Sleep; Cognitive D/os

Front 1

cycle that lasts one day

Back 1

circadian

Front 2

cycle that lasts longer than one day

Back 2

infradian

Front 3

cycle that lasts less than one day

Back 3

ultradian

Front 4

Neurons from the retina project to the _______ of the hypothalamus allowing for entrainment of circadian rhythms

Back 4

suprachiasmatic nucleus

Front 5

What are the two primary stages of sleep?

Back 5

1) REM sleep (desynchronized)
2) non-REM sleep (synchronized)

Front 6

What are alpha waves associated with?

Back 6

Drowsiness, relaxation

Front 7

What are beta waves associated with?

Back 7

wakefulness

Front 8

What are theta waves associated with?

Back 8

Stage 1 non-REM sleep

Front 9

What are theta background waves with superimposed sleep spindles (faster rhythmic activity) and K-complexes associated with?

Back 9

Stage 2 non-REM sleep

Front 10

Stage 1 and 2 sleep both have ___ waves

Back 10

theta

Front 11

What stage is characterized by sleep spindles and K complexes?

Back 11

2

Front 12

What are delta waves associated with?

Back 12

stage 4 non-REM sleep

Front 13

high-amplitude positive and negative waves

Back 13

K complexes

Front 14

Called D sleep, characterized by low voltage, random, fast "sawtooth" waves

Back 14

REM sleep

Front 15

What happens if body is deprived of REM sleep?

Back 15

Will experience REM rebound

Front 16

What is sleep like in newborn?

Back 16

2/3 of day is spent in sleep.

1/2 of sleep is REM sleep.

Sleep cycle is relatively short

Front 17

What is sleep like in childhood (starting around 3-4 years old?)

Back 17

REM sleep falls to adult levels.

Compared with adults, kids spend more time in deep sleep with less awakenings.

Begin to increase ADH release during sleep, allowing for nighttime urinary continence.

Front 18

Amount of time spent in deep sleep peaks when?

Back 18

early adolescence and gradually shortens with age

Front 19

When does deep sleep time nearly disappear?

Back 19

Around the 60s

Front 20

What stage of sleep:
Arousing neurons and REM-off neurons using norepinephrine, sertonin and acetylcholine are highly active.

Back 20

wakefulness

Front 21

What stage of sleep:

1) Sleep inducing factor is released--requires adequate levels of serotonin.

2). Firing rate of the arousing neurons using norepinephrine, serotonin and acetylcholine decreases.

3.) Hypnic jerks may occur.

Back 21

Stage 1 - Light sleep

Front 22

What stage of sleep:

Muscle atonia
Conjugate eye movements
The right amygdala-hippocampal complex becomes activated leading to dreaming.
Autonomic arousal occurs leading to penile and clitoral erections, and nocturnal emissions.

Back 22

REM sleep

Front 23

Primary disorders of initiating of maintaing sleep, or of excessive sleepiness.

Characterized by a disturbance in the amount, quantity, or timing of sleep

Back 23

Dyssomnias (includes insomnia and hypersomnia)

Front 24

Unusual or undesirable behavior or event occurs during sleep at the threshold between waking and sleeping, usually occurs in stages 3-4

Back 24

parasomnias

Front 25

displacement of sleep from desired circadian period, patient can't sleep when he/she wants, but is able to sleep at other times

Back 25

Sleep-wake schedule disturbances.

Front 26

Disorders of sleep are evaluated using _________

Back 26

polysomnography.

Front 27

polysomnography: defn

Back 27

assesses multiple physical parameters while the patient sleeps/attempts to sleep

Front 28

psychophysiological insomnia/primary insomnia: defn

Back 28

Somatized tension and learned sleep-preventing associations resulting in insomnia and decreased functioning during wakefulness

exacerbated by poor sleep hygiene and conditioning

Front 29

psychophysiological insomnia/primary insomnia: treatment

Back 29

teaching good sleep hygiene techniques.

Front 30

Narcolepsy: defn

Back 30

Excessive daytime sedation plus:

Narcoleptic triad:

1) Sleep attacks
2) Cataplexy
3) Sleep paralysis
4) hypnagogic (sleep-onset) and hypnopompic (upon awakening) hallucinations

Front 31

sudden loss of motor tone in all or part of the body; often triggered by intense emotion

Back 31

cataplexy

Front 32

Visual hallucinations occurring with onset of sleep

Back 32

hypnagogic hallucinations

Front 33

Visual hallucinations occurring upon awakening

Back 33

hypnopompic hallucinations

Front 34

When does narcolepsy begin?

Back 34

adolescence or early adulthood

Front 35

What is the narcolepsy polysomnogram characterized by?

Back 35

SOREMPS

Sleep-Onset Rapid Eye Movement Periods

these occur within 10 minutes of sleep onset or during cataplectic attacks

Front 36

Narcolepsy: tx

Back 36

1) Forced daytime naps

2) Psychostimulants w or w/o antidepressants, ESPECIALLY if cataplexy is present

3) Modafinil

Front 37

repeated episodes of upper airway obstruction during sleep, usually lasting >10s, resulting in reduction in blood oxygen saturation

Back 37

obstructive sleep apnea syndrome

Front 38

what occurs in polygraphic tracing of snoring?

