Clinical Sleep

Question 1

Stages of sleep and waves

Answer 1

Awake - alpha
NREM 1 - theta
NREM 2 - spindles and K-complex
NREM 3 - delta

Seizure is beta

Question 2

Metab during sleep

Answer 2

During REM sleep, kicked up higher than when awake

Increased CBF, resp and HR, atonia, erections

Question 3

Sleep changes as older

Answer 3

Decreased stage 3 adn 4
Increased awakenings
Phase advancement (vs. phase delay in college students)

Question 4

Hormones and sleep

Answer 4

GH - during 3 and 4
Prolactin - during sleep
Thyroid - decrease at ngiht
Leptin and ghrelin - balnce

Question 5

Diabetes

Answer 5

Chronic deprivation will decrease sensitivity and increase production

Question 6

RLS diagnosis

Answer 6

URGE

Urge to move
Rest worsens
Get better with activity
Evenings worse

Question 7

Pathophys of RLS

Answer 7

Dopamine dysfunction/iron deficiency

WOrse in women

Question 8

Rate limiting of dopamine sytnehsi

Answer 8

Tyrosine hydroxylase (needs iron)

Question 9

Tx of RLS

Answer 9

Ropinirole, pramiprexole, rotigotine, agabpentin

Question 10

Sleep apnea

Answer 10

Upper air obstruction or neural probelm

HTN, Afib, MI, stroke (via increase platelet agg)
Also increase resistance to insulin, nocturia, decreased libido

BP rises at end

Question 11

Narcolepsy

Answer 11

Immediate REM sleep

Excessive daytime sleepiness
Hypnagogic hallucination
Sleep paralysis
Cataplexy