032615 sleep Flashcards
normal sleep-primary neurotransmitters?
REM: Ach, NE
NREM: serotonin
sleep efficiency
time sleeping/time spent trying to sleep
in normal individuals, is 100%
what stage of sleep makes of 45% of the sleep?
stage 2
most deep sleep occurs
first half of night
what waves are slow and large
delta (stage 3, 4)
aging’s effects on sleep
decreased REM
decreased stage 3, 4
increased night time awakenings-decreased sleep efficiency
depression’s effects on sleep
frequent awakenings early morning awakening decreased REM latency (first REM in 45 minutes) INCREASED total REM decreased stage 3, 4 sleep
dyssomnias
abnormal timing, quality, and amount of sleep
parasomnias
abnormal behaviors assoc w sleep (bruxism in stage 2, night terror, sleepwalking, REM sleep behavior disorder)
dyssomnias-list them
timing: narcolepsy, circadian rhythm sleep disorder
quality: restless legs, sleep apnea
amount: insomnia, hypersomnia
narcolepsy
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
neurobiologic factors in narcolepsy
hypocretin (orexin) deficiency association
tx for narcolepsy
scheduled daytime naps
psychostimulants (methylphenidate, modafinil)
circadian rhythm sleep disorder
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
tx for circadian rhytm sleep disorder
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
restless legs syndrome
uncomfortable sensation in legs causing jerking and frequent night time awakenings
epidemiologic factors for restless legs syndrome
usually older adults. Parkinson’s, CKD, pregnant
tx for restless legs syndrome
antiparkinsonian agents (levodopa, carbidopa/levodopa, ropinirole)
insomnia
3x/wk or more
duration of at least 1 month
daytime sleepiness
tx for insomnia
avoid caffeine AM exericse develop sleep routine relaxation techniques hypnotic medication (benzodiazepines-may however decrease REM and delta sleep)
REM sleep behavior-eyes open or closed?
closed
REM sleep behavior disorder is assoc w
Parkinson dis and Lewy body dementia
tx for REM sleep behavior disorder
making environment safe
melatonin or low dose benzodiazepines
