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PSYCH ROTATION > First Aid: Sleep Disorders > Flashcards

First Aid: Sleep Disorders Flashcards

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1
Q

What does elevated DA or NE do to sleep?

A

Decrease total sleep time

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2
Q

What does elevated Ach do to sleep?

A

increases total sleep time

increase proportion of REM sleep

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3
Q

What does elevated 5-HT do to sleep?

A
  • increases total sleep time

- increased proportion of delta wave sleep

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4
Q

What is a primary sleep disorder?

A

NOT due to another medical condition or substance use

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5
Q

What is a secondary sleep disorder?

A

due to another medical condition or substance use

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6
Q

What is the word for disturbances in the amount, quality, or timing of sleep?

A

dyssomnias

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7
Q

What is the word for abnormal events in behavior or physiology during sleep?

A

parasomnias

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8
Q

What percent of sleep is REM?

A

25%

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9
Q

What type of EEG wave is seen in those with eyes closed and person awake?

A

alpha waves (only in 88% of people)

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10
Q

What EEG changes are seen in stage 1 sleep?

A

loss of alpha waves

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11
Q

What EEG changes are seen in stage 2 sleep?

A

sleep spindles

k-complexes

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12
Q

What EEG changes are seen in stage 3-4 sleep?

A

delta waves (low frequence)

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13
Q

What is the most restorative stage of sleep?

A

3-4 (deep sleep)

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14
Q

What EEG changes are seen in REM sleep?

A
  • Sawtooth waves

- Rapid eye movement

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15
Q

How long do REM cycles last?

A

10-40 mintues

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16
Q

When do REM cycles occur?

A

every 90 mintues

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17
Q

What occurs during REM sleep?

A

dreaming
lack of motor tone
erections

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18
Q

What happens to REM sleep as you age?

A

REM sleep decreases

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19
Q

What is REM rebound?

A

increase in amount of REM sleep that occurs after a night of sleep deprivation

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20
Q

When evaluating insomnia, what should you always ask?

A

daily caffeine intake

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21
Q

What is the diagnostic criteria for primary insomnia?

A
  • Difficulty initiating or maintaining sleep
  • Daytime drowsiness or difficulty fulfilling tasks
  • Disturbance occurs 3 or more times per week for at least 1 month
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22
Q

What percent of the population has primary insomnia?

A

30%

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23
Q

What tends to exacerbate primary insomnia?

A

anxiety

preoccupation with getting enough sleep

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24
Q

What drugs can be used to treat primary insomnia?

A

Benadryl
Zolpidem (ambien)
Zaleplon
Trazodone

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25
Q

What is the diagnostic criteria for primary hypersomnia?

A

-At least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition (narcolepsy), medications, poor sleep hygiene, or insufficient sleep

26
Q

When does primary hypersomnia typically start?

A

adolescence

27
Q

What is the treatment for hypersomnia?

A
  • Stimulant drugs (amphetamines)

- SSRIs

28
Q

What is the criteria for diagnosing narcolepsy?

A

Repeated, sudden attacks of sleep in the daytime for at least 3 months, associated with:

  • Cataplexy (in 70% of patients) associated with emotion like laughter
  • Short REM latency
  • Sleep paralysis (50% of patients)
  • Hypnagogic (as you GO to sleep) or hypnopompic (as you POP up from bed) hallucinations
29
Q

When does narcolepsy usually begin?

A

childhood or adolescence

30
Q

Do people with narcolepsy get good sleep at night?

A

usually poor nighttime sleep

31
Q

How do you treat narcolepsy?

A
  • Timed daily naps
  • Stimulant drugs (amphetamines and methylphenidate)
  • SSRIs or sodium oxalate (for cataplexy)
32
Q

What is the prevalence of breathing-related sleep disorders?

A

10%

33
Q

What are associated complications of breathing-related sleep disorders?

A
  • Headaches
  • Depression
  • Excessive daytime sleepiness (EDS)
  • Pulmonary HTN
  • Sudden death in elderly and infants
34
Q

What is OSA strongly associated with?

A

snoring

35
Q

What is CSA strongly associated with?

A

heart failure

36
Q

What is the collar size at risk for OSA?

A

> /= 17

37
Q

What are some structural risk factors for OSA?

A
  • Deviated nasal septum
  • “Kissing” tonsils
  • Large uvula/tongue
  • Retrognathia
38
Q

What is the difference between EDS and fatigue?

A
  • EDS is falling asleep when you don’t want to

- Fatigue is being too tired to complete activities

39
Q

How do you treat OSA?

A
  • nasal CPAP
  • weight loss
  • nasal surgery
  • uvulopalatoplasty
40
Q

How do you treat CSA?

A

-mechanical ventilation (b-PAP) with a backup rate

41
Q

What is the difference between OSA and CSA?

A

OSA has respiratory effort that is disrupted by physical obstruction of air flow. CSA is periodic cessation of respiratory effort

42
Q

What are some subtypes of circadian rhythm sleep disorder?

A
  • Jet lag type
  • Shift work type
  • Delayed sleep type
  • Advanced sleep phase type
43
Q

How long does it typically take jet lag to remit?

A

2-7 days

44
Q

What might be helpful to treat shift work type of circadian rhythm sleep disorder?

A

lgiht therapy

45
Q

What drug might be given 5.5 hours before desired bedtime to help with circadian rhythm sleep disorder?

A

melatonin

46
Q

What is required for the diagnosis of nightmare disorder?

A
  • Repeated awakenings with recall of extremely frightening dreams
  • Occurs in REM sleep and causes significant distress
47
Q

Who gets nightmare disorder and why?

A

usually in childhood and more frequently during times of stress or illness

48
Q

What is the treatment for nightmare disorder?

A

TCAs or other agents that suppress total REM sleep may be used (but usually NO treatment)

49
Q

What is night terror disorder?

A
  • Repeated episodes of apparent fearfulness during sleep (usually begins with scream and intense anxiety)
  • Patient is not awake and does not remember the episode
50
Q

When do episodes typically occur in night terror disorder?

A

first third of the night during stage 3 or 4 sleep (non-REM)

51
Q

What gender usually gets night terrors?

A

boys

52
Q

What is the prevalence of night terror disorder?

A

1-6% of children

53
Q

What is a common comorbid sleep disorder seen with night terrors?

A

sleepwalking disorder

54
Q

What is the potential treatment for night terrors?

A

diazepam (small doses) at bedtime

55
Q

What is somnambulism?

A
  • Repeated episodes of getting out of bed and walking (blank stare, difficult to wake up)
  • May get dressed, talk or scream
  • Behavior usually terminates when pt gets back in bed
56
Q

When do episodes of sleep walking typically occur?

A

first 1/3 of night during stages 3 and 4 of sleep

57
Q

Do people remember sleepwalking?

A

NO

58
Q

When do people start sleepwalking?

A

between ages 4 and 8

59
Q

What is the peak prevalence age for sleep walking?

A

12

60
Q

What gender usually sleep walks?

A

boys > girls

PSYCH ROTATION (18 decks)

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