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Neurology-Week 4 & 5 > 8. Sleep Disorders > Flashcards

8. Sleep Disorders Flashcards

1
Q

Daily rhythms in physiology and behavior that control the sleep-wake cycle; controlled by the Suprachiasmatic Nucleus of the Hypothalamus which receives info from the retina and secretes Melatonin

A

Circadian rhythms

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2
Q

Circadian rhythm is controlled by which Hypothalamic nucleus? and received direct input from _______

A 
Suprachiasmatic Nucleus (SCN)
retina
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3
Q

The Suprachiasmatic Nucleus of the Hypothalamus controls Circadian sleep with ___________ secreted by the __________ gland to control Circadian Rhythm

A

Melatonin; Pineal

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4
Q

Circadian rhythm is done through the nocturnal release of what chemicals?

A

Melatonin (pineal)
Prolactin
ACTH
Norepinephrine (SCN)

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5
Q

Damage to the Suprachiasmatic Nucleus will result in what?

A

Insomnia

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6
Q

(NREM/REM) sleep is the vast majority

A

NREM (Non-Rapid Eye Movement) (~80%)

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7
Q

What is the pattern of normal sleep from the beginning?

A

NREM (Stage 1–>2–>3–>4) then REM

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8
Q

Average length of first NREM-REM sleep cycle is _________________ minutes

A

70-100 minutes

*cycles last a little longer after that

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9
Q

(NREM/REM) sleep increases as the night goes on

A

REM

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10
Q

Patients with narcolepsy enter sleep in (NREM/REM)

A

REM

*normal is to start with NREM

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11
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen in a WAKEFUL states, eyes open and alert mental concentration

A

Beta (high frequency, low amplitude)

*remember BATS Drink Blood

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12
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen when you are awake with EYES CLOSED

A

Alpha

*remember BATS Drink Blood

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13
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen in NREM stage 1, which is LIGHT sleep

A

Theta

*remember BATS Drink Blood

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14
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen in NREM stage 2, which is moderate sleep

A

Sleep Spindles (and K complexes)

*remember BATS Drink Blood

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15
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen in NREM stage 3, which is DEEP sleep; can see sleepwalking, night terrors and bedwetting

A

Delta

*remember BATS Drink Blood

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16
Q

Which stage of sleep do you typically see Sleepwalking, Night Terrors or Bedwetting

A

NREM 3 (deepest sleep, Delta waves)

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17
Q

(Beta/Alpha/Theta/Sleep Spindles/Delta) waves are seen in REM sleep, loss of muscle tone and extra-ocular movements due to paramedian pontine reticular activity

A

Predominantly Beta

*remember BATS Drink Blood

**also saw in Wakeful State

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18
Q

Which STAGE of sleep do you see loss of muscle tone

A

REM

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19
Q

Test of sleep cycles and stages through the use of continuous recordings of brain waves, muscle tone, eye movements, etc.

A

Polysomnogram (Sleep Study)

20
Q

Examples of Sleep Disorders

A 
Insomnia
Sleep Apnea (Obstructive)
Narcolepsy
Restless Leg Syndrome
Parasomnias (Night Terrors, Sleep Walking, etc.)
21
Q

Sleep Disorder; difficulty getting to sleep or staying asleep or having non-refreshing sleep for at least 1 MONTH; can be due to stress, chronic pain, anxiety, mood disorders or caffeine

A

Insomnia

22
Q

Treatments for Insomnia

A

Behavioral (reduce anxiety, relax)
Sleep Hygiene (routines, strict bedtime, hot bath, etc.)
Pharmacology (as a last resort!)

