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Behavioral Health: Week 1 > Franklin: Sleep > Flashcards

Franklin: Sleep Flashcards

1
Q

What is stage 1 sleep?

A

Stage 1 – transition between waking and sleep (~30 sec – 7 minutes)

Reactivity to outside stimuli 
Short dreams
People feel they are awake if asked
Disconjugate rolling eye movements

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2
Q

What is stage 2 sleep?

A

About 50% of total sleep time

Spindles/K complexes

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3
Q

What is Delta (slow wave) sleep?

A

EMG activity low
Physiologically stable – heart rate/respiration slow and regular
Arousal difficult
10-20% of total sleep time

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4
Q

What is REM sleep?

A 
EEG resembles stage 1/waking trace
EMG lowest activity (PARALYSIS)
RAPID EYE movements
DREAMS 
physiologic instability
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5
Q

When is slow wave sleep?

A

EARLY in the night

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6
Q

When is the most REM sleep?

A

Morning

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7
Q

What is a nocturnal polysomnogram?

A

Sleep study

  • EEG (are they sleeping/stages)
  • EOG (eye leads)
  • EMG (paralysis)
  • Respiratory effort and airflow (sleep apnea)
  • EKG
  • oximetry
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8
Q

What is the diff between dims and does? Which one needs a sleep study?

A

DIMS- insomnias

DOES- everything else *needs a sleep study

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9
Q

Who needs a sleep study?

A

Loud snorers, witnessed apneas, marked daytime somnolence
Lifelong sleepiness despite adequate sleep,
RLS / PLMS /movement disorders/noc seizures

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10
Q

What is clinically significant EDS?

A

Persistent and unremitting

Increasing sleep time may not fix the sleepiness

Patient may c/o sleep loss consequences, i.e., loss of energy, memory loss or fatigue

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11
Q

What are four general causes of EDS?

A 
Sleep at night
-Quantity
-Quality
Circadian rhythm
Drugs
CNS pathology
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12
Q

How does alcohol affect sleep at night?

A

Decreases sleep latency
Worsens underlying sleep path
Fragments sleep

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13
Q

What is sleep related CNS pathology?

A

Narcolepsy
Idiopathic CNS hypersomnolence
Central apneas
R.L.S.

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14
Q

What is an abnormal apnea/hypoapnea index?

A

over 20 is an issue

O2 sats can get down to 72%

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15
Q

How do you treat someone w/ severe obstructive sleep apnea?

A

11 cm N-CPAP
follow up in 2 mos

*follow up is impt b/c there may be more than 1 underlying disorder

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16
Q

What is sleep apnea syndrome?

A

When a person, especially advanced in years, is lying on his back in heavy sleep and snoring loudly, it very commonly happens that inspiration fails to overcome the resistance in the pharynx, of which stridor or snoring is the audible sign, and there will be perfect silence through 2, 3 or 4 respiratory cycles in which there are ineffectual chest movements; finally, air enters with a loud snort, after which there are several compensatory deep inspirations

17
Q

What are the three places that can obstruct in sleep apnea?

A
  1. nasal septum
  2. uvula
  3. pharynx
18
Q

What is a partial obstruction?

A

snoring

19
Q

What is hte mechanism of sleep apnea?

A 
partial obstruction>
full obstruction>
catecholamine burst>
arousal from sleep>
resumption of airflow>
return to sleep
20
Q

What are the sxs of sleep apnea?

A

Excessive daytime sleepiness after adequate sleep time
Loud snoring with silent pauses - witnessed apnea
Irritability, Memory Loss
Morning headaches - Hypoxemia, Hypercapnia
Interfering with daily life

21
Q

Down syndrome, prior broken nose, rhinophyma, deviated septum, mandibular insufficiency, crowding, large tongue…you should suspect…

A

sleep apnea

22
Q

What cardiac changes are associated w/ abnormal sleep?

A

NREM: INCREASED
Heart Rate
Blood Pressure

REM: INCREASED
Heart Rate variability
Blood pressure variable
Arrhythmias

*all variables are usually DECREASED in normal sleep

23
Q

Sleep apnea is present in what percent of ppl w/ HTN?

A

40%

More severe OSA higher the BP

24
Q

What is the MC cause of secondary HTN?

A 
sleep apnea (87%)
*chances increased if you're on more than 3 antihypertensives
25
Q

What improves LV function and mortality?

A

compliance w/ CPAP

26
Q

What are the 4 tx for sleep apnea?

A

Positive Airway Pressure device (99% effective)

Surgery: Tracheostomy, Uvulopalatopharyngoplasty (UVPP)

Oral Appliances

Weight Loss

27
Q

What are oral appliances?

A

Second choice for MILD sleep apnea that work 70% of the time

Upper and lower gaurd that opens up lower airspace

SE: can affect bite and cause TMJ

28
Q

What are surgical treatments for sleep apnea?

A

Tracheostomy (uncommon)

Uvulopalatopharyngoplasty (UVPP)

29
Q

What are the cardinal sxs of OSA?

A

Snoring, witnessed apneas and EDS

OSA is common
Serious complications
Treatment is effective in reversing the complications
It is a chronic illness requiring careful follow-up

30
Q

What is narcolepsy?

A

Three stages:
Awake-(non-REM)-REM (paralyzed, rapid eye movements, dreams)

Def in hypothalumus of oxecretin>
screws cycle up>
Awake intrudes on all their sleep cycles (fragmented)>
REM intrudes into WAKE state

31
Q

How do narcoleptics present?

A
  1. pathologic sleepiness***
    (Below are ancillary sxs)
  2. instantly become paralyzed (cataplexy)
  3. Sleep paralysis (wake up from nap and can’t move a muscle)
  4. Dreaming intrudes on wake state (hypnogotic hallucinations)
32
Q

How do you test for narcolepsy?

A
  1. Actingrophy (are they getting enough sleep)
  2. overnight sleep test (look for things that wake you up–sleep apnea, movement disorders, seizures). If normal–>
  3. Multiple sleep latency test (measure how long it takes to fall asleep and if you go into REM)–> if you go into REM on a 20 min nap this is ABNORMAL.
33
Q

How do you dx narcolepsy?

A

Sleep latency <8 mins during naps and 2 early REM onsets

34
Q

How do you tx narcolepsy?

A

Provigil
Neuvigil
Ridalin
Amphetamines (Adderol)

*if these drugs don’t work use REM suppressants (ophrenon)

35
Q

What is a hypnic jerk?

A

Excessive rxn to minimal external stimuli

N1 phenomena as you’re going to sleep, indicates that you’re excessively sleepy

36
Q

What is restless leg syndrome?

A

Comes from substantia negra (Parkinsons place)

Uncomfortable sense that you can’t hold legs still as you’re falling asleep–> can lead to PERIODIC LEG MVMNTS IN THE NIGHT

37
Q

How do you dx RLS?

A
  1. test Fe stores

2. Period leg mvments in the night

38
Q

What seizure disorders can disrupt sleep?

A

stereotypic repetitive movement at night that happens over and over

39
Q

An elderly gentleman comes in and says “he acts out his dreams”. What does he have?

A

REM behavior disorder

Pons has to be stimulated to create paralysis during REM. Ppl actually remember this.

Tx: clonapin

Downside is that 50% of ppl end up with nasty neurologic disease like Parkinsons in 10-15 yrs

Behavioral Health: Week 1 (14 decks)

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