Part 2 Sleep Medicine Flashcards
What are the two basic highly coupled processes that govern sleep and wakefulness (the “two process” sleep system)
Homeostatic process (Process S) - primarily regulates the length and depth of sleep, related to accumulating somnogens Circadian rhythm (Process C) - influences the internal organization of sleep and timing and duration of daily sleep-wake cycles, and govern predictable patterns of alertness throughout the 24 hr day
Where is the “master circadian clock” that controls sleep-wake patterns located?
in the suprachiasmatic nucleus (SCN) in the ventral hypothalamus
There is a high prevalence of partial arousal parasomnias (sleepwalking and sleep terrors) in preschool and early school-aged children due to preponderance of which sleep pattern?
a. slow wave sleep (SWS)
b. rapid eye movement (REM)
a. SWS
proportion of REM sleep decreases from birth (50% of sleep) through early childhood into adulthood (25-30%), and a similar initial predominance of SWS that peaks in early childhood, drops off abruptly after puberty (40-60% decline), and then further decreases over the life span
The human circadian clock is actually slightly longer than 24 hr. Intrinsic circadian rhythms are synchronized or “entrained” to the 24 hr day cycle by environmental cues called _____.
zeitgeber (zayt-gay-ber)
The most powerful of these zeitgebers is the light–dark cycle; light signals are transmitted to the SCN via the circadian photoreceptor system within the retina (functionally and anatomically separate from the visual system), which switch the body’s production of the hormone melatonin off (light) or on (dark) by the pineal gland.
What time periods are considered circadian troughs or periods of maximum sleepiness?
(2)
a. 6am to 7 am / 6pm-7pm
b. 4am-5am / 4pm-5pm
c. 6am-7am / 4pm-5pm
d. 3am-5am / 3pm-5pm
D. 3am-5am / 3pm-5pm
There are 2 periods of maximum sleepiness, 1 in the late afternoon (3:00-5:00 pm) and one toward the end of the night (3:00-5:00 am), and 2 periods of maximum alertness, 1 in mid-morning and 1 in the evening, just prior to sleep onset (the so-called second wind).
What is the most restorative form of sleep?
a. REM (rapid eye movement)
b. SWS (slow wave sleep)
B. SWS
Stage of sleep involved in vital cognitive functions (eg consolidation of memory) and development of the CNS?
a. REM
b. SWS
a. REM
Which sleep disorder is associated with preschool children (3-5 yo)?
a. Behavioral insomnia of childhood, limit setting type
b. Behavioral insomnia of childhood, sleep onset association type
c. Primary or psychophysiologic insomnia
a. Behavioral insomnia of childhood, limit setting type
Bedtime problems, including stalling and refusing to go to bed, are more common in preschool-aged and older children.
- often the result of parental difficulties in setting limits and managing behavior, including the inability or unwillingness to set consistent bedtime rules and enforce a regular bedtime, and may be exacerbated by the child’s oppositional behavior
Sleep disorder common in infants and toddlers wherein the child learns to fall asleep only under certain conditions or associations which typically require parental presence, such as being rocked or fed, and does not develop the ability to self-soothe
a. Behavioral insomnia of childhood, limit setting type
b. Behavioral insomnia of childhood, sleep onset association type
c. Primary or psychophysiologic insomnia
b. Behavioral insomnia of childhood, sleep onset association type
Management of night wakings should include establishment of a set sleep schedule and bedtime routine, and implementation of a behavioral program (rapid or gradual withdrawal)
Type of insomnia that is not primarily a result of parent behavior or secondary to another sleep disturbance, or to a psychiatric or medical problem
a. Behavioral insomnia of childhood, limit setting type
b. Behavioral insomnia of childhood, sleep onset association type
c. Primary or psychophysiologic insomnia
c. Primary or psychophysiologic insomnia
- also sometimes called “learned insomnia”
- usually occurs largely in adolescents and is characterized by a combination of learned sleep-preventing associations and heightened physiologic arousal resulting in a complaint of sleeplessness and decreased daytime functioning
A hallmark of this type of insomnia is excessive worry about sleep and an exaggerated concern of the potential daytime consequences
a. Behavioral insomnia of childhood, limit setting type
b. Behavioral insomnia of childhood, sleep onset association type
c. Primary or psychophysiologic insomnia
c. Primary or psychophysiologic insomnia
Treatment usually involves educating the adolescent about the principles of sleep hygiene (Table 17-3), institution of a consistent sleep-wake schedule, avoidance of daytime napping, instructions to use the bed for sleep only and to get out of bed if unable to fall asleep (stimulus control), restricting time in bed to the actual time asleep (sleep restriction), addressing maladaptive cognitions about sleep, and teaching relaxation techniques to reduce anxiety
Respiratory disorder that is characterized by repeated episodes of prolonged upper airway obstruction during sleep despite continued or increased respiratory effort, resulting in complete (apnea) or partial (hypopnea; ≥50% reduction in airflow) cessation of airflow at the nose and/or mouth, as well as in disrupted sleep
Obstructive sleep apnea
Metabolic dysfunction in both obese and non-obese children with OSA
insulin resistance
dyslipidemia
- indicated by an increase in peripheral markers of inflammation such as C-reactive protein (CRP)
- Both systemic inflammation and arousal-mediated increases in sympathetic autonomic nervous system activity with altered vasomotor tone may be key contributors to increased cardiovascular risk in both adults and children with OSA.
