Lecture 8 Flashcards
What is sleep apnea?
“cessation of breathing lasting 10 secs/longer during sleep, terminated w/ arousal or oxygen desaturation”
- observable (family) & measurable (lab)
What is central sleep apnea?
absence of effort to breathe & of airflow in mouth and nose
What is obstructive sleep apnea?
persistent, increasing effort to breathe w/ absence of airflow in mouth and nose
What are the symptoms of OSA? (LNSMFT)
- loud snoring + pause, choking, cessation of breathing, followed by gasp of breath
- night sweats, morning headaches, dry mouth
- sleep deeply & difficult to arouse, but awaken “foggy headed”, blackouts
- more sleep/naps not refreshing
- frequent awakenings w/ little-no awareness
- thrashing/moving, frequent urination
What is snoring and its features?
sign of airflow & airway obstruction
- throat tissue vibrates as air is forced through narrow passage
- common in 50% of adults
What are symptoms of an obstructive apnea episode? (TBRTC)
- thick tissue at neck & face
- big tongue, nasal adenoidal breathing + speech, small jaw = smaller upper airway, pharyngeal dimensions
- reduced throat muscle tone
- trying to inspire air thru small opening, sucks relaxed tissue closed
- chest moves, trying to inflate lungs but air cannot pass, no airflow thru nose & mouth
What are symptoms of OSA? (HAOCVCWA)
- hypopnea
- Apnea/Hypopnea Index
- O2 sat. reduces, BP & HR increases
- correlated w/ high BP; can reduce w/ treatment
- very little/no N3, reduced REM
- can trigger grand mal seizure
- worsens w/ time, can die in sleep
- alcohol, antihistamines, sleeping pills worsen symptoms
What is hypopnea?
inspiration continues w/ reduced volume of air, respiratory effort increases
What is the Apnea/Hypopnea Index?
of ap or hyp ending in arousal or O2 desat/hrs of sleep
- mild (5-10)
- moderate (15-30)
- severe (30-45)
- very severe (45+)
What are the effects of obstructive sleep apnea? (SDDCB)
- sleepiness affects work
- depression, irritable - hostility
- diminished libido, sexuality
- concentration, judgement, memory issues
- bed partner issues: severe sleep deprivation, conflict, sleep in separate rooms
What is treatment for OSA? (AWSCOS)
- avoid alcohol, opioids, or muscle relaxants
- weight loss
- sleep different position
- CPAP
- oral appliance: splints/guards, holding lower jaw forward opening the throat
- surgery: UPPP, phased airway reconstruction
What is CPAP and its features?
self-adjusting, “smart” machines
- nasal mask, prevent inspiration effort
- compliance issues (lifetime use)
What is UPPP and its con?
resect uvula, tonsillar pillars, soft palate
- can be problematic or worsen due to scar tissue
What is phased airway reconstruction?
UPPP + advancing tongue, mandibular and maxillary advancement
What are parasomnias? (UMCGLC)
- undesirable, unpleasant occurrences during sleep
- more take place in waking, NREM, some in REM
- “components of one state intrude on another”
- genetic, environmental factors play a role
- limited cognitive function, amnesia of events
- can be symptom for OSA
What is somnambulism (sleepwalking)? (BNMWM VN)
- begins during NREM, first 1/2 - 1/3rd of night
- > 1min, 15 min up, rare occurrences 1 hr or more
- no dream recall
- move in bed, sit up, eyes open
- walk around room, house, yard, neighbourhood
- movements:
- purposeless, clumsy, trip/bump into walls, cuts/burns
- complex (meal, drive vehicle, motorcycle, instrument)
- vocalize, conversation, no screaming
- no full mental capacity: memory, planning, interacting w/ others
What are facts about somnambulism?
- 33% have immediate family does the same/sleep terrors
- more common in children, onset 4-6yrs, peak occurrence at 11-12yrs, abates at 15-17yrs
- v. few adult sleepwalkers (3-4%), 1-2x per year, rare in elderly
What are the causes for somnambulism?
- sleep deprivation/irregular sleep-wake cycle
- other sleep disorders
- fever
- extreme stress
- noise
- full bladder (disrupts N3)
- posterior cingulate cortex is active/like waking
- PFC reduced activity/like sleep
What are ways to help sleepwalkers?
