Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
Sleep and wake cycles that is 24-25 hours long is called the ____.
|
Circadian Cycle
|
|
REM and NonREM sleep make up the ____ cycle.
|
Ultradian Cycle
|
|
What type of sleep is this?
brain highly active body paralyzed fast respiration |
REM sleep
|
|
What type of sleep is this?
brain not active high muscle tone slow respiration |
NON-REM sleep
|
|
REM sleep cycle lasts about ___ min.
|
90-100 min
|
|
Stage III and IV of NON-REM sleep is also called ____.
|
Slow-wave sleep / Delta sleep
|
|
What is Delta sleep?
|
Also known as slow-wave sleep: stage III and IV of NON-REM sleep.
|
|
T/F: During healthy sleep, there is about 20% NON-REM and 80% REM sleep.
|
False.
20% REM 80% NON-REM |
|
How many cycles of REM and NON-REM are there is a night of healthy sleep?
|
4-5 cycles
|
|
T/F: REM sleep periods becomes longer and closer together as the night goes.
|
T.
|
|
Which muscles are still active during REM sleep?
|
- occular muslces for eye movements
- diaphram |
|
Describe the EEG of REM sleep:
- speed - amplitude - frequency |
fast
low amplitude mixed frequency |
|
What type of sleep is this?
idling brain in a moveable body. |
NON-REM sleep
|
|
Describe the levels of the following molecules during REM sleep.
- Ach - NE - Serotonine |
- Ach: high
- NE: low - Serotonine: low |
|
Which neurotransmitter inhibits REM sleep?
|
serotonine
|
|
List some types of dyssomnias. (5)
|
- primary insomnia
- primary hypersomnia - narcolepsy - breathing-related sleep disorder - circadian rhythm sleep disorder |
|
List some types of parasomnias. (3)
|
- nightmare disorder
- sleep terror disorder - sleepwalking disorder |
|
What 2 types of sleep disorder are most commonly seen in primary care?
|
- sleep apnea (breathing-related)
- periodic limb movements (nocturnal myclonus) |
|
These people are at risk for which type of sleep disorder?
obeise hypertensive high palate, enlarged tonsils |
obstructive sleep apnea
|
|
T/F: Males are more likely to have obstructive sleep apnea than women.
|
True.
|
|
Which ethnic group under age 25 is more likely to have obstructive sleep apnea?
|
African American male
|
|
What is the sequence of events that lead to obstructive sleep apnea?
|
- low inspiratory pressure
- completely collapsed hypopharyngeal airway - hypoxemia - increased respiratory effort - more collapsed airway - pulmonary hypertension - right heart failure, systemic hypertension(stroke and CV disease) |
|
People with obstructive sleep apnea are at risk for what diseases?
|
pulmonary hypertention which leads to either right heart failure or systemic hypertension which will cause stroke and CV diseases.
|
|
Why are people with obstructive apnea sleepy during daytime?
|
People keeps waking up without knowing when effort to breath fails.
|
|
What kinds of treatment are out there for people with obstructive sleep apnea?
|
- nasal continuous positive airway pressure splints airway.
- surgery: limited use |
|
What type of sleep disorder is this?
stereotypical leg twitches every 20-40s periods range from minutes to hours |
Nocturnal myoclonus / Periodic limb movement disorder
|
|
Which muscle usually twiches in people with nocturnal myoclonus?
|
anterior tibialis
|
|
80% of people with restless leg syndrome will have this sleep disorder.
|
nocturnal myoclonus
|
|
What percentage of people with nocturnal myoclonus have restless leg syndrome?
|
only 15%
|
|
When does restless leg syndrome symptom occur?
|
right before sleep
|
|
How to treat nocturnal myoclonus?
|
- Benzodiazapine: raises wakening threshold.
- Ropinorole (Requip): reduces twitches. |
|
What is this sleep disorder?
