032615 sleep

Question 1

normal sleep-primary neurotransmitters?

Answer 1

REM: Ach, NE
NREM: serotonin

Question 2

sleep efficiency

Answer 2

time sleeping/time spent trying to sleep

in normal individuals, is 100%

Question 3

what stage of sleep makes of 45% of the sleep?

Answer 3

stage 2

Question 4

most deep sleep occurs

Answer 4

first half of night

Question 5

what waves are slow and large

Answer 5

delta (stage 3, 4)

Question 6

aging’s effects on sleep

Answer 6

decreased REM
decreased stage 3, 4

increased night time awakenings-decreased sleep efficiency

Question 7

depression’s effects on sleep

Answer 7

frequent awakenings
early morning awakening
decreased REM latency (first REM in 45 minutes)
INCREASED total REM
decreased stage 3, 4 sleep

Question 8

dyssomnias

Answer 8

abnormal timing, quality, and amount of sleep

Question 9

parasomnias

Answer 9

abnormal behaviors assoc w sleep (bruxism in stage 2, night terror, sleepwalking, REM sleep behavior disorder)

Question 10

dyssomnias-list them

Answer 10

timing: narcolepsy, circadian rhythm sleep disorder
quality: restless legs, sleep apnea
amount: insomnia, hypersomnia

Question 11

narcolepsy

Answer 11

sleep attacks (a lot of REM sleep)

hypnogogic/hypnopompic hallucinations

cataplexy (sudden loss of muscle tone)

sleep paralysis (when falling asleep or waking up)

decreased REM latency (less than 10 min), less REM overall

Question 12

neurobiologic factors in narcolepsy

Answer 12

hypocretin (orexin) deficiency association

Question 13

tx for narcolepsy

Answer 13

scheduled daytime naps

psychostimulants (methylphenidate, modafinil)

Question 14

circadian rhythm sleep disorder

Answer 14

inability to sleep at appropriate or desired times

two types: delayed or advanced

causes: intrinsic and extrinsic. extrinsic would be things like shift work, jet lag

Question 15

tx for circadian rhytm sleep disorder

Answer 15

for delayed: melatonin, light at desired waking time

for advanced: light in the evening

for shift work: modafinil or caffeine for alertness, melatonin or hypnotic at bedtime

Question 16

restless legs syndrome

Answer 16

uncomfortable sensation in legs causing jerking and frequent night time awakenings

Question 17

epidemiologic factors for restless legs syndrome

Answer 17

usually older adults. Parkinson’s, CKD, pregnant

Question 18

tx for restless legs syndrome

Answer 18

antiparkinsonian agents (levodopa, carbidopa/levodopa, ropinirole)

Question 19

insomnia

Answer 19

3x/wk or more
duration of at least 1 month
daytime sleepiness

Question 20

tx for insomnia

Answer 20

avoid caffeine
AM exericse
develop sleep routine
relaxation techniques
hypnotic medication (benzodiazepines-may however decrease REM and delta sleep)

Question 21

REM sleep behavior-eyes open or closed?

Answer 21

closed

Question 22

REM sleep behavior disorder is assoc w

Answer 22

Parkinson dis and Lewy body dementia

Question 23

tx for REM sleep behavior disorder

Answer 23

making environment safe

melatonin or low dose benzodiazepines