Lec 46 Sleep Disorders Flashcards by Anna Cushing

What is the function of sleep?

physical restoration
optimize waking neurocognitive and emotional function
learning, emotional processing
health + survival

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What kind of waves in awake state with eyes open? eyes closed?

eyes open = beta (highest freq)

eyes closed = alpha = 8-14 Hz

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What are the stages of non-rem sleep? what percent of sleep do they make up?

stage 1 = 5% of sleep = light sleep
stage 2 = 45% of sleep - deeper sleep
stage 3/4 = 25% of sleep- deep slow wave sleep

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What kind of sleep is stage 1? type of waves?

light sleep ~5% of sleep
have theta waves [4-7 Hz]
muscle activity slows; occasional twitches

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What is mneumonic for EEG waves of awake/sleep?

At night, BATS Drink Blood

Beta [awak open eyes]
Alpha [awake closed eyes]
Theta [1]
Sleep spindles + K complex [2]
Delta [3/4]
Beta [REM]

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What kind of sleep is stage 2? type of waves?

deeper sleep = ~45% of sleep
theta continues plus have sleep spindles and K complexes
breathing and HR slow

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What kind of sleep is stage 3/4? type of waves?

deep/slow sleep = ~25% of sleep
delta waves (0.5-2 Hz) = slow wave
limited muscle activity
when sleepwalking, night terrors, bedwetting occur

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What stage of sleep has sleep spindles and k complexes?

stage 2

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What are characteristics of REM sleep?

makes up ~25% of sleep; 4-6 episodes per night
absent motor tone/activity
rapid eye movements
dreaming
increased HR/BP, brain uses more O2
may serve memory processing function

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What is the pattern of sleep cycle?

one cycle: 1 –> 2 –> 3 –> 4 –> 3 –> 2 –> REM

repeats ~ 90-120 min
more REM in second half of night

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What is sleep latency?

the time from lights out to first NREM stage 1

- usually takes 10-20 min

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What is REM latency?

the time from sleep onset to first REM

- usually takes 90-100 min

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What is sleep efficiency?

amount of sleep/total time in bed * 100

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How much sleep does average adult need?

7-9 hrs

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How much of day do infants sleep? how much REM?

sleep 2/3 of day

50% of sleep in REM

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What happens to sleep cycle with aging?

increased: sleep latency, noctural awakenings, NREM stage 1
decreased: delta, REM, REM latency, sleep efficiency

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What does polysomnography measure?

EEG to get brain electrical acivity
electro-oculography to measure eye movements
EMG to measure muscle tone

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What is multople sleep latency test?

to assess objective daytime sleepiness
monitor sleep for a night then allow pt to nap 4-5 times at 2 hr intervals during day and see how many times they go into REM

if go straight into REM during nap –> sign of narcolepsy

What is a dyssomnia?

disorder of too little or too much sleep

What is a parasomnia?

abnormal behavior or psych even during specific sleep stages or during transition wake to sleep

What is definition of sleep apnea?

repetitive episodes of complete or partial cessation of air flow during sleep that causes ox desaturation and ends with brief arousals

may be due to reduced resp drive [central] or upper airway obstruction [obstructive]

What are symptoms of sleep apnea?

excessive daytime sleepiness
snoring, choking, gasping during sleep
also:
impaired conc, memory loss
associated with obesity/HTN

What causes each of the 2 types of sleep apnea?

central: due to decreased resp drive from brainstem lesion
obstructive: due to upper airway obstruction, associated with obesity

What are consequences of obstructive sleep apnea?

increased mortality

- CHF, stroke, HTN

How prevalent is obstructive sleep apnea?

~15%

What are treatments for obstructive sleep apnea?

- weight loss - positional therapy - postive airway pressure therapy

What is narcolepsy?

profound excessive daytime sleepiness tetrad of signs: daytime somnolence, cataplexy, sleep paralysis, hallucination - have repeated attacks of irresistible sleep with REM immediate onset - cataplexy = REM sleep during wakefulness causes muscle weakness - sleep paralysis: paralysis during waking + falling asleep - hallucinations - often have normal polysomnogram

When does narcolepsy normally present?

- teens - early 10s; symptoms worsen for first few years then persist

What is pathophysiology of primary narcolepsy? secondary?

- genetic or autoimmune origin - destruction of hypothalamic orexin secreting neurons in lateral hypothalamus secondary: head trauma, MS, craniopharyngioma, tumor in upper brainstem, hypthalamic sarcoid granuloma

How do you treat narcolepsy?

daytime -- stimulants (amphetamines, modafinil) | nighttime -- sodium oxybate

What is ondine's curse? cause?

primary hypoventilation syndrome - total loss of automatic breathing esp. in sleep - have apneic periods that lead to awakenings due to: absent external arcuate nuclei of medulla and depleted neurons in medullary respiratory areas

What is kleine levin syndrome?

- repeated episodes of excessive daytime somnolence - hypersexuality - hyperphagia [eat a lot] - episodes last days to wks etiology unknown

What is a circadian rhythm disorder?

misalignment between desired sleep-wake scheudle and endogenous circadian-rhythm

What are symptoms of shift work sleep disorder?

- excessive sleepiness during work hours scheduled during usual sleep period - insomnia when attempting to sleep during usual wake period - mood instability - associated with insomnia, excessive sleepiness, or both - non-specific GI symptoms - work related errors, industrial accidents

What is restless leg syndrome?

spontaneous leg movement/urge to move leg occurs at rest only has negative impact on sleep initiation and maintenance

What is etiology of restless leg?

genetic = dominant inheritance secondary: iron deficiency, renal disease, diabetes, MS, parkinsons

When does sleepwalking disorder occur?

non-rem sleep stage 3-4

when does sleep terror occur?

non-rem stage 3-4

what does nightmare disorder occur?

REM sleep

for non-rem sleep disorder: What is timing? amnesia? confusion? dreaming? demographics? autonomic activity?

- occurs in first 2 hours of night - amnesia occurs - confusion follows - occurs in children - variable autonomic activity

for rem sleep disorder: What is timing? amnesia? confusion? dreaming? demographics? autonomic activity?

- occurs anytime - no amnesia = vivid dream recall - no confusion - occurs in older men - high autonomic activity acting out dreams, unresponsive to environment

What is cause of non-rem sleep disorders?

disorders of arousal --> sudden brief but incomplete arousal genetic component to it its relatively benign

What causes REM sleep disorders?

idiopathic | can be early manifestation of neurodegeneration [PD]