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PSYC 208 > Lecture 8 > Flashcards

Lecture 8 Flashcards

1
Q

What is sleep apnea?

A

“cessation of breathing lasting 10 secs/longer during sleep, terminated w/ arousal or oxygen desaturation”

  • observable (family) & measurable (lab)
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2
Q

What is central sleep apnea?

A

absence of effort to breathe & of airflow in mouth and nose

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3
Q

What is obstructive sleep apnea?

A

persistent, increasing effort to breathe w/ absence of airflow in mouth and nose

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4
Q

What are the symptoms of OSA? (LNSMFT)

A
  • 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
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5
Q

What is snoring and its features?

A

sign of airflow & airway obstruction

  • throat tissue vibrates as air is forced through narrow passage
  • common in 50% of adults
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6
Q

What are symptoms of an obstructive apnea episode? (TBRTC)

A
  • 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
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7
Q

What are symptoms of OSA? (HAOCVCWA)

A
  • 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
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8
Q

What is hypopnea?

A

inspiration continues w/ reduced volume of air, respiratory effort increases

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9
Q

What is the Apnea/Hypopnea Index?

A

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+)
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10
Q

What are the effects of obstructive sleep apnea? (SDDCB)

A
  • sleepiness affects work
  • depression, irritable - hostility
  • diminished libido, sexuality
  • concentration, judgement, memory issues
  • bed partner issues: severe sleep deprivation, conflict, sleep in separate rooms
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11
Q

What is treatment for OSA? (AWSCOS)

A
  • 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
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12
Q

What is CPAP and its features?

A

self-adjusting, “smart” machines

  • nasal mask, prevent inspiration effort
  • compliance issues (lifetime use)
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13
Q

What is UPPP and its con?

A

resect uvula, tonsillar pillars, soft palate

- can be problematic or worsen due to scar tissue

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14
Q

What is phased airway reconstruction?

A

UPPP + advancing tongue, mandibular and maxillary advancement

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15
Q

What are parasomnias? (UMCGLC)

A
  • 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
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16
Q

What is somnambulism (sleepwalking)? (BNMWM VN)

A
  • 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
17
Q

What are facts about somnambulism?

A
  • 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
18
Q

What are the causes for somnambulism?

A
  • 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
19
Q

What are ways to help sleepwalkers?

A
  • 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
20
Q

What is REM behaviour disorder (REMBD)?

A
  • 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)
21
Q

What are features of REMBD?

A
  • 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
22
Q

What are facts about REMBD?

A
  • 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
23
Q

What is treatment for REMBD?

A
  • making bedroom safe (objects, placement of furniture)
  • medication: Klonopin (side effects)
  • calm voice/instructions - movement sensor triggers recording
24
Q

What is somniloquy (sleep talking)?

A
  • 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)
25
Q

What are features of somniloquy?

A
  • 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
26
Q

What are nightmares?

A
  • “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
27
Q

What are features of nightmares?

A
  • 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
28
Q

What are bad dreams?

A
  • 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
29
Q

What are features of both nightmares and bad dreams?

A
  • 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”
30
Q

What are features of sleep terrors?

A
  • childhood, 1-6% peaking at 5-7 yrs, reduce/cease at adolescence, can occur in adults
  • boys more likely, frequent than girls
31
Q

What are symptoms of sleep terrors? (1)

A
  • 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)
32
Q

What are symptoms of sleep terrors? (2)

A
  • 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

PSYC 208 (7 decks)

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