PATHOPHYS: Sleep Medicine

Question 1

What is the behavioral definition of normal sleep?*

Answer 1

a reversible state of perceptual disengagement from (and unresponsiveness to) the environment

Question 2

What is normal sleep USUALLY accompanied by?*

Answer 2

Postural recumbency

Physical quiescence

Question 3

How much of every day do we sleep?

Answer 3

around 8 hours

Question 4

How many years of our life do we sleep?

Answer 4

25 years (so sleep takes up around 1/3 of our life–and this is important for many reasons)

Question 5

What are some symptoms seen by sleep specialists?*

Answer 5

• Sleepiness
• Insomnia
• Snoring
• Abnormal behaviors
• Nightmares
• Abnormal movements

Question 6

What is insomnia closely linked to?

Answer 6

depression

Question 7

What things should you ask about during a patient’s history in the sleep clinic?

Answer 7

medications
pain
medical conditions
depression
environmental "problems"
bed partner

Question 8

What is mallampati?*

Answer 8

amount of airway obstruction

Question 9

What is class 4 mallampati?

Answer 9

when you can see no glottis

Question 10

Why is the mouth important to examine?

Answer 10

teeth grinding
airway
etc.

Question 11

Who have more sleep problems, the young or the elderly?

Answer 11

elderly

Question 12

What causes of morbidity and mortality can be caused by sleep deprivation?

Answer 12

• Car accidnets
• Cognitive harm
• CVD
• HTN
• CHF/PHTN
• A Fib

Question 13

How is the heart linked to sleep?

Answer 13

sleep interruptions arouse the brain (giving increases in epinephrine) so that you do not get normal BP drop at night

Question 14

How often do you have REM sleep?

Answer 14

every 90 minutes (and the periods of REM get longer as the night progresses)

Question 15

What is REM sleep associated with?

Answer 15

muscle paralysis and brain activity is ON

Question 16

What is the role of the thalamus in sleep? When you are awake?

Answer 16

produces disengagement during sleep

Awake: place where all sensory information stops before going to brain

Question 17

What is the role of the suprachiasmatic nucleus in sleep?

Answer 17

controls the “switch” of going to sleep at night and waking up in the morning

Question 18

What are of the brain controls the “need” for sleep?

Answer 18

hypothalamus

Question 19

What hormones are released when we are sleeping?

Answer 19

melatonin
growth hormone
prolactin
etc.

Question 20

What is OHS?

Answer 20

obesity hypoventilation syndrome (people have CO2 retention at night and during hte day)

Question 21

What is RLS?

Answer 21

restless leg syndrome

Question 22

What is parasomnia?

Answer 22

movement/behavior during sleep

Question 23

What causes periods of no breathing in sleep apnea?

Answer 23

hypoid bone is just attached to ligaments, so during REM sleep, when the muscles relax, the airway can collapse (usually collapse is correlated with weight gain pusing down on airway in neck)

Question 24

What is the prevalence of men and women aged 30-60 with diagnosed sleep apnea?*

Answer 24

4% men

2% women

Question 25

What percentage of people with sleep apnea are not diagnosed?

Answer 25

50%

Question 26

What are the common symptoms of sleep apnea?

Answer 26

snoring + day time sleepiness

Question 27

What is the treatment used for sleep apnea?

Answer 27

CPAP- cutaneous positive airway pressure

Question 28

What is a multiple sleep latency test?

Answer 28

EEG defined sleep latency during 4-5 daytime naps

Question 29

What is the Epworth sleepiness scale?

Answer 29

self-reported tendency to fall asleep in 8 different situations in their soporific nature

Question 30

What are the major symptoms of narcolepsy?

Answer 30

Excessive daytime sleepiness
Cataplexy
Hypnagogic hallucinations
sleep paralysis