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20. Sleep-Wake Disorders > Brian Chow Sleep Powerpoint > Flashcards

Brian Chow Sleep Powerpoint Flashcards

1
Q

what % of total nighttime sleep is NREM

A

75%

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2
Q

what % of total sleep is REM

A

25%

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3
Q

when does slow wave sleep/N3 occur in the night

A

in first half of the sleep period

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4
Q

when does REM occur

A

more frequently during last THIRD of the sleep period

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5
Q

what is another term for N3 sleep

A

slow wave sleep

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6
Q

what does sleep architecture look like on a sleep histogram

A
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7
Q

what % of sleep is stage 2 sleep

A

50%

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8
Q

how many types of NREM sleep are there

A

W, N1, N2 and N3/SWS

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9
Q

what % of sleep is N3/SWS

A

20%

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10
Q

what % of sleep is N1

A

5%

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11
Q

list the 8 elements included in polysomnography

A

EEG–> brainwaves (central and occipital leads)

EOG–> eye movements

EMG–> muscle tone (chin and legs)

ECG–> heart

breathing–> airflow (nose/mouth) and effort (thoracic, abdo)

SaO2

snore microphone

digital AV recording

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12
Q

how do you conduct a multiple sleep latency test

A

do this after PSG

4-5 x 20 min naps at 2 hour intervals

check for average sleep onset latency

sleep onset REM periods

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13
Q

what is considered “pathological sleepiness” on a MSLT

A

fall asleep in 8 min or less and 2 or more SOREMPs (sleep onset REM periods)

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14
Q

what is the state of physiological arousal during NREM sleep

A

HYPOarousal –> low HR, low BP, low resting muscle tone

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15
Q

what is N1 sleep

A

light sleep–> slow rolling eye movements (hypnic jerks)

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16
Q

what stage of sleep is the most physically restorative

A

N3 (SWS)

physically restorative, consolidates declarative memory

are most difficult to rouse in this state

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17
Q

what happens to N3 sleep as we age

A

decreases

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18
Q

what waves are seen in EEG in the following phase? what frequency are these waves?

Awake

A

BETA waves

13-30 Hz

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19
Q

what waves are seen in EEG in the following phase? what frequency are these waves?

Drowsy

A

ALPHA waves

8-12 Hx

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20
Q

what waves are seen in EEG in the following phase? what frequency are these waves?

N1 sleep

A

THETA waves

3-7 Hz

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21
Q

what waves are seen in EEG in the following phase? what frequency are these waves?

N2 sleep

A

SLEEP SPINDLES and K COMPLEXES

12-14 Hz

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22
Q

what waves are seen in EEG in the following phase? what frequency are these waves?

N3 sleep

A

DELTA waves

0.5-2 Hz

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23
Q

which stage of sleep shows the slowest frequency waves on EEG

A

N3/SWS

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24
Q

which stage of sleep (NOT awake) shows the highest frequency waves on EEG

A

N2

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25
Q

which stage of sleep is associated with sleep spindels and K complexes

A

N2

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26
Q

with is a mnemonic to remember EEG waveform in various stages of sleep

A

BATS eat KD

beta, alpha, theta, sleep spindles and k complexes, delta

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27
Q

what type of waves are seen on EEG in REM sleep

A

SAWTOOTH waves

theta

slow alpha

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28
Q

why is REM called “paradoxical sleep”

A

because looks like awake on EEG

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29
Q

in what stage of sleep do you dream

A

REM

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30
Q

what is the physiological state of the body in REM sleep

A

HYPERarousal of autonomic state

HR, BP, RR show increased variability, can be irregular

brain–> increased glucose metabolism, blood flow, cerebral temp

poikilothermic condition prevails

penile erection

skeletal muscles are in NEAR TOTAL PARALYSIS

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31
Q

when do you have your first REM cycle

A

90 minutes after falling asleep

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32
Q

how long is your first REM cycle compared to later cycles

A

first is short (under 10 min) then later ones are longer (15-45 min)

have REM cycles every 90-100 minutes

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33
Q

in what stage of sleep are skeletal muscles in a state of near total paralysis

A

REM

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34
Q

what do the various brain waves look like in different stages of sleep (image)