Back 38

There is reduction in but not cessation of airflow.

There is evidence of considerable effort in firing pattern of accessory muscles of inspiration.

Front 39

Pickwickian syndrome: aka

Back 39

Obesity hypoventilation syndrome.

Front 40

Obesity hypoventilation syndrome: defn

Back 40

condition in which severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels. Many people with this condition also frequently stop breathing altogether for short periods of time during sleep (obstructive sleep apnea), resulting in many partial awakenings during the night, which leads to continual sleepiness during the day.

Front 41

Obesity hypoventilation syndrome: treatment

Back 41

CPAP

Front 42

periods of apnea due to CNS dysfunction during sleep

Back 42

central sleep apnea

Front 43

obstructive sleep apnea: treatment

Back 43

1) Keep patient off back - supine position worsens upper airway obstruction

2) CPAP

3) Weight loss

4) Nasal surgery

5) other surgeries

There is no effective med

Front 44

What is central alveolar hypoventilation syndrome?

Back 44

Inability to maintain adequate tidal volume or respiratory rate during sleep, may result in death

Front 45

central alveolar hypoventilation syndrome: Treatment

Back 45

address underlying cause, patient will need to sleep with ventilator

Front 46

Periodic limb movement disorder: defn

Back 46

nocturnal myoclonus.

periods of reptitive and highly stereotyped limb movements during sleep, usually involving tibialis anterior m.

Front 47

Periodic limb movement disorder: treatment

Back 47

benzos to suppress limb movements.

DA drugs may be used but isn't clear why they're effective

Front 48

uncomfortable sensation (painful tingling or creeping sensation) in the legs, usually prior to sleep onset, that causes almost irresistible urge to move legs

Back 48

restless legs syndrome

Front 49

What conditions does restless legs syndrome commonly occur in?

Back 49

Pregnancy

Anemia

Front 50

attempts to reset the biological clock by sleep advancement or sleep delay exercises

Back 50

chronotherapy

Front 51

repetitive motor behavior while sitting up in bed. Cannot communicate with the person and is difficult to arouse. May awaken suddenly.

Back 51

sleepwalking

Front 52

right amygdala-hippocampal complex is associated wtih what?

Back 52

dreaming

Front 53

disturbance in consciousness and cognition developing over a short period of time

Back 53

delirium

Front 54

delirium: etiology

Back 54

due to underlying medical condition or toxic substances

Front 55

Diagnosis of delirium:

Back 55

Mental status exam.

EEG shows diffuse slow ways, but not specific.

Front 56

Differential dx of delirium: What things must be considered?

Back 56

Dementia

Schizophrenia

Bipolar disorder

(malingering - rare)

Front 57

What are the hallucinations like in delirium?

Back 57

Transient and simple

Front 58

T/F Incontinence is common in delirium

Back 58

T

Front 59

Most likely cause of delirium in outpatient or patient admitted < 24 hours ago

Back 59

Alcohol withdrawal

Front 60

Most likely cause of delirium in elderly patient, especially one with dementia already

Back 60

UTI

Front 61

Pharmacologic Tx of delirium

Back 61

1) Haloperidol - low dose (except pts with long QT)

2) benzo if haldol is ineffective

(NOT valium though)

Front 62

inability to carry out activity despite intact motor function

Back 62

apraxia

Front 63

failure to recognize or identify

Back 63

agnosia

Front 64

T/F In depressive pseudodementia, the individual is unaware of deficits

Back 64

F. They are aware and complain

Front 65

How do responses to questions differ in dementia vs. pseudodementia?

Back 65

Dementia - often wrong
Pseudodementia (from depression) - "I don't know"

Front 66

What is mood like in dementia vs. pseudodementia?

Back 66

Dementia: normal or altered
Pseudodementia: depressed

Front 67

Complications of dementia

Back 67

Depression: 25%
Hallucinations: 20%
Delusions: 35%
Behavior probs, suicide, malnutrition, incontinence

Front 68

Pharmacologic treatment of dementia

Back 68

1) Get rid of aggravating meds : sedatives, anticholinergics, opiates

2) Treat serious symptoms symptomatically

3) No drug cures cognitive deficits

Front 69

What drugs show modest benefits in a minority of patients with AD?

Back 69

Cholinesterase inhibitors:

Donepezil, rivastigmine, galantamine

Front 70

Pathological crying/laughing is aka

Back 70

emotional incontinence/lability

Front 71

Pathological crying/laughing: tx

Back 71

antidepressant medication

Front 72

Apathy is usually a consequence of what type of brain injury?

Back 72

frontal or anterior temporal brain injury

Front 73

Apathy: tx

Back 73

may improve with DA agonists or stimulants

Front 74

Transient global amnesia: defn

Back 74

benign sudden onset disorder in middle aged-elderly.

Amnesia for recent events and inability to register new memories for about 4 hours. Unknown etiology.

Front 75

belief that a family member or other person has been replaced with a double

Back 75

capgras delusion

Front 76

What is Charles Bonnet syndrome?

Back 76

Vivid visual hallucinations in a patient who's lost their vision, typically of "friendly" creatures like elves and rabbits. Patient knows they're not real.