First Aid: Sleep Disorders Flashcards
What does elevated DA or NE do to sleep?
Decrease total sleep time
What does elevated Ach do to sleep?
increases total sleep time
increase proportion of REM sleep
What does elevated 5-HT do to sleep?
- increases total sleep time
- increased proportion of delta wave sleep
What is a primary sleep disorder?
NOT due to another medical condition or substance use
What is a secondary sleep disorder?
due to another medical condition or substance use
What is the word for disturbances in the amount, quality, or timing of sleep?
dyssomnias
What is the word for abnormal events in behavior or physiology during sleep?
parasomnias
What percent of sleep is REM?
25%
What type of EEG wave is seen in those with eyes closed and person awake?
alpha waves (only in 88% of people)
What EEG changes are seen in stage 1 sleep?
loss of alpha waves
What EEG changes are seen in stage 2 sleep?
sleep spindles
k-complexes
What EEG changes are seen in stage 3-4 sleep?
delta waves (low frequence)
What is the most restorative stage of sleep?
3-4 (deep sleep)
What EEG changes are seen in REM sleep?
- Sawtooth waves
- Rapid eye movement
How long do REM cycles last?
10-40 mintues
When do REM cycles occur?
every 90 mintues
What occurs during REM sleep?
dreaming
lack of motor tone
erections
What happens to REM sleep as you age?
REM sleep decreases
What is REM rebound?
increase in amount of REM sleep that occurs after a night of sleep deprivation
When evaluating insomnia, what should you always ask?
daily caffeine intake
What is the diagnostic criteria for primary insomnia?
- Difficulty initiating or maintaining sleep
- Daytime drowsiness or difficulty fulfilling tasks
- Disturbance occurs 3 or more times per week for at least 1 month
What percent of the population has primary insomnia?
30%
What tends to exacerbate primary insomnia?
anxiety
preoccupation with getting enough sleep
What drugs can be used to treat primary insomnia?
Benadryl
Zolpidem (ambien)
Zaleplon
Trazodone
What is the diagnostic criteria for primary hypersomnia?
-At least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition (narcolepsy), medications, poor sleep hygiene, or insufficient sleep
When does primary hypersomnia typically start?
adolescence
What is the treatment for hypersomnia?
- Stimulant drugs (amphetamines)
- SSRIs
What is the criteria for diagnosing narcolepsy?
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
When does narcolepsy usually begin?
childhood or adolescence
Do people with narcolepsy get good sleep at night?
usually poor nighttime sleep
How do you treat narcolepsy?
- Timed daily naps
- Stimulant drugs (amphetamines and methylphenidate)
- SSRIs or sodium oxalate (for cataplexy)
What is the prevalence of breathing-related sleep disorders?
10%
What are associated complications of breathing-related sleep disorders?
- Headaches
- Depression
- Excessive daytime sleepiness (EDS)
- Pulmonary HTN
- Sudden death in elderly and infants
What is OSA strongly associated with?
snoring
What is CSA strongly associated with?
heart failure
What is the collar size at risk for OSA?
> /= 17
What are some structural risk factors for OSA?
- Deviated nasal septum
- “Kissing” tonsils
- Large uvula/tongue
- Retrognathia
What is the difference between EDS and fatigue?
- EDS is falling asleep when you don’t want to
- Fatigue is being too tired to complete activities
How do you treat OSA?
- nasal CPAP
- weight loss
- nasal surgery
- uvulopalatoplasty
How do you treat CSA?
-mechanical ventilation (b-PAP) with a backup rate
What is the difference between OSA and CSA?
OSA has respiratory effort that is disrupted by physical obstruction of air flow. CSA is periodic cessation of respiratory effort
What are some subtypes of circadian rhythm sleep disorder?
- Jet lag type
- Shift work type
- Delayed sleep type
- Advanced sleep phase type
How long does it typically take jet lag to remit?
2-7 days
What might be helpful to treat shift work type of circadian rhythm sleep disorder?
lgiht therapy
What drug might be given 5.5 hours before desired bedtime to help with circadian rhythm sleep disorder?
melatonin
What is required for the diagnosis of nightmare disorder?
- Repeated awakenings with recall of extremely frightening dreams
- Occurs in REM sleep and causes significant distress
Who gets nightmare disorder and why?
usually in childhood and more frequently during times of stress or illness
What is the treatment for nightmare disorder?
TCAs or other agents that suppress total REM sleep may be used (but usually NO treatment)
What is night terror disorder?
- Repeated episodes of apparent fearfulness during sleep (usually begins with scream and intense anxiety)
- Patient is not awake and does not remember the episode
When do episodes typically occur in night terror disorder?
first third of the night during stage 3 or 4 sleep (non-REM)
What gender usually gets night terrors?
boys
What is the prevalence of night terror disorder?
1-6% of children
What is a common comorbid sleep disorder seen with night terrors?
sleepwalking disorder
What is the potential treatment for night terrors?
diazepam (small doses) at bedtime
What is somnambulism?
- 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
When do episodes of sleep walking typically occur?
first 1/3 of night during stages 3 and 4 of sleep
Do people remember sleepwalking?
NO
When do people start sleepwalking?
between ages 4 and 8
What is the peak prevalence age for sleep walking?
12
What gender usually sleep walks?
boys > girls
