Franklin: Sleep Flashcards
What is stage 1 sleep?
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
What is stage 2 sleep?
About 50% of total sleep time
Spindles/K complexes
What is Delta (slow wave) sleep?
EMG activity low
Physiologically stable – heart rate/respiration slow and regular
Arousal difficult
10-20% of total sleep time
What is REM sleep?
EEG resembles stage 1/waking trace EMG lowest activity (PARALYSIS) RAPID EYE movements DREAMS physiologic instability
When is slow wave sleep?
EARLY in the night
When is the most REM sleep?
Morning
What is a nocturnal polysomnogram?
Sleep study
- EEG (are they sleeping/stages)
- EOG (eye leads)
- EMG (paralysis)
- Respiratory effort and airflow (sleep apnea)
- EKG
- oximetry
What is the diff between dims and does? Which one needs a sleep study?
DIMS- insomnias
DOES- everything else *needs a sleep study
Who needs a sleep study?
Loud snorers, witnessed apneas, marked daytime somnolence
Lifelong sleepiness despite adequate sleep,
RLS / PLMS /movement disorders/noc seizures
What is clinically significant EDS?
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
What are four general causes of EDS?
Sleep at night -Quantity -Quality Circadian rhythm Drugs CNS pathology
How does alcohol affect sleep at night?
Decreases sleep latency
Worsens underlying sleep path
Fragments sleep
What is sleep related CNS pathology?
Narcolepsy
Idiopathic CNS hypersomnolence
Central apneas
R.L.S.
What is an abnormal apnea/hypoapnea index?
over 20 is an issue
O2 sats can get down to 72%
How do you treat someone w/ severe obstructive sleep apnea?
11 cm N-CPAP
follow up in 2 mos
*follow up is impt b/c there may be more than 1 underlying disorder
What is sleep apnea syndrome?
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
What are the three places that can obstruct in sleep apnea?
- nasal septum
- uvula
- pharynx
What is a partial obstruction?
snoring
What is hte mechanism of sleep apnea?
partial obstruction> full obstruction> catecholamine burst> arousal from sleep> resumption of airflow> return to sleep
What are the sxs of sleep apnea?
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
Down syndrome, prior broken nose, rhinophyma, deviated septum, mandibular insufficiency, crowding, large tongue…you should suspect…
sleep apnea
What cardiac changes are associated w/ abnormal sleep?
NREM: INCREASED
Heart Rate
Blood Pressure
REM: INCREASED
Heart Rate variability
Blood pressure variable
Arrhythmias
*all variables are usually DECREASED in normal sleep
Sleep apnea is present in what percent of ppl w/ HTN?
40%
More severe OSA higher the BP
What is the MC cause of secondary HTN?
sleep apnea (87%) *chances increased if you're on more than 3 antihypertensives
What improves LV function and mortality?
compliance w/ CPAP
What are the 4 tx for sleep apnea?
Positive Airway Pressure device (99% effective)
Surgery: Tracheostomy, Uvulopalatopharyngoplasty (UVPP)
Oral Appliances
Weight Loss
What are oral appliances?
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
What are surgical treatments for sleep apnea?
Tracheostomy (uncommon)
Uvulopalatopharyngoplasty (UVPP)
What are the cardinal sxs of OSA?
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
What is narcolepsy?
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
How do narcoleptics present?
- pathologic sleepiness***
(Below are ancillary sxs) - instantly become paralyzed (cataplexy)
- Sleep paralysis (wake up from nap and can’t move a muscle)
- Dreaming intrudes on wake state (hypnogotic hallucinations)
How do you test for narcolepsy?
- Actingrophy (are they getting enough sleep)
- overnight sleep test (look for things that wake you up–sleep apnea, movement disorders, seizures). If normal–>
- 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.
How do you dx narcolepsy?
Sleep latency <8 mins during naps and 2 early REM onsets
How do you tx narcolepsy?
Provigil
Neuvigil
Ridalin
Amphetamines (Adderol)
*if these drugs don’t work use REM suppressants (ophrenon)
What is a hypnic jerk?
Excessive rxn to minimal external stimuli
N1 phenomena as you’re going to sleep, indicates that you’re excessively sleepy
What is restless leg syndrome?
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
How do you dx RLS?
- test Fe stores
2. Period leg mvments in the night
What seizure disorders can disrupt sleep?
stereotypic repetitive movement at night that happens over and over
An elderly gentleman comes in and says “he acts out his dreams”. What does he have?
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