A
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35
Q

in what stage of sleep do you see slow, rolling eye movements

A

N1

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36
Q

in what stage of sleep are there no eye movements

A

N2, N3

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37
Q

in what stage of sleep are there bursts of eye movements

A

REM

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38
Q

what brain areas are related to NREM sleep

A

anterior hypothalamus

thalamus

basal forebrain

nucleus tractus solitarius (medulla)

dorsal raphe nucleus (midbrain)

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39
Q

what brain areas are related to REM sleep

A

PONTINE RETICULAR FORMATION

midbrain

medulla

hypothalamus

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40
Q

what brain area controls the ONSET of sleep

A

hypothalamis

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41
Q

what brain area helps initiate REM sleep

A

pons

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42
Q

what brain area regulates the transition between sleep and wakefulness

A

reticular formation

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43
Q

what brain area is active during dreaming

A

hippocampus and amygdala

hippocampus=memory
amygdala=emotion

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44
Q

what brain area prevents sensory signals from reaching the cortex during sleep

A

thalamus

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45
Q

what neurotransmitter is associated with the pons

A

acetylcholine

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46
Q

what neurotransmitter is associated with the raphe nucleus

A

serotonin

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47
Q

what neurotransmitter is associated with the locus ceruleus

A

norepinephrine

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48
Q

where is orexin released from

A

hypothalamus

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49
Q

where does orexin act

A

locus ceruleus–> wakefulnes pathway

raphe nuclei–> wakefulness pathway

ventral tegmental area–> reward pathway

nucleus accumbens –> reward pathway

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50
Q

what are the two primary factors that control the physiological need for sleep

A

homeostasis –> PROCESS S

circadian rhythm–> PROCESS C

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51
Q

what is process S

A

“sleep drive”

homeostatic control of physiological need for sleep

tendency to sleep increases the further from last sleep you are

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52
Q

what is process C

A

controlled by “biological clock”–> the circadian rhythm

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53
Q

what brain area controls the circadian rhythm

A

SUPRACHIASMATIC NUCLEUS in the anterior hypothalamus

receives PHOTIC and NON-PHOTIC inputs

synchronizes circadian rhythm to environmental cues

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54
Q

list the WAKE promoting neurotransmitters

A

norepinephrine

dopamine

orexin (hypocretin)

histamine

glutamate

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55
Q

list the SLEEP promoting neurotransmitters

A

acetylcholine–> REM

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56
Q

which neurotransmitter is both awake and sleep promoting

A

serotonin

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57
Q

what does the suprachiasmatic nucleus do

A

regulates the timing of nocturnal melatonin secretion from the pineal gland via the superior cervical ganglion

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58
Q

how does exposure to light during the biological night affect melatonin production

A

exposure to light SUPPRESSES melatonin production

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59
Q

when do melatonin levels peak

A

middle of the night–> decline to low daytime amounts

starts being produced in the evening

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60
Q

what produces melatonin

A

pineal gland

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61
Q

how does total sleep change across the lifespan

A

decreases

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62
Q

how does REM sleep change across the lifespan

A

wayyyy more in kids up until about age 2-4, then steadily decreases into old age

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63
Q

how does NREM sleep amount change over the lifespan

A

decreases (not as dramatically as REM)

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64
Q

does NEED for sleep change over the lifespan

A

no–> need for sleep stays the same

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65
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

REM sleep

A

declines after age 65

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66
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

sleep fragmentation

A

increases

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67
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

total sleep time

A

decreases

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68
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

ability to sleep

A

decreases

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69
Q

how does the following sleep parameter change as someone ages:

natural circadian rhythm

A

phase ADVANCE (earlier to sleep and wake)

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70
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

sleep efficiency

A

decreased

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71
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

SWS

A

decreased

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72
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

sleep latency

A

increased

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73
Q

how does the following sleep parameter change (increased or decreased) as someone ages:

total sleep time

A

decreased

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74
Q

how much sleep is recommended for a newborn

A

14-17 hours

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75
Q

how much sleep is recommended for a school age child

A

9-11 hours

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76
Q

how much sleep is recommended for a teen

A

8-10 hours

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77
Q

how much sleep is recommended for adults

A

7-9 hours

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78
Q

how much sleep is recommended for an odler adult

A

7-8 hours

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79
Q

what factors, and their related etiologies, can result in excessive daytime sleepiness