23
Q

Sleep Disorder; produced by upper airway obstruction; demonstrate daytime somnolence, snoring, apnea and cognitive impairment; risk factors are age, obesity and alcohol; treat with CPAP and weight loss

A

Obstructive Sleep Apnea

24
Q

Treatments for Obstructive Sleep Apnea

A

CPAP

Weight Loss

25
Q

Sleep Disorder; caused by REM sleep occurring during wakefulness; characterized by Excessive Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations; sleep study shows REM at ONSET

A

Narcolepsy

26
Q

What are the 4 main features of Narcolepsy

A

Excess Sleepiness (a must!)
Cataplexy (sudden muscle weakness in the leg)
Sleep Paralysis (가위)
Hypnagogic Hallucinations

27
Q

Sleep Disorder; uncomfortable crawling sensations and urge to move legs; associated with IRON DEFICIENCY ANEMIA; treat with Dopamine Agonists

A

Restless Legs Syndrome (RLS)

28
Q

Tests/Treatments for Restless Legs Syndrome

A

Check Ferritin (due to Iron Deficiency Anemia)
Replace Iron
DOPAMINE Agonists

29
Q

Sleep Disorder; loss of normal skeletal muscle atonia during REM sleep; end up “acting out dreams” like a dog chasing a squirrel

A

REM Sleep Behavior Disorder

30
Q

Sleep Disorder; sudden unexplained bouts of terror/fear during Stage 3 or 4 sleep; common in CHILDREN; last about 10 minutes

A

Night Terrors

31
Q

Sleep Disorder; wandering around in your sleep; common, especially in children; no memory of it; very difficult to arouse

A

Sleep Walking

32
Q

Sleep Disorder; grinding of teeth during sleep; common; occurs in both children and adults

A

Bruxism

33
Q

Examples of Hypnotic Drugs

A 
Benzodiazepines (-pam/lam)
Non-Benzodiazepines ("Z" drugs: Zolpidem, Zaleplon, EsZopiclone)
Melatonin Agonists (Ramelteon)
Orexin Antagonists (Suvorexant)
Antidepressants (TCAs, Mirtazepine)

Older Hypnotics: Diphenhydramine, Trazodone

34
Q

Examples of Non-Benzodiazepine Hypnotics

A

Zolpidem
Zaleplon
EsZopiclone (Zopiclone)

35
Q

Examples of Short-Acting Benzodiazepines

A

Alprazolam
Triazolam
Oxazepam
Midazolam

(ATOM)

36
Q

Uses of Benzodiazepines

A 
Anxiety
Spasticity
Status Epilepticus
Detox (Alcohol Withdrawal)
Night Terrors
Sleep Walking
Anesthesia
37
Q

Antidote for Benzodiazepines

A

Flumazenil (Romazicon)

38
Q

Benzodiazepine receptor agonists that bind to GABA receptor sub-type (BZ1) that specifically modulate sleep; metabolized by liver RAPIDLY, so short acting

A

Non-Benzodiazepine Hypnotics (Zolpidem and Zaleplon)

39
Q

What are some drug interactions of Non-Benzodiazepine Hypnotics

A

P450 inducer/inhibitor
- Inducer: increase metabolism
- Inhibitor: decrease metabolism
Antiviral Protease inhibitor (Hep C and HIV treatment)

40
Q

Drug that activates melatonin receptors in Suprachiasmatic nuclei of Hypothalamus; decreases the latency of sleep onset; side effects are dizziness, fatigue, allergic reactions, endocrine changes (dec. testosterone, inc. prolactin)

A

Ramelteon

  • only FDA approved drug for insomnia b/c it hasn’t been associated with abuse and withdrawal.
41
Q

Side effects of Ramelteon

A 
Dizzy
Fatigue
Nausea
Headache
Allergic reaction
Endocrine (dec. testosterone, inc. prolactin)
42
Q

Ramelteon is metabolized by…

A

CYP450

43
Q

Orexin receptor antagonist approved for insomnia; CONTRAINDICATED for Narcolepsy, Liver disease and CYP3A4 inhibitors (Macrolides and Azoles)

A

Suvorexant

44
Q

Contraindications for Suvorexant (Orexin receptor antagonist)

A

Narcolepsy
Liver Disease
CYP3A4 inhibitors (Macrolides, Azoles, etc.)

45
Q

Non-benzodiazepines should NOT be co-administered with what drugs?

A

Protease Inhibitors

46
Q

Side effects of Non-Benzodiazepines

A

Ataxia
Sedation/confusion
Rebound insomnia
Withdrawal/addiction

47
Q

Side effects of Ramelteon

A

endocrine changes (reduced testosterone, increased prolactin)

Neurology-Week 4 & 5 (14 decks)

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