- keep out of harm
- awakening - difficult, confusion, resistance/violence possible
- gently lead back to room, bed
- outgrow it
- reduce triggers
- make bedroom safe
- lock up keys to vehicles or tools
- schedule awakenings: 15-20 mins before typical occurrence
- adult (intense, frequent or dangerous) - medication, stress management/relaxation therapy
What is REM behaviour disorder (REMBD)?
- unusual, vivid dreams/nightmares with activity & violent confrontations
- experiencing fear, acts of defence
- behaviour parallels events/”stories” in reported dream/nightmare
- animated & violent physical behaviour; kicking, punching, gradding, leaping from bed, vocalisations (swearing, shouting)
What are features of REMBD?
- eyes closed, sleepwalking/leaving bed uncommon
- injuries to sleeper & sleep partner common
- 2-14x per week, every 90 mins
- more frequent in 2nd half of night, occur during REM
- remain asleep, no awakening (stay in bed)
- episode ends when individual awakes, becomes alert, reports dream
What are facts about REMBD?
- 1 in 200 ppl
- common in older males, average onset is early 60’s
- early sign of brain degeneration (2/3rds of ppl with REMBD develop dementia, Alzheimers, Parkinson disease)
- can take place in children
- side effect of medication/psychoactive drug withdrawal
- co-occur with other sleep disorder (narcolepsy)
- chronic & becomes progressively worse over time
- motor inhibition (REM paralysis) malfunctions
What is treatment for REMBD?
- making bedroom safe (objects, placement of furniture)
- medication: Klonopin (side effects)
- calm voice/instructions - movement sensor triggers recording
What is somniloquy (sleep talking)?
- mumbling, garbled
- singing, laughing
- some understandable words to full sentences
- seconds to minutes
- during N1, N2, only 10% during REM (more emotions, grammatically correct; not dream content)
What are features of somniloquy?
- most common in children, some in adults (almost everyone at some point)
- occur in related, family
- secrets, two-way conversations? unlikely, not replicable: issues with relationships (content, offensive), believe wake
- not treated typically = not dangerous
What are nightmares?
- “night + mare” (goblin/demon)
- “coherent dream sequences that seem real and become increasingly disturbing as they unfold. Emotions usually involve anxiety, fear, or terror and other negative feelings” (American Academy of Sleep Medicine, 2005)
- abrupt awakening, full alertness w/ increase in HR
- immediate & full recall of the content of the nightmare, distressing
What are features of nightmares?
- occur during 2nd 1/2 of sleep period/night, typically 10 min into REM episode
- persistent: impact daily living, anxiety, insomnia, daytime sleepiness
- all ages, 3-5 yrs old (10-50%), 70-80% adults report occasional
What are bad dreams?
- do not awaken, but recall disturbing content
- triggered by illness, fevers, indigestion/heart burn, withdrawal from drugs/alcohol, or medication side effects
- during crisis, loss or trauma
What are features of both nightmares and bad dreams?
- response to psychological issues/trauma
- replicate memories exactly or metaphorically (tidal wave, fire)
- soon after trauma - terror, fear, vulnerability, followed by grief, anger
- fade away/return when experience revives memory
- more common in people absorbed in fantasy & w/ “thin boundaries”
What are features of sleep terrors?
- childhood, 1-6% peaking at 5-7 yrs, reduce/cease at adolescence, can occur in adults
- boys more likely, frequent than girls
What are symptoms of sleep terrors? (1)
- arouse suddenly (from N3 typical, 1st 3rd of night), piercing scream, terrified facial expression, possible thrashing
- sweating, racing heart, breathing rapidly, wide open glassy eyes, dilated pupils
- elevated HR, blood pressure, skin flushing
- escape behaviour (run out of room/house)
- attempts to soothe the child are unsuccessful, physically hostile toward comforter (dazed, unresponsive)
What are symptoms of sleep terrors? (2)
- morning - child has no recall of incident (“monster/walls closing”, picture)
- fever, emotional stress
- awareness of stressors, scheduled awakenings
- bolted windows/alarms, remove sharp furniture/objects
