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35 Cards in this Set
- Front
- Back
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Problem sleepiness affects what % if population?
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.5-5%
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Two primary causes of sleep problems?
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Lifestyle factors
Sleep Disorders |
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Two general mechanisms by which sleep disorders lead to excessive daytime sleepiness?
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Insufficient Sleep (inadequate duration)
Fragmented Sleep (poor quality) |
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Define Excessive Daytime Sleepiness (EDS)
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inability to consistently acheive and sustain wakefulness and alertness to accomplish the tasks of daily living
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daily activities affected in mild, moderate, and severe EDS?
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Mild: reading, TV
Moderate: meetings Severe: eating, driving |
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How to measure sleepiness?
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Subjective Scales (epworth scale)
Objective Tests: Multiple Sleep latency test (MSLT) Maintenance of Wakefulness Test (MWT) |
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Kickers for MSLT?
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After overnight sleep study
5 20 minute nap chances Timed to see how long it takes you to fall asleep Normal >10 min Bad < 5 |
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Short list of EDS causes?
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Self-imposed restriction
Sleep Apnea Narcolepsy Idiopathic hypersomnia Periodic Limb Movement RLS Meds Med/psych disorder |
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What disorders can sleep studies dx?
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Sleep Apnea
Narcolepsy Idiopathic Hypersomnia Periodic Limb movement |
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Def of Obstructive Apnea?
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Breathing stops for at least 10 seconds
Inc breathing effort Brain wakes you up |
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Define Obstructive Hypopnea?
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Reduction in airflow to about 50% of normal
SaO2 decreases > 4% Usually steadily increasing effort until arousal |
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Scale for obstructive sleep apnea?
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Apnea + Hypopnea Index (AHI)
Degree of O2 Desaturation |
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Presenting complaints?
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heroic snoring
pauses in breathing (apneas) Excessive sleepiness insomnia |
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Risk factors for sleep apnea?
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Fat
Male Neck size > 17 inches Menopause AA, Asian, Hispanic |
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Behavioral Rx for Sleep Apnea?
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Lose wt
Stop smoking Avoid booze Avoid sleep deprivation |
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Other treatments i might forget?
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CPAP
Oral appliances Median Glossectomy Maxillomandibular Advancement Tracheostomy (geez) |
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What is sleep apnea associated with a higher risk of?
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HTN
Stroke CHF Arrhythmias Impotence Death |
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Role of severe sleep apnea and HTN?
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Severe sleep apnea doubles risk of HTN
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What does CPAP do to BP?
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lowers it
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Types of Arrhythmias associated w/ SDB
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Sinus arrest 10%
AV Block 5% VT 3-13% |
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way to reduce arrhythmias in SDB?
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O2 and CPAP
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What else can SDB increase your chance of?
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MI
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What is the narcolepsy tetrad?
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EDS
Cataplexy Hypnagogic Hallucinations Sleep Paralysis Fragmented Sleep |
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what is sleep paralysis?
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Inability to move for a few seconds/minutes during sleep onset/offset
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how many narcoleptics experience sleep paralysis?
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17-40%
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When does paralysis end?
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spontaneously
after mild sensory stimulation |
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What are hypnagogic hallucinations?
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Vivid, waking dreams
Occur during transition between sleep and wakefulness make accompany sleep paralysis |
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What is cataplexy?
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Episodic weakness w/o altered consciousness precipitated by excitement or emotion
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Most common inducer of cataplexy?
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Laughter
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gender and narcoplepsy?
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m = f
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When does narcolepsy usually start?
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teens or 20's
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Pathophys of Narcolepsy?
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Sleep-onset REM => Sx's
Impaired sleep/wake regulation is primary problem |
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Rx for narcolepsy?
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Stimulants
TCA's Sodium Oxybate Naps and sleep hygiene |
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Rx for RLS?
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Exercise
Mentally engrossing activity Hot/Cold baths Avoid caffeine, nicotine, booze, antidepressants, antihistamines |
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Meds for RLS?
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Iron
Ropinirole Premipexole L-Dopa (low dose parkinson drugs) |