A
  1. lack of sleep (inadequate quantity)
    –> insufficient time in bed
  2. inadequate quality of sleep
    –> sleep apnea, PLMS, environment
  3. intrinsic sleepiness
    –> narcolepsy, idiopathic hypersomnia
  4. medical/psych disorder
    –> mood disorder, medical, meds
  5. circadian rhythm disturbance
    –> shift work, delayed sleep phase etc
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80
Q

what factors, and their related etiologies, can result in nocturnal spells

A
  1. NREM sleep arousal disorder (parasomnia)
    –> night terror type, sleep walking type
  2. REM sleep arousal disorder (parasomnia)
    –> nightmares, REM sleep behaviour disorder
  3. seizure disorder
  4. psychiatric
    –> panic attacks etc
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81
Q

how is cortisol release affected by insomnia

A

increased HPA activity with insomnia–> cortisol–> this normalizes with treatment of insomnia

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82
Q

why should you avoid excessive time in bed

A

can lead to sleep fragmentation

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83
Q

why should you not have a clock in your bedroom

A

watching clock leads to worry, rumination

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84
Q

why should you avoid caffeine, alcohol, nicotine

A

all can impact sleep and activate RLS

alcohol can worsen OSA

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85
Q

why should you reduce HS fluid intake

A

reduces nightime awakenings related to full bladder

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86
Q

why should you eat a light bedtime snack

A

promotes sleep by reducing hypoglycemia

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87
Q

list 7 strategies that fall under “sleep hygiene”

A

limit time in bed

regular sleep schedule–> esp. awakening time

no clock in bedroom

avoid caffeine, nicotine, alcohol

eat light bedtime snack

reduce HS fluid intake

dont try to fall asleep, or take worries to bed

88
Q

why does having a regular sleep schedule help with sleep

A

strengthens homeostatic process and circadian synchrony

89
Q

what is the goal of stimulus control in the treatment of insomnia

A

aim to re-associate sleep stimuli with falling asleep

90
Q

what are elements of stimulus control in the treatment of insomnia

A

only go to bed when SLEEPY

only use BEDROOM for SLEEP

if unable to sleep, GET OUT OF BED

arise at SAME TIME every morning

DO NOT NAP during the day

91
Q

why does sleep restriction work for insomnia

A

limits time in bed to ACTUAL sleep time

creates mild sleep deprivation and results in more consolidated and efficient sleep

92
Q

how does sleep restriction work/how do you do it

A

maintain sleep log–> determine average total sleep time

decrease allowable time in bed to usual sleep time (NOT less than 5 hours)

change time in bed by 15 min increments weekly–> if sleep efficiency is above 85%, then increase by 15 min. If sleep efficiency below 85%, decrease by 15 min

wake time is kept constant and bedtimes are adjusted

93
Q

what is the goal of CBT for insomnia

A

change the underlying beliefs that perpetuate insomnia that maintain maladaptive sleep behaviours

94
Q

what are 6 basic cognitive strategies for insomnia

A

keep realistic expectations

do not blame insomnia for all impairments

do not give too much importance to sleep

do not catastrophize after a poor nights sleep

never TRY to fall asleep

develop tolerance to the effects of insomnia

95
Q

list 3 first line NON pharmacological interventions for insomnia

A

sleep hygiene education

stimulus control therapy

sleep restriction therapy

96
Q

list 2 second line NON pharmacological interventions for insomnia

A

cognitive training

relaxation training

97
Q

when is pharmacological treatment appropriate for insomnia

A

SHORT term and TRANSIENT insomnia

NOT indicated for chronic insomnia

98
Q

what are the prescribing principles when Rx for insomnia

A

lowest effective dose

intermittent dosing (2-4x per week)

short term prescribing (less than 4 weeks)

gradual discontinuation (reduce rebound insomnia)

meds with shorter half life–> minimize daytime sedation

99
Q

how do you assess for hypersomnolence disorder

A

PSG–> rule out BRSD, PLMD, narcolepsy

use the epworth sleepiness scale

MSLT

100
Q

what is the gold standard for testing daytime sleepiness

A

MSLT

101
Q

what score on the epworth sleepiness test suggests hypersomnolence disorder

A

men are above 11

female are above 9

102
Q

how do you treat hypersomnolence disorder

A

stimulants

modafinil–> less potential for abuse, no peripheral sympathomimetic action

ritalin, dexedrin–> abuse potential, can cause irritability, headaches, insomnia, excessive sweating

