Imported: Neuro Test 2: Clawges_Sleep

Front 1

what stage of sleep is light sleep with slow irreguglar brain waves, you have occasional twitching

Back 1

Stage 1

Front 2

what stage of sleep is described by

Still easy to awaken – may require shaking

Sleep Spindles: 25 sec bursts of 12-14 cps waves

K complexes: 2 sec rise & fall

Largest percentage of total sleep time (45-55%)

Slight decrease in body temperature

Back 2

sleep stage 2

Front 3

this is the stage where sleep walking, eating, and night terrors occur

Back 3

3/4

Front 4

what stage of sleep is restorative sleep?

Back 4

3/4

Front 5

“Active” or “paradoxical” sleep

Associated with dreaming ?

Back 5

REM

Makes up 20 – 25% of total sleep time

Absence of skeletal muscle movement (EMG = silent)

Rapid eye movements occur

Pulse, respiration, BP increased but less regular

Nightmares and REM Sleep Behavior Disorder may occur

Front 6

difference in sleep for old ppl

Back 6

less delta sleep
less REM
more awakenings

Front 7

which occurs earlier in sleep, delta or REM?

Back 7

delta

Front 8

ID: 65 year old female
CC: difficulty falling asleep
HPI:
Problem for 10-15 years
Goes to bed at 9pm, reads or watches TV for 1 hour, does not fall asleep until midnight, wakes 4-5 times, gets up at 5am
Has some excessive daytime sleepiness
Has tried numerous sleep aids
PMH: hypertension, coronary artery disease, asthma and depression
Medications: metoprolol, aspirin, albuterol, singulair and prozac
PE: anxious appearing female otherwise unremarkable

pt has?

Back 8

Insomnia

A repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment

Front 9

A repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment

Back 9

insomnia

Front 10

treatment success = in insomnia?

Back 10

*treatment success = improved sleep latency by 30 minutes (patient needs to have realistic expectations)
** treatment is chronic, often symptoms wax and wane

Front 11

which is better for tx of insomnia, drugs or Cognitive behavioral therapy

Back 11

Cognitive behavioral therapy

Front 12

ID: 54 year old male
CC: snoring and witnessed apnea
HPI:
Snoring for 10-15 years
Wife will not sleep in same room
Excessive daytime sleepiness, occasionally falls asleep at the wheel
PMH: atrial fibrillation (failed cardioversion), hypertension
Medications: coumadin, metoprolol, aspirin
FH: +CAD, +CVA
PE: BMI-35 obese B/P – 145/90
Heart – irregularly, irregular

pt has?

Back 12

Obstructive Sleep Apnea

Disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns

Front 13

Disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns

Back 13

Obstructive Sleep Apnea

pt is still trying to breathe but cant

Front 14

Excessive daytime sleepiness
Difficulty concentrating
bed wetting
ADHD

associated with?

Back 14

Obstructive Sleep Apnea in kids

Front 15

Obstructive Sleep Apnea has higher incidence of...

Back 15

death

MI

stroke

aka its real bad

Front 16

tx for Obstructive Sleep Apnea

Back 16

Positive pressure ventilation (CPAP or BiPAP)
Oral appliances
Weight reduction (10%)

Front 17

what is a curative tx of Obstructive Sleep Apnea for kids?

Back 17

Surgery (Tonsillectomy and adenoidectomy in children)

Front 18

ID: 18 year old male
HPI:
2 year history of excessive daytime sleepiness, causing problems staying awake at school
Reports feeling weak in the knees whenever he laughs or is embarrassed, but has never actually fallen
Reports rare episodes when he can’t move for a few minutes when he wakes up in the morning

Back 18

narcolepsy

Front 19

excessive daytime sleepiness=??

Back 19

Narcolepsy

Sleepiness not relieved by adequate sleep
Usually most bothersome symptom
Disturbed Nocturnal Sleep
Fragmented sleep
Frequent unexplained arousals

Front 20

Sleep Paralysis
Hypnogogic Hallucinations
and Cataplexy are seen in?

