back 22

1) Increased sleep latency
2) decreased sleep efficiency
3) decreased stage 3 and 4

Front 23

What are effects of nicotine on sleep?

Back 23

In active smokers who smoke at bedtime:
1) Increased sleep latency
2) frequent arousals --> reduce TST

Front 24

What types of prescription medications are used to induce sleep?

Back 24

Hypnotic Medications

Front 25

What medications are Benzodiazepines?

Back 25

1) Temazepam (Ristoril)
2) Estazolam (ProSom)
3) quazepam (Doral)
4) trazadon (Halcion)

Front 26

What medications are non-benzodiaepines and what are they used for?

Back 26

Short term use
1) zopidem (Ambien)
2) zaleplon (Sonata)

Front 27

How do benzodiazepine medications affect sleep?

Back 27

1) Shorten SL
2) Decrease WASO
3) Increase TST
4) Assc with increase in spindles
5) May reduce REM
6) Suppress SWS

Front 28

How do non-benzodiazepines affect sleep?

Back 28

1) shorten sleep latency
2) Zopidem: mild reduction in REM, no effect on SWS

Front 29

What drugs are available without a prescription to help induce sleep?

Back 29

1) Alcohol
2) Antihistamines
3) Melatonin
4) L-typtophan
5) Herbs (chamomile, valerian, marijuana)

Front 30

How does Alcohol affect sleep when taken at bedtime?

Back 30

1) Shorten SL
2) Increased NREM
3) Decreased REM
4) poor sleep quality
5) Reduced TST

Front 31

How do antihistamines affect sleep?

Back 31

may increase drowsiness

Front 32

What is melatonin?

Back 32

1) natural substance, made in pineal gland
2) suppressed by sunlight and rises in darkness
3) sold as a health food supplement

Front 33

How does marijuana affect sleep?

Back 33

1) Occasional use- minimal sleep disruption
2) regular use- suppression of Stage 3 (SWS)

Front 34

What anti-depressant medication may cause sleepiness?

Back 34

Trazodone

Front 35

What types anti-depressant medication may cause insomnia?

Back 35

1) Tricyclics
2) Selective Serotonin Reuptake Inhibitors (SSRIs)

Front 36

What types of anti-depressant medication may cause suppression of REM sleep

Back 36

1) Tricyclics
2) SSRIs

Front 37

What anti-depressant medication may cause REM Sleep Behavior Disorder?

Back 37

1) Venlafaxine (Effexor)
2) SSRIs

Front 38

What types anti-depressant medication may cause PLMs?

Back 38

1) Tricyclics
2) SSRIs
3) lithium
4) dopamine receptor antagonists

Front 39

What medication may cause REMs in all stages?

Back 39

fluoxetine (Prozac)

Front 40

What complaints are reported by people taking antihypertensives?

Back 40

1) Fatigue
2) Sedation
3) Mental Confusion
4) Insomnia
5) Depression
6) Anxiety

Front 41

What complaints are reported by people taking Anti-arrhythmics?

Back 41

1) Fatigue
2) Drowsiness
3) Sleepiness
4) Insomnia
5) Diminished Memory
6) Nightmares

Front 42

What complaints are reported by people taking medications for high cholesterol (Anitlipemic drugs)?

Back 42

1) Insomnia
2) Fatigue
3) Drowsiness

Front 43

What is Gastroesophageal Reflux (GER)

Back 43

Backwash of stomach acid; pain due to regurgitation or backwash of stomach contents, usually acidic, into the lining of the esophagus leading to burning of the lining of the the esophagus

Front 44

What is sleep-related GER?

Back 44

Patient awaken from sleep with sour taste in their mouth, complain of disrupted sleep, and awaken feeling panicked

Front 45

What is esophageal pH monitoring?

Back 45

1) pH measure for acidity or alkalinity of fluid
2) a thin (1/16th inch diameter) plastic tube is passed through the nose, down the throat, and into the esophagus
3) the tube is attached to a monitor that records each eps of acid reflux

Front 46

How is Sleep-Related GER diagnosed?

Back 46

1) PSG with continuous pH monitoring
2) Episode of acid reflux during sleep
3) Eps often assc with arousals from sleep

Front 47

What is alpha intrusion?

Back 47

1) Common but unexplained EEG finding
2) Alpha can be seen in stage N2 and N3
3) originally called alpha-delta sleep
4) frequency is 7-12 Hz
5) More prominent over frontal than occipital leads