Insomnia Flashcards
Bell Regulations: New York State Health Code include which 6 stipulations?
1) 12-hr work limits for residents and attendings in ED
2) work periods not > 24 hrs consecutively in areas other than ED
3) Scheduled work week for resident physicians not exceeding an avg of 80 hrs/wk over a 4-wk period
4) At least one 24-hr period of nonworking time per week
5) 24 hr supervision of acute care inpatient units by experienced attendings
6) improved working conditions and ancillary support for resident physicians
How common is insomnia?
occurs in at least 1/3 of all adults at some time in their lives.
Which waves are seen on EEG when an awake person relaxes with closed eyes and becomes drowsy?
-alpha waves over occipital and parietal lobes
W/ active mental concentration, what does the EEG show?
-w/ active mental concentration, beta waves over the frontal lobes predominate
What are the 2 major physiological states in normal sleep?
rapid eye movement (REM) –> fast-wave EEG activity
nonrapid eye movement (NREM) sleep –> 4 stages ofincreasing depth and slowing of EEG
What makes up approx 75% of total sleep time?
Non-REM sleep -slow eye movements, high amplitude, low-frequency brain waves, increased muscle tone
Explain the 4 stages of Non-REM sleep (makes up up to 75% of total
Stage 1: 5% of total sleep; low voltage theta wave activity; stage 1 quickly changes to stage 2
Stage 2: spindle-shaped waves (sleep spindles) & slow, high amplitude groups of waves called K-complexes; 45% of sleep time; tooth grinding (bruxism)
Stages 3&4: slow wave or delta sleep; delta sleep takes up about 25% of sleep time and occurs mainly during the first 1/2 of the sleep cycle; delta is the deepest part of NREM sleep and can be associated with unusual behaviors (sleepwalking, night terrors, bed wetting)
In which stage of sleep does teeth grinding aka bruxism occur?
Stage 2: K complexes
In which stage of sleep does unusual behaviors (sleep walking, bed wetting, night terrors) occur?
In the deepest part of NREM sleep, stages 3 & 4 characterized by delta waves.
REM sleep is characterized by rapid eye movements, decreased muscle tone, low amplitude, high freq brain waves that form a tracing that resembles what? REM sleep occurs in the latter half of sleep cycle and is associated with?
sawtooth waves
associated with high levels of brain activity and dreaming
NREM or REM: people in which sleep stage are less likely to be woken by external stimuli but are more likely to wake spontaneously?
REM sleep
People normally experience about how many minutes of REM periods, and how often?
The avg time to first REM period after falling asleep (REM latency) is 90 min. Then, ppl normally experience periods of 10-40 min of REM, each occurring about every 90 minutes thru out the night.
REM sleep is characterized by suppression of sympathetic activity as shown by?
miosis (pupil constriction), penile and clitoral erection
but body is essentially paralyzed during REM sleep
What is REM sleep behavior disorder (RBD)?
rare condition that includes episodes of REM w/o muscle atonia. The resulting physical activity associated with dreaming or nightmares –> pts harming themselves or sleep partners during REM sleep.
REM sleep behavior disorder has been associated in some patients with development years later of which 2 conditions?
Parkinson’s disease
Lewy body dementia
What is REM rebound?
increase in REM sleep due to people being deprived of sleep. This shows that REM sleep and dreaming are impt in learning and memory consolidation (only a theory)
Explain sleep architecture
sleep goes thru 4 stages of NREM then reverses back to stage 1, followed by REM. Abt 5-6 cycle of NREM sleep with an REM period occur per night
Explain how aging affects sleep architecture
neonates -sleep 16 hrs per day; 50% in REM
young adulthood -REM is 25%
seniors -combination of changes –> nonrestful sleep and daytime tiredness (prolonged sleep latency, further reduction in REM sleep, decreased total sleep time, decreased delta sleep, increased nighttime awakenings)
How does depression affect sleep architecture?
depressed pts:
- normal sleep latency of less than 20 min or prolonged sleep latency
- short REM latency
- increased REM early in sleep cycle
- decreased REM later in sleep cycle
- Long first REM
- increased total REM
- decreased delta
- increased nighttime awakenings
(shift in REM from last to first part of sleep cycle, long first REM period, reduced slow wave sleep, shortened REM latency, greater percentage of REM)
What is fatal familial insomnia?
rare disorder due to mutations in the prion protein gene leading to degeneration of thalamus, which is associated with arousal and consciousness. This results in complete inability to sleep, followed by dementia. It is fatal within 1-2 years.
Which NTs promote sleep?
Serotonin (increase serotonin –> increase total sleep time and delta sleep) and acetycholine (induces REM sleep)
what are some symptoms of extended sleep deprivation?
- initial confusion
- agitation
- aggression
- loss of touch with reality including delusional thinking
Conditions associated with decreased acetylcholine, such as normal aging and Alzheimer’s, what happens to REM sleep, total sleep time and delta sleep?
they all decrease
What are NE and DA effects on sleep?
NE and dopamine promote arousal and wafefulness. Increased levels of NE may increase sleep latency and decrease both total sleep time and the percentage of time spent in REM sleep. Increased dopamine is associated with decreased total sleep time.
What is glutamate’s effects on REM sleep?
Glutamate enhances REM sleep and is particularly associated with producing REM sleep’s characteristic muscle atonia
Two major categories of sleep disorders are? Define them and which one is more common?
1) Dyssomnias (most common): problems in the timing, quality, or amt of sleep (e.g. insomnia, sleep apnea, narcolepsy, restless leg syndrome, circadian rhythm sleep disorder…)
2) Parasomnias: abnormalities in physiology or in behavior associated with sleep (e.g. bruxism, nightmare disorder, sleep terror disorder, sleepwalking, REM sleep behavior disorder (RBD))
What are characteristics of insomnia?
- difficulty falling asleep or staying asleep
- present for AT LEAST 1 month and leads to daytime sleepiness or problems fulfilling social or occupational obligations
how to manage insomnia?
- avoid caffeine
- develop a sleep ritual
- maintain a fixed sleep and wake schedule
- relaxation techniques
- non-benzodiazepine sleep agents (Zolpidem (Ambien))
What are characteristics of breathing-related sleep disorder (i.e. sleep apnea)?
A Dyssomnia
- cessation of breathing for periods during sleep
- leads to anoxia and nighttime awakenings
- results in chronic daytime sleepiness
How to manage breathing related sleep disorder like sleep apnea?
A Dyssomnia
- weight loss (if overweight)
- continuous positive airway pressure
- surgery to enlarge the airway
- respiratory stimulates