103
Q

how many hours in bed is characteristic of someone with kleine-levin syndrome

A

18-20 hours in bed or asleep

104
Q

list the characteristic features of kleine-levin syndrome

A

recurrent periods of SLEEPINESS

disinhibition

derealization

indiscriminate HYPERSEXUALITY

compulsive OVEREATING, acute weight gain

non specific neuro findings–> decreased deep tendon reflexes, nystagmus, dysarthria

105
Q

is there any familial aggregation in kleine-levin syndrome

A

no

106
Q

what is the course of kleine-levin syndrome

A

may continue with periodic course of decades

often resolves with middle age

107
Q

are more men or women affected by kleine-levin syndrome

A

more men (3x)

108
Q

what does the epworth sleepiness scale ask

A

how likely someone is to fall asleep doing various activities

109
Q

what is the narcolepsy “pentad” (5 features)

A
  1. excessive daytime SLEEPINESS
    –> may fall asleep without warning, in unusual situations
  2. cataplexy
  3. hypnagogic/pompic hallucinations
  4. sleep paralysis
  5. disturbed nocturnal sleep
110
Q

what % of those with narcolepsy have cataplexy

A

75%

111
Q

what % of those with narcolepsy have hypnagogic/pompinc hallucinations

A

50-66%

112
Q

what % of those with narcolepsy will have sleep paralysis

A

50-66%

113
Q

list 3 non pharmacologic interventions for narcolepsy

A

scheduled napping

lifestyle adjustment

psychological counselling

114
Q

what pharmacologic intervention can you use for the daytime sleepiness associated wtih narcolepsy

A

modafinil (could also consider ritalin or dexedrine)

115
Q

what pharmacologic intervention can you use for the cataplexy associated wtih narcolepsy

A

sodium oxybate/GHB (also improved daytime sleepiness)

SSRIs, TCAs–> try SSRIs first before above as its safer

116
Q

why might you use SSRIs to treat narcolepsy

A

are REM suppresants–> helps with sleep paralysis, hypnagogic/pompic hallucinations, cataplexy

117
Q

list 4 physical exam findings common in OSA

A

often overweight

increased neck size

if normal weight, often have a structural abnormality like adenotonsillar enlargement

nasal airway obstruction even when awake (noisy breather)

118
Q

are those with central sleep apnea likely to be overweight

A

less likely to be overweight

119
Q

what are two sequelae of breathing related sleep disorders

A

HTN

can develop right heart failure/cor pulmonale

120
Q

how do you assess breathing related sleep disorders

A

overnight PSG

121
Q

how do you manage OSA

A

weight loss

avoid sleeping on back

tennis balls

nasal CPAP

nasal surgery

uvuloplasty

oral devices

122
Q

what should you avoid in OSA

A

use of sedative meds and alcohol as can exacerbate OSA

123
Q

what population is more likely to have non-24 hour circadian rhythm disorder

A

blind people

124
Q

what population is more likely to have irregular sleep wake disorder

A

institutionalized or demented patients

125
Q

what is the clinical presentation of irregular sleep wake disorder

A

chronic insomnia and excessive sleepiness and disorganzied sleep rhythm with 3+ sleep bouts in a 24 hour period–> total sleep time NORMAL for age

126
Q

management of delayed sleep phase disorder

A

chronotherapy

melatonin in early evening (5-6 hours before sleep)

bright light in the MORNING

127
Q

management of advanced sleep phase disorder

A

bright light in EARLY EVENING

128
Q

management of non-24 hour sleep wake disorder

A

sleep wake scheduling

melatonin at bedtime

129
Q

management of irregular sleep phase disorder

A

sleep wake scheduling

bright light exposure during the day and bright light therapy in the morning

130
Q

what is the primary management of NREM sleep arousal disorders

A

educating and reassuring patients

maintain safety and avoid precipitates

131
Q

when might you consider meds for NREM sleep disorders and what meds would you consider

