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Clinical Neurology > Neuro - Sleep > Flashcards

Neuro - Sleep Flashcards

1
Q

The stages of sleep are?

A

Stage I - light sleep
Stage II - K complexes and sleep spindles
Stage III/IV - restorative sleep, slow wave sleep
REM - rapid eye movement, dreaming

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2
Q

Where is sleep regulated?

A

Suprachismatic nucleus

Involved structures:
Basal forebrain
ANterior Hypothalamus
Dorsolateral medullary reticular formation

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3
Q

What chemicals are involved?

A 
Serotonin
Melanocyte stimulating hormone
Prostaglandin D2
Melanin
Uridine
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4
Q

DIMS

A

Disorders of initiating and maintaining sleep

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5
Q

What is insomia?

A

Patient has difficulting falling asleep or maintaining sleep. Will also complain of a disturbance of sleep

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6
Q

What are some signs of insomnia?

A

Memory difficulties
inability to cope with stress
Falling asleep with friends
MVAs

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7
Q

What is transient insomnia?

A

Last several days from an acute lifestyle change.

Examples: Jet lag, change in environment, acute illness, situational stress, medications (caffeine, alcohol, drugs)

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8
Q

What is Short term insomnia?

A

2 to 3 weeks of insomnia

Major lifestyle changes:
Marriage, divorce, moving, bereavement, pain/hospitalizations

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9
Q

What is chronic insomnia?

A

Lasts greater than three weeks

Need to workup
Associated with physical and emotional illness.
Medications, alcohol, or illicit drugs

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10
Q

Who must bring up insomnia?

A

The physician must bring up the topic

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11
Q

What are some causes of sleep disturbances?

A 
Alcohol
Snoring
Dreaming
Restless leg syndrome
Nightmares
Changes in sleep habits
MEdications
Daytime performance
Caffeine
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12
Q

What drugs need to be avoided because of their disturbances of sleep?

A 
Stimulants
Antihistamines
antidepressants
Amphetamines
Opiates
Sympathomimetics
Anticholinergics
TCAs prevent REM sleep
Benzodiazepines prevent stage III/IV
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13
Q

What should be avoided in patients with sleep apnea?

A

Sleep aids

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14
Q

What are two examples of sleep aids?

A

Sedating antidepressants - amitryptiline

Antihistamines - hydroxyzine and diphenhydramine

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15
Q

Who should avoid TCA sleep aids?

A

Amitrytiline should be avoided with patients with BPH (prostate) or cardiovascular disease

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16
Q

What is Restless leg syndrome

A

Creeping, crawling or searing pain that causes constant desire to move legs. Can be helped with walking, rubbing and heat

17
Q

What are some associations with restless leg syndrome?

A 
Pregnancy
Uremia BUN and creatine (renal failure)
Rheumatoid arthritis
Iron deficiency
Peripheral neuropathy (diabetes)
Drug withdrawal
Myelopathy
18
Q

What is the treatment for restless leg syndrome?

A

Anti-Parkinson medications (Sinemet, entacapone/tolcapone)
Benzodiazepines (may effect stage III/IV)
Opiates
Tricyclic antidepressants (amitryptiline; may effect REM sleep)

19
Q

What is the most common disorder of excessive daytime somnolence?

A

Sleep apnea

20
Q

What are the causes of sleep apnea

A

Obesity

Nasopharyngeal structural changes

21
Q

What morbidities are associated with sleep apnea?

A 
Hypertension
cardiac dysrhythmias
Strokes
MI's
Accidents (daytime somnolence)
22
Q

Treatment for sleep apnea?

A

Lose weight, CPAP (continous positive airway pressure), tennis ball to make sleeping on back uncomfortable, surgery, avoid sleep agents and alcohol

23
Q

What are the genetics of Narcolepsy?

A

Mutation of chromosome for the gene that codes for hypocretin 2 (orexin B) that is used in the hypothalamus. Associated with HLA-DR2/DQ1

24
Q

What are the four clinical features of Narcolepsy?

A 
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)
25
Q

What is the treatment for Narcolepsy?

A

Scheduled naps, exercise and education

Medications:
TCA amitryptiline (inhibit REM sleep)
caffeine
methylphenidate (Ritaline)
Modafinil

Sodium oxybate for Cataplexy

26
Q

What tests should be performed for someone with sleep disorders?

A

CBC (iron deficiency), BUN and creatine (kidney function), liver function, electrolytes (seizures), endocrine (thyroid)

27
Q

What Drugs will inhibit REM sleep?

A

MAO inhibitors

TCA

28
Q

What are parasomnias?

A

Conditions that results in abnormal behaviors during sleep.
Somnambulism (sleep walking)
Night terrors (Pavor Nocturnus)
Bedwetting (Nocturnal Enuresis)

29
Q

What stage of sleep does sleep walking occur?

A

Stage II/IV. Patients will have no memory of the events

30
Q

What are some treatments for Pavor Nocturnus?

A

Benzodiazepines
Pyschological therapy
Guard against injury

31
Q

What are some treatments for Nocturnal enuresis

A

Imipramine (TCA)

desmopressin (ADH synthetic)

32
Q

What are some conditions associated with Nocturnal enuresis?

A 
Diabetes mellitus
Diabetes inspidus
UTI's
Myelopathies
Seizures

Clinical Neurology (18 decks)

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