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psych sleep disorders Flashcards

1
Q

how long is a cycle of sleep?

A

approx every 90 min, NREM sleep alernates with REM sleep;

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2
Q

progression through NREM

A

results in slower brain wave patterns and hgiher arousal thresholds

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3
Q

REM sleep brain wave pattern

A

resembles the EEG of an aroused person

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4
Q

vivid dream recall

A

assoc with awakening from REM sleep

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5
Q

dysomnias

A

insufficient, excessive, or altered timing of sleep

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6
Q

parasomnias

A

unusual sleep-related behaviors

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7
Q

primary insomnia

A

difficulty initiaing sleep (sleep onset insomnia), freq nocturnal awakenings (middle of the night or sleep maintenance insomnia)early morning awakenings (late night or sleep offset insomnia); waking up feeling fatigued (nonrestorative sleep)

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8
Q

acute insomnia

A

between 1 and 4 weeks; usually assoc with stress and resolves spontaneously

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9
Q

chronic insomnia

A

more than 4 weeks; assoc with reduced quality of life and increased risk of psych illness

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10
Q

dsm criteria for dyssomnias

A

difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 mo

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11
Q

treatment for dyssomnias

A

sleep hygiene measures; CBT; benzos, non-benzo sedatives, antidepressants

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12
Q

benzos used for dyssomnias

A

reduce sleep latency and nocturnal awakening; side effects incl development of tolerance, addiction, daytime sleepiness, and rebound insomnia

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13
Q

non-benzos used for dyssomnias

A

zolpidem (ambien), eszopiclone (Lunesta), and zaleplon (sonata); effective for short-term treatment; assoc with low incidence of daytime sleepiness or orthostatic hypotension

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14
Q

zolpidem in the elderly

A

increased risk of falls and may induce cognitive impairment

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15
Q

antidepressants used for dyssomnias

A

trazadone, amitrytpiline, and doxepin (off-label use)

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16
Q

most prescribed sedating antidepressant for patients with chronic insomnia and