A

in difficult cases

antidepressants–> SSRIs, TCAs

benzos–> historically, but now would avoid as can worsen symptoms (per brian chow sleep powerpoint)

132
Q

what do you do to treat PTSD assoc nightmares

A

prazosin

can also do non pharm–> IRT, ERRT, EMDR, hypnosis

133
Q

what types of psychotherapy might help in nightmare disorder

A

conflict resolution

image rehearsal therapy

progressive deep muscle relaxation

systematic desensitization

134
Q

what is primary treatment for nightmare disorder

A

primarily nonpharm–> reassurance and psychotherapy

135
Q

what meds can be used in nightmare disorder

A

in severe cases can use REM suppressant like SSRIs

136
Q

how do you manage REM sleep behaviour disorder

A
  1. ensure safety of patient and partner–> address sleep environment
  2. CT/MRI head–> rule out lesions
  3. PSG–> rule out sleep disordered breathing, confirm REM without atonia
  4. pharmacological–> clonazepam, melatonin, dopamine agonists
137
Q

what is the most commonly used pharmacological treatment for REM sleep behaviour disorder

A

clonazepam 0.5-2mg

BUT we recently read updated guidelines that said melatonin high dose (like up to 12mg) is as good if not better than clonazepam so would likely start with that

138
Q

what 3 types of medication can be used to treat REM slepe behaviour disorder

A

clonazepam (increases threshhold for arousal)

melatonin

dopamine agonists

139
Q

what do you expect to see on PSG in REM sleep behaviour disorder

A

REM without atonia

140
Q

what is a mnemonia to remember the features of restless leg syndrome

A

URGE

Urge to move legs
Rest makes symptoms worse
Gets better with movement
Evening is time of worst symptoms

141
Q

what is the prevalence of RLS

A

5-10%

142
Q

what is the hypothesized mechanism behind RLS

A

brain DOPAMINE dysfunction

involves CIRCADIAN fluctuations in dopamine

deficiencies in other substances likely play a role

143
Q

deficiency in what substance may play a role in RLS

A

iron

144
Q

what neurotransmitter is hypothesized to be implicated in RLS

A

dopamine

145
Q

list 6 factors that exacerbate RLS

A

caffeine

tobacco

alcohol

DA blockers

SSRIs

mirtazapine

146
Q

do SSRIs help RLS or make it worse

A

make it worse

147
Q

what is another term for periodic limb movement disorder

A

nocturnal myoclonus

148
Q

what is periodic limb movement disorder

A

repetitive leg movements DURING SLEEP about which patient is usually unaware

20-40 sec apart

cause awakenings and fragmentation

bed partner reports “kicking”

149
Q

how do you manage RLS/periodic limb movement disorder–> first step

A

correct underlying deficiencies or stop causative agent

150
Q

list nonpharmacological interventions for periodic limb movement disorder/RLS

A

decrease alcohol, nicotine, caffeine consumption

hot baths

applying hot/cold compresses

massage

keep the mind alert

good sleep hygiene

151
Q

what are two first line pharmacologic agents for periodic limb movement disorder/RLS

A

ropinirole

pramipexole

both are dopamine agonists

(can also use levodopa but not first line)

152
Q

list all medications that can be used to treat periodic limb movement disorder/RLS

A

dopamine agonists–> ropirinole, pramipexole = FIRST LINE, also levodopa

gapabentin (recent studies)

benzos

opioids (low dose oxycodone_)