- sleep attacks - cataplexy - sleep paralysis - hypnogogic or hypnopompic hallucinations These are the diagnostic tetrad for the disease. |
narcolepsy
|
|
What is this called?
brief, almost imperceptible weakness of isolated muscle groups. This is a symptom of which disease? |
cataplexy, a symptom of narcolepsy.
|
|
The sleep attacks in people with narcolepsy are composed of what type of sleep? (hint: REM or NON-REM)
|
REM mostly
*may progress to full REM sleep |
|
What is this called?
inability to move during sleep onset or wakening.The person is wake, but cannot move. This is a symptom of what disease? |
Sleep paralysis: a symptom of narcolepsy.
|
|
In normal people, REM normally occurs within ___ minutes after falling asleep.
What about in narcoleptic people? |
60-90min for normal people
<10 min for narcoleptic people (decreased REM latency) |
|
In normal people, REM normally occurs within ___ minutes after falling asleep.
What about in narcoleptic people? |
60-90min for normal people
<10 min for narcoleptic people (decreased REM latency) |
|
What drugs treat narcolepsy?
|
agents that stimulate NE which suppresses REM:
- methylphenidate - amphetamine - pemoline * modafinil: reduce GABA release, alter DA transporter. |
|
What is the underlying cause of narcolepsy?
|
Lack of normal REM inhibition: alpha-adrenergic and serotonin inhibition on pontine reticular activating system.
|
|
What physical conditions will cause insomnia? (4)
|
- pain
- CV disorders: CHF, chronic obstructive pulmonary disease - GI disorders: reflux esophagitis - genitourinary: nocturia, UTI, prostatic hypertrophy |
|
Why do people with CHF more likely to have insomnia?
|
CHF -> pulmonary edema (worsened when lying down)
|
|
Sleep onset insomnia is characteristic of what syndrome?
|
anxiety: sleep architecture is preserved.
also seen in depression. |
|
What does this person has?
sleep onset insomnia early AM wakening midnight wakening |
major depression
|
|
For people under major depression, what is their sleep architecture?
|
shortened REM latency
|
|
Shortened REM latency is seen is which 2 conditions?
|
- narcolepsy
- major depression (still longer than narcolepsy) |
|
What is the mainstay treatment this?
self-contained depression reactive to stress sleep pattern resemble anxiety |
psychotherapy
|
|
What is the mainstay treatment for major depression?
|
antidepressants
no need for hypnotic adjunctive |
|
What is the effect of alcohol on sleep?
|
- reduce sleep latency
- supresses REM - interferes with slow-wave sleep |
|
Which substance cause the following?
- reduce sleep latency - supresses REM - interferes with slow-wave sleep |
alcohol
|
|
Which has more effect on REM and slow-wave sleep?
alcohol vs its metabolite (acetaldehyde) |
metabolite acetaldehyde
|
|
Compare the sleep architecture between alcohol intake and withdrawal.
|
alcohol:
- reduced REM - reduced NON-REM alcohol withdrawal: - increased REM - decreased NON-REM |
|
Some considerations when doing a sleep history.
|
- interview bed partner as well: movement, snoring
- ask about other physical conditions (eg CV, GI, GU) - ask about sleep habits, exercise, alcohol. - ROS to rule out psychiatric disorders |
|
What should you do if still unsure about a sleep disorder diagnosis after careful history, physical exam, and labs?
|
order polysomnography.
(need to confirm the condition before starting treatments) |
|
What should you tell patients when you can't find a specific etiology for insomnia?
|
- behavioral interventions: sleep habits, diet, caffeine, alcohol, exercise.
- relaxation techniques |
|
What is the effect of classic benzodiazepine on sleep?
|
supresses REM
- induce sleep: BZ1 - relieve anxiety: BZ2 - muscle relaxant: BZ3 can induce delirium and dependence |
|
Name 3 drugs that are specific for BZ1 receptors.
|
- zaleplon (sonata)
- zolpidem (ambien) - eszopiclone (lunesta) |
|
Is melatonin useful for treating insomnia?
|
depends (variable content and purity)
-improves sleep onset, duration and quality. - keep sleep architecture intact |
|
Which drug binds to MT1 and MT2 melatonine receptors in the suprachiasmatic nucleus of the hypothalamus?
|
Ramelteon (Rozerem): too new to evaluate vs melantonin,
|