Back 20

Narcolepsy

Cataplexy (inappropriate intrusion of REM sleep physiology into wakefulness)
Sudden loss of postural tone brought on by emotion, especially laughter (legs, knees, jaw, slurred speech)
If present, essentially diagnostic for narcolepsy
Seen in 60 – 80% of patients and may be very subtle

Front 21

Pathophysiology of narcolepsy?

Back 21

Lack of hypocretin neurons of the lateral hypothalamus
Low CSF hypocretin levels

Front 22

tx for Cataplexy in Narcolepsy?

Back 22

Sodium Oxybate (aka GHB

Front 23

56 yr old 72”, 200 lb male
Chief complaint: Snoring and restless sleep (wife complains she can’t sleep with him)
Sleeps 7-8 hours per night
Complains of excessive daytime sleepiness and some difficulty at work

Back 23

Restless Leg Syndrome (RLS):
Clinical diagnosis made primarily on subjective report of the patient

note: Periodic Limb Movements (PLMs):
An objective polysomnographic finding

Front 24

4 sx of RLS?

Back 24

RLS – Core Symptoms…”URGE”
Urge to move limbs accompanied by an uncomfortable, unpleasant feeling in the limbs
Rest or inactivity precipitates symptoms
Getting up and moving improves symptoms
Evening or nighttime is associated with worsening of symptoms (circadian fluctuation)

Front 25

common finding in RLS?

Back 25

iron deficiency

Front 26

Pharmacologic Management of PLM

Back 26

Dopamine agonists
Ropinirole (Requip)
Pramipexole (Mirapex)
Levodopa
Clonazepam
Clonidine (children)

Front 27

ID: 4 yo M
HPI:
Past 1 month waking up screaming, kicking
Agitated, unconsolable
Events occur between 10:30 and midnight
Goes to bed at 9:00pm, wakes at 7:00am
Occasional naps
FH: dad OSA
PMH, ROS, PE: unremarkable

pt has? tx?

Back 27

sleep terrors

Reassurance, usually no treatment necessary
Environment may need to be secured

Front 28

Episodic physiologic and behavioral, usually undesirable behaviors that involve autonomic or skeletal muscle disturbances, and/or disorientation
Occur exclusively during or exacerbated by sleep=

Back 28

Parasomnias

Front 29

mom comes in and said before going to bed her kid bangs his head on the crib...she asks you what to do...

Back 29

this is a normal parasomnia

Front 30

Inability to fall asleep or remain asleep
Most common sleep disorder (10-15%)
Hyperarousal and conditioned sleep disturbance
Treatment: identify cause or confounding factors, cognitive behavioral therapy……. pharmacologic therapy
*treatment is difficult and chronic

***

Back 30

Insomnia

Front 31

18 million Americans have it
Symptoms: excessive daytime sleepiness, snoring, memory impairments…
Complications: hypertension, arrythmias, congestive heart failure, pulmonary hypertension, stroke, death…
Treatment: positive pressure ventilation, oral devices, surgery

Back 31

Obstructive Sleep Apnea

Front 32

a child who snores......

Back 32

should be evaluated for obstructive sleep apnea

snoring in kids is never normal

Front 33

Excessive daytime sleepiness, cataplexy, hypnogogic hallucinations, sleep paralysis…AND disrupted sleep
Diagnostic testing: ANP and MSLT
Shortened REM latency, short mean sleep latency, sleep onset REM episodes
Treatment
EDS: Stimulants, Modafinil
Cataplexy: TCA, SSRI, Sodium Oxybate

Back 33

Narcolepsy

Front 34

which is subjective/objective considering RLS and PLM

Back 34

RLS – subjective, PLM – objective

Front 35

tx for RLS and PLM

Back 35

RLS – dopamine agonist
PLM – dopamine agonist, clonazepam, clonidine

Front 36

Most episodic, stereotyped behaviors at night are benign
Take a good history, sleep diary or home videotaping
Rule out concomittant primary sleep disorders (OSA, RLS/PLMS)
Consider PSG or nocturnal video EEG for unusual presentation

Back 36

Parasomnias