153
Q

how does alcohol affect sleep ACUTELY

A

decreases sleep latency

increases SWS initially, then decreased in second half of sleep

decreased REM in first 2-4 hours of sleep period

REM rebounds in 2nd half of sleep period

intense DREAMS, nightmares

sleep FRAGMENTATION

154
Q

how does chronic alcohol use affect sleep

A

INCREASED sleep latency

decreased sleep efficiency

decreased SWS

decreased REM

decreased TOTAL sleep time

155
Q

how does alcohol withdrawal affect sleep

A

disrupted continuity of sleep

increased REM assoc with vivid dreaming

after acute withdrawal, chronic users may experience LIGHT, FRAGMENTED sleep for WEEKS TO YEARS

assoc with PERSISTENT decrease in SWS

156
Q

alcohol exacerbates which sleep disorders

A

OSA

PLMD

RLS

parasomnias

RBD

SWS

157
Q

opioids cause what ACUTE sleep changes

A

decreased total sleep time

decreased REM

decreased SWS

158
Q

how does chronic opioid use affect sleep

A

same as with acute changes but these changes are minimized

159
Q

how does opioid withdrawal affect sleep

A

insomnia

decreased REM and SWS

160
Q

which sleep disorders are exacerbated by opioids

A

OSA

CSA

161
Q

how does acute cannabis use affect sleep

A

decreased sleep latency

decreased REM

increased SWS

162
Q

how does chronic cannabis use affect sleep

A

TOLERANCE to sleep induction effects and to SWS effects

decrease total sleep time

decreased sleep efficiency

decreased REM sleep

163
Q

how does cannabis withdrawal affect sleep

A

starts after 2-3 days and lasts 2-7 weeks

REM REBOUND with increased dreaming and nightmares

decreased SWS

164
Q

how do sedative/hypnotic/anxiolytic drugs affect sleep acutely

A

increased sleepiness

decreased wakefulness

165
Q

how does chronic use of sedative/hypnotic/anxiolytic drugs affect sleep

A

tolerance–> with subsequent return of insomnia

166
Q

how does sedative/hypnotic/anxiolytic drug withdrawal affect sleep

A

withdrawal and rebound insomnia

167
Q

what sleep disorder is associated with benzo receptor agonists

A

parasomnias

(also sedative/hypnotic/anxiolytic drugs increase frequency and severity of apneas)

168
Q

how do stimulants affect sleep acutely

A

insomnia

decreased total sleep time, REM and SWS

increased sleep latency

increased sleep continuity disturbance

169
Q

how does chronic stimulant use affect sleep

A

increased sleep latency

decreased total sleep time

decreased sleep efficiency, REM, SWS

170
Q

how does stimulant withdrawal affect sleep

A

excessive sleepiness

171
Q

how does depression affect the following sleep parameter:

REM sleep

A

SHORTENED REM latency (under 60 min until first REM cycle rather than 90 min)

more REM sleep, increased REM density

shift to predominance of REM in first half of sleep (rather than SWS in first half)

172
Q

how does depression affect the following sleep parameter:

SWS

A

decreased SWS

173
Q

how does depression affect the following sleep parameter:

sleep continuity

A

disturbed sleep continuity, early morning awakenings

174
Q

what effect does one night of total sleep deprivation have on patients with depression

A

one night with total sleep deprivation can temporarily alleviate depression in 40-60% of patients

175
Q

how does mania affect sleep

A

TRUE reduction in need for sleep
awakens refereshed after 2-4 hours

176
Q

what two changes in sleep are noted in patients with GAD

A

increased sleep latency

increased sleep fragmentation

177
Q

what % of patients with PTSD have nightmares

A

96%

nightmares may also occur in NREM sleep, especially N2

may have MOTOR ACTIVITY with nightmares

178
Q

how does PTSD affect the following sleep parameter:

N1

A

increased

179
Q

how does PTSD affect the following sleep parameter:

SWS

A

decreased

180
Q

how does PTSD affect the following sleep parameter:

REM

A

higher REM density but disrupted REM continuity

181
Q

how does PTSD affect the following sleep parameter:

movements in sleep

A

PLMs occur frequently

182
Q

what two changes are seen in sleep in those with panic disorder

A

paroxysmal AWAKENINGS upon entering N3/SWS

nocturnal panic attacks

183
Q

how does SCZ affect the following sleep parameter:

REM

A

short REM latency

decreased REM sleep early during exacerbations

184
Q

how does SCZ affect the following sleep parameter:

total sleep

A

decreased

185
Q

how does SCZ affect the following sleep parameter:

NREM

A

decreased NREM during EXACERBATIONS

186
Q

what is the most consistently found sleep abnormality in SCZ

A

short REM latency

187
Q

name 3 changes to sleep seen in dementia

A

decreased REM sleep

decreased SWS

decreased melatonin

188
Q

name Freuds 4 “distorting operations” in dream interpretation

A

condensation

displacement

visualization

symbolism

189
Q

in Freud’s dream interpretation, what is the following operation:

condensation

A

one dream object stands for several ideas

190
Q

in Freud’s dream interpretation, what is the following operation:

displacement

A

a dream objects emotional significance is separate from its real object or content, and attached to an entirely different one that does not raise the censors suspicions

191
Q

in Freud’s dream interpretation, what is the following operation:

visualization

A

a thought is translated into visual images

192
Q

in Freud’s dream interpretation, what is the following operation:

symbolism

A

a symbol replaces an action, person or idea

193
Q

what stage of sleep is most likely affected in the following disorder:

sleep terror

A

1st third of the night, during SWS–> N3

194
Q

what stage of sleep is most likely affected in the following disorder:

nightmare disorder

A

2nd half of night, during REM sleep

(less commonly can have during NREM)

195
Q

what stage of sleep is most likely affected in the following disorder:

sleepwalking disorder

A

1st third of night, during SWS–> N3

196
Q

what stage of sleep is most likely affected in the following disorder:

REM sleep behaviour disorder

A

REM sleep

197
Q

is there often a family history of sleep terror or sleepwalking?

A

yes

198
Q

what is the typical duration for a sleep terror

A

1-10 min

199
Q

what is the typical duration for a sleepwalking episode

A

5-10 min (above 30 min is rare)

200
Q

what is the typical duration for a nightmare (in nightmare disorder)

A

5-15 min

201
Q

what is the typical duration for an episode of REM sleep behaviour disorder

A

seconds to 20 min

202
Q

what are the symptoms of nightmare disorder

A

ABRUPT arousal with PANICKY scream/cry

autonomic and behavioural manifestations of intense fear

NO clear dream recall

203
Q

what are the symptoms of sleepwalking disorder

A

automatisms

getting out of bed

walking

204
Q

what are the symptoms of nightmare disorder

A

SUDDEN awakening with anxiety and VIVID DREAM RECALL

on awakening, QUICKLY become ALERT AND ORIENTED

205
Q

what are the symptoms of REM sleep behaviour disorder

A

limb movements, kicking, punching, talking

potential for injury of self/bed partner

on awakening, QUICKLY become ALERT and ORIENTED

206
Q

are there any symptoms post-episode in nightmare disorder or sleepwalking disorder

A

if are awakened during the spell, are CONFUSED and DISORIENTED for SEVERAL MINUTES

NO clear dream recall

usually does NOT awaken fully

AMNESIA of episode in the morning

207
Q

are there any symptoms post-episode in nightmare disorder

A

VIVID recall of dream

anxiety may interfere with falling back asleep

208
Q

are there any symptoms post-episode in REM sleep behaviour disorder

A

vivid recall of dream with theme of VIOLENCE

209
Q

what are some possible pathophysiologies for nightmare disorder and sleepwalking disorder

A

alcohol, sedatives

sleep deprivation

emotional stress

sleep-wake schedule disruptions

predisposing psychopathology

210
Q

what are some possible pathophysiologies for nightmare disorder

A

medications

daytime stress

predisposing psychopathology

211
Q

what are some possible pathophysiologies for REM sleep behaviour disorder

A

PONTINE lesions

synucleinopathies

drug induced (i.e SSRIs, TCA, MAOI)

alcohol withdrawal

paraneoplastic syndrome

212
Q

treatment for nightmare disorder and sleepwalking disorder

A

reassurance, ensure safety

avoidance of precipitants

psychotherapy

in difficult cases, consider SSRI, TCA

213
Q

treatment for nightmare disorder

A

avoid stress

sleep hygiene

tx psych illnesses

prazosin, REM suppresant

IRT

214
Q

name 3 antidepressants that have been known to cause nightmares

A

venlafaxine

duloxetine

buproprion

215
Q

what effect do SSRIs have on REM sleep behaviour disorder and PLMs/RLS

A

can induce REM sleep behaviour disorder and PLMD/RLS

216
Q

which antidepressant does not cause RLS/PLMD

A

buproprion

20. Sleep-Wake Disorders (3 decks)

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