Neuro - Sleep Flashcards
The stages of sleep are?
Stage I - light sleep
Stage II - K complexes and sleep spindles
Stage III/IV - restorative sleep, slow wave sleep
REM - rapid eye movement, dreaming
Where is sleep regulated?
Suprachismatic nucleus
Involved structures:
Basal forebrain
ANterior Hypothalamus
Dorsolateral medullary reticular formation
What chemicals are involved?
Serotonin Melanocyte stimulating hormone Prostaglandin D2 Melanin Uridine
DIMS
Disorders of initiating and maintaining sleep
What is insomia?
Patient has difficulting falling asleep or maintaining sleep. Will also complain of a disturbance of sleep
What are some signs of insomnia?
Memory difficulties
inability to cope with stress
Falling asleep with friends
MVAs
What is transient insomnia?
Last several days from an acute lifestyle change.
Examples: Jet lag, change in environment, acute illness, situational stress, medications (caffeine, alcohol, drugs)
What is Short term insomnia?
2 to 3 weeks of insomnia
Major lifestyle changes:
Marriage, divorce, moving, bereavement, pain/hospitalizations
What is chronic insomnia?
Lasts greater than three weeks
Need to workup
Associated with physical and emotional illness.
Medications, alcohol, or illicit drugs
Who must bring up insomnia?
The physician must bring up the topic
What are some causes of sleep disturbances?
Alcohol Snoring Dreaming Restless leg syndrome Nightmares Changes in sleep habits MEdications Daytime performance Caffeine
What drugs need to be avoided because of their disturbances of sleep?
Stimulants Antihistamines antidepressants Amphetamines Opiates Sympathomimetics Anticholinergics TCAs prevent REM sleep Benzodiazepines prevent stage III/IV
What should be avoided in patients with sleep apnea?
Sleep aids
What are two examples of sleep aids?
Sedating antidepressants - amitryptiline
Antihistamines - hydroxyzine and diphenhydramine
Who should avoid TCA sleep aids?
Amitrytiline should be avoided with patients with BPH (prostate) or cardiovascular disease
What is Restless leg syndrome
Creeping, crawling or searing pain that causes constant desire to move legs. Can be helped with walking, rubbing and heat
What are some associations with restless leg syndrome?
Pregnancy Uremia BUN and creatine (renal failure) Rheumatoid arthritis Iron deficiency Peripheral neuropathy (diabetes) Drug withdrawal Myelopathy
What is the treatment for restless leg syndrome?
Anti-Parkinson medications (Sinemet, entacapone/tolcapone)
Benzodiazepines (may effect stage III/IV)
Opiates
Tricyclic antidepressants (amitryptiline; may effect REM sleep)
What is the most common disorder of excessive daytime somnolence?
Sleep apnea
What are the causes of sleep apnea
Obesity
Nasopharyngeal structural changes
What morbidities are associated with sleep apnea?
Hypertension cardiac dysrhythmias Strokes MI's Accidents (daytime somnolence)
Treatment for sleep apnea?
Lose weight, CPAP (continous positive airway pressure), tennis ball to make sleeping on back uncomfortable, surgery, avoid sleep agents and alcohol
What are the genetics of Narcolepsy?
Mutation of chromosome for the gene that codes for hypocretin 2 (orexin B) that is used in the hypothalamus. Associated with HLA-DR2/DQ1
What are the four clinical features of Narcolepsy?
Excessive daytime sleepiness (patient will go straight into REM sleep) Cataplexy (loss of muscle tone after strong emotional response) Hypnagogic hallucinations (believing that they hear and see sounds or lights that don't exist) Sleep paralysis (inability to move extremities immediately after awaking)
