Circadian Rhythm and Parasomnias Flashcards
Circadian rhythm is linked to your
1.
2.
3.
and influenced by
1.
2.
3.
- Core body temp.
- hormone levels
- hunger/satiety
- Light exposure
- Sleep wake/centers of brain
- Genetics
If humans were to be kept in complete darkness, would they ultimately adopt their internal circadian rhythm for sleep-wake cycles?
How long is a typical sleep wake cycle?
Yes, 24.2 hrs
Your suprachiasmatic nucleus regulates ____/____information
Pineal gland secretes ____ in response to increased darkness
Light receptors in eyes relay this info to the ______
light/dark
melatonin
pineal gland
Circadian Rhythm Sleep-Wake D/O
Sleep disturbances from altered _________ cycle
May be delayed (night-owls) or advanced phase (morning people)
Their schedule, job, other factors may interfere, _______ ______ ________ constantly “resets” their clock
Sleep is of ______ quality and pts can usually sleep enough if allowed to
sleep-wake cycle
morning light exposure
Normal
Circadian Rhythm Sleep/wake D/O tx
General tx:
Shift work tx:
Jet lag tx:
Delayed sleep phase: delay on successive nights for 30 min-3 hrs unit full 24 hr period of wakefulness achieved, then sleep at “normal” time
Shift work: stop working night shift or Nuvigil (armodafinil- FDA approved)
Jet lag (not DSM-5): Zolpidem, melatonin short term; keep nml sleep schedule
NREM Sleep Arousal D/O
Familial, most common in ______, outgrow by ______
Occurs in STAGE _ of NREM
Sleepwalking and sleep terrors, usually during first ___ of major sleep episode
children, adolescence
Stage 3
⅓
In NREM sleep d/o, pts have_____ _____ behavior w/o conscious awareness during NREM sleep, little to no memory
Sleep walking pts are very hard to arouse, have a _____ ___ and ____ upon awakening
Sleep terrors partial arousal from _____ ____, usually w/ screaming in terror, motor activity, may not fully awaken and [will/will not] remember episode
complex motor
blank stare, amnesia
delta sleep
Will not
NREM sleep d/o tx
Keep them safe!!!
ID triggers, stressors, avoid caffeine/alcohol, sleep hygiene
BZD promote stage 3 sleep
TCAs, SSRIs, melatonin have been used, no real evidence of effectiveness
Nightmare D/O usually occurs during [REM/NREM] sleep and during ____ ____ of a sleep period
Well-remembered, immediately alert after waking
Body movements and vocalizations [are/are not] typical
Kids maybe unable to distinguish b/wn reality and dream
REM
2nd half
are not
Nightmare d/o tx
Tx underlying cause, if clear EtOH/BZD w/drawal
Tx underlying mental d/o→ depression, trauma therapy
Judicious use of hypnotics/sedatives
REM Sleep Behavior D/O occurs usually [earlier/later] in sleep cycle (> 90 mins)
Arousal during sleep assoc. w/ _____ and/or complex ________ __________
Often dream of being _______ or ______
Can usually recall dream content
Complex _____ activity has the ability to cause injury to the pt or others
vocalizations, complex motor movements
attacked or escaping
motor
REM Sleep Behavior d/o is assoc. w/ 3 diseases:
____% of those presenting to sleep clinics will develop a ________ d/o
PD, Lewy Body Dementia, and multiple system atrophy
50%, neurodegenerative
Tx of REM Sleep Behavior d/o
Keep them safe! May have partners sleep separately; ID triggers, stressors
TCAs, SSRIs, BB have been associated w/ this d/o, minimize/stop if possible
Clonazepam is the drug of choice, but sxs will often return if meds are stopped
Restless Leg Syndrome (RLS) affects ___% population
It is a ______ d/o, Desire to move legs assoc. w/ unpleasant sensations, tingling, “creeping, crawling”
At least ___ nights/wk x ____mos
Sensations/movement delay sleep or wake pt from sleep
Movement of legs relieves unpleasant sensations
~5%
sensorimotor
3 nights/wk x 3 mos
RLS tx
R/o medical conditions (leg cramps, arthritis, positional ischemia/PAD, myalgias, peripheral neuropathy)
DA agonists are mainstay:
Ropinirole 0.25 mg -4.0 mg/day
Pramipexole 0.125 mg -0.5 mg/day
