12 sleep med

Question 1

why take a sleep history

Answer 1

sleep disorders are: common, serious, treatable and underdiagnosed

Question 2

sleep history: BEARS stands for?

Answer 2

bedtime, excessive daytime sleepiness, awakenings, regularity/duration of sleep, snoring

Question 3

3 things leading to excessive daytime somnolence (EDS)

Answer 3

sleep deprivation. sleep disruption (fragmented sleep). primary disorders of sleep.

Question 4

EDS leads to? (aka what clinical impacts)

Answer 4

neurobehavioural deficits = performance deficits, decreased quality of life, increased morbidity and mortality

Question 5

4 levels of EDS

Answer 5

mild: falls asleep in quiet environments. moderate: social settings. severe: public settings, work. most severe: dangerous environments, red lights, etc.

Question 6

diagnose sleep disorders with what?

Answer 6

polysomnography: an overnight sleep study. will record sleep stage, breathing, oxygen, heart rate, leg movements, ECG, and video

Question 7

etiology of excessive daytime somnolence (sleepiness): 5?

Answer 7

drugs. respiratory induced (snoring, sleep apnea, upper airway resistance syndrome, periodic breathing). periodic leg mvts. narcolepsy. idiopathic hypersomnolence.

Question 8

hypopnea? apena?

Answer 8

when ventilation decreases ~50%, then starts again (Vs. apnea = complete cessation of breathing)

Question 9

upper airway resistance syndrome

Answer 9

lying down = collapses airways a bit = higher resistance = higher amount of work needed to maintain airflow = jars them to lower level of sleep.

Question 10

obstructive apnea: def

Answer 10

complete blockage of airway despite efforts to breathe (thoracic effort still there, but air flow decreases)

Question 11

normal # obstructions per hour

Answer 11

fewer than 5 apneas and hypopneas per hour

Question 12

cause of sleep apnea

Answer 12

imbalance in pressures keeping airway open so pharynx collapses with breath

Question 13

what makes sleep apnea more likely

Answer 13

anything which narrows airway, or anything which causes loss muscle tone

Question 14

anatomical causes of sleep apnea

Answer 14

abnormal anatomy of head/neck. retrognathia. obesity. family history. ethnicity.

Question 15

symptoms of sleep apnea

Answer 15

daytime sleepiness. waking at night choking. intellectual impairment. increased irritability. sexual impairment. mood changes: aggressive, irritable, bursts of anxiety, depression

Question 16

heart complications of sleep apnea

Answer 16

increased risk of hypertension, MI, stroke –> excess mortality is due to cardiovascular causes

Question 17

treatment: reversible risks for sleep apnea

Answer 17

excess alcohol consumption. smoking. medications. obesity

Question 18

treatments for obstructive sleep apnea

Answer 18

nasal CPAP = gold standard. can also have:dental applicances, surgery

Question 19

central apnea definition

Answer 19

complete cessation of airflow resulting from a reduction in respiratory effort –> upper airway patent, but resp. center temporarily fails to trigger

Question 20

central sleep apnea treatment

Answer 20

identify and treat reversible risk factors. biPAP with back up rate

Question 21

PLMS definition? stands for? diagnosed by?

Answer 21

periodic leg movements: repetitive stereotypic uncontrollable mvts of lower limbs; diagnosed with polysomnography EMG