CMS final key notes Flashcards
whats predominant in first half of sleep vs second half
1st- N3
2nd- REM
who’s more likely to get insomnia
women
insomnia definition
A repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment
distress and impair daytime functioning
chronic vs short term vs other insomnia disrosder
chronic- 3x/week for 3 months
short term- 1 to 3 months
what distinguished short term from chronic insomnia
identifiable cause (i.e. stressful life event, medications, withdrawal from drugs)
genes and molecules in chronic insomnia
ApoE4, orexin, histamine, gaba, serotonin, melatonin
Zeitgebers examples
social activities, meals, light-dark cycle
biological clock in
SCN of hypothalamus
ganglion cells of retina send information to SCN
SCN stimulate pineal gland to release melatonin
when does melatonin peak
3 hours before waking
normal circadian intrinsic rhythm
> 24 hours- get to 24 hours by zeitgebers
intrinsic vs extrinsic circadian rhythm sleep disorder
extrinsic: shift work, jet lag
intrinsic: advance sleep phase disorder, delayed sleep phase disorder etc
Delayed Sleep-Wake Phase Disorder
Delayed sleep and wake times relative to what is desired or expected à inadequate sleep and resultant daytime functional impairment
lose at least 2 hours of sleep
sleep inertia (confused when wake up)
depression, excess caffeine and light
treat: sleep hygiene
Advanced Sleep-Wake Phase Disorder
Excessive evening sleepiness and early morning awakening
i.e. if out late with friends will still wake up early
hypothesis: internal circadian clock <24 hours
treat: evening bright light therapy
Irregular Sleep-Wake Rhythm Disorder
Failure of the circadian rhythm system to consolidate sleepàmultiple short periods of sleep and wakefulness
> 3 periods of wakefulness for at least 1 hour during 24 hrs
esp in dementia
from lack of external cues (zeitgebers)
treat: behavioural and melatonin
jet lag disorder
> 2 time zones (can only adjust to 1-1.5 time zones per day)
eastward travel worse
shift work disorder
insomnia occurs despite sleep debt
rotating schedules bad (better if swings progress later in day instead of earlier)
try to get 3-4 hours of “anchor” sleep at same time every day
non-24 sleep-wake rhythm disorders
Results from a circadian rhythm system not entrained or running without
apparent regulation
i.e. blindness
treat: Rx Tasimelteon (melatonin-receptor agonist)
narcolepsy
excessive daytime sleepy with 15 minute sleep attacks
cataplexy (muscle weak)
sleep paralysis (muscle flacid + conscious)
hypnogogic or hypnopompic hallucinations
narcolepsy and REM
abrupt transition into REM
narcolepsy after nap
feel refresh
narcolepsy type 1 and type 2
type 1- low levels of orexin or episode of cataplexy
type 2- normal orexin and no episodes of cataplexy
idiopathic hypersomnia
-daytime sleep
-no cataplexy
etccc
klein levin syndrome
mostly young men
3-4 times a year for 2 days of hypersonic attack (i.e. 15 hour sleep)
hyrerphagia (hungry), hypersexial
hypersomnia from
medical condition (i.e. parkinsons, POTS)
medication/substance
infufficient sleep
psychiatric disorder