Exam 3 - sleep

Question 1

What are some characteristics of normal sleep?

Question 2

What are the different sleep stages?

Answer 2

• NREM
• 1 & 2 - light sleeping
• 3 & 4 - deep sleep or delta stages
  
  • biggest and slowest brain waves
• REM
  
  • dream state

Question 3

What are some different type of sleep disorders?

Answer 3

• Insomnia disorder
• Hypersomnolence disorder
• Breathing related disorders
  
  • Obstructive sleep apnea/hypopnea
  • Central sleep apnea
  • Sleep-related hypoventilation
• Narcolepsy
• Circadian rhythm sleep disordern
• Restless legs syndrome

Question 4

What is insomnia disorder?

Answer 4

• Most common sleep disorder
• Subjective complaint of inadequate quality or quantity of sleep
• Variable patterns of sleep
  
  • difficulty in initiating or maintaining sleep
  • waking up too early in the morning
  • the experience of non-restorative sleep

Question 5

What is hypersomnolence disorder?

Answer 5

• nEpisodes of excessive sleepiness for at least 3 months
• nDifficulty being awake after abrupt awakening
• nAt least 3 times a week
• nCause significant distress or impairment in functioning

Question 6

What is Obstructive Sleep Apnea/Hypopnea?

Answer 6

• Evidence by polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep and either:
  
  • Noctural breathing disturbances (snoring, snorting/gasping, breathing pauses during sleep
  • Daytime sleepiness, fatigue, or unrefreshing sleep
• Or evidence by polsomnography of 15 or more obstructive apneas and/or hyponeas per hour

Question 7

What classifies central sleep apnea?

Answer 7

nEvidence by poly somnography of 5 or more central apneas per hour of sleep

Question 8

What characterises sleep-related hypoventilation?

Answer 8

nPolysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels

Question 9

What is narcolepsy and what are the characteristics of it?

Answer 9

Characterized by:

• daytime sleepiness
• cataplexy
• hypnogogic hallucinations
  
  • ( vivid, perceptual experiences occurring at sleep)
• hypnopompic hallucinations
  
  • (vivid, perceptual experiences occuring at awakening)
• sleep paralysis
• disturbed nocturnal sleep

Question 10

What are some characteristics of circadian rhythm disorders?

Answer 10

• Inability to sleep at traditional times
• Associated with shift work
• Advanced sleep syndrome
  
  • elderly
• Delayed sleep phase syndrome
  
  • adolescents

Question 11

What is restless legs syndrome?

Answer 11

• Unpleasant sensations that may be temporarily relieved by moving limbs
• Tend to increase in evening hours when lying down
• May be exacerbated by SSRIs and tricyclic antidepressants

Question 12

What are some medications used to treat insomnia?

Answer 12

• Benzodiazepines: Halcion, Ativan, Restoril, Klonopin, Dalmane, Prosom
• Nonbenzodiazepines: Sonata, Ambien, Lunesta
• Antidepressants: Desyrel, Remeron
• Melatoninergics: melatonin, Rozerem
• Antihistamine: Benadryl

Question 13

What are some behavior interventions for insomnia?

Answer 13

• Sleep restriction
• Progressive muscle relaxation
• Biofeedback
• Imagery training
• Sleep hygiene education
• Cognitive-behavioral therapy

Question 14

What are some treatments for breathing related sleep disorders?

Answer 14

• Avoid sleeping in the supine position
• Weight loss
• Abstain from long acting hypnotics and alcohol
• Continuous positive airway pressure (CPAP)
• Oropharyngeal surgery

Question 15

What are some treatments for circadian rhythm disorders?

Answer 15

• bright light therapy
• maximize exposure to sunlight while awake and minimize exposure during sleep

Question 16

What are some treatments for narcolepsy?

Answer 16

nDexedrine, Adderall, Ritalin, Provigil, Xyrem

Question 17

What are some medications used to treat restless legs syndrome?

Answer 17

ntreated with dopaminergic agents (e.g. L-DOPA, Mirapex, Requip), benzodiazepines (eg, clonazepam, trizolam), anticonvulsants (eg, gabapentin), opioids

Question 18

What are some good sleep habits?

Answer 18

Poor sleep hygiene habits possible; educate all patients with sleep problems on sleep hygiene:

• Avoid napping during the day.
• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime.
• Exercise daily, however avoid vigorous exercise too close to bedtime.
• Avoid large meals too close to bedtime.
• Ensure adequate daily exposure to natural light.
• Establish a regular relaxing bedtime routine. Avoid emotionally upsetting conversations before trying to go to sleep.
• Associate your bed with sleep. Avoid using bed to watch TV, listen to radio.
• Make sure sleep environment is pleasant and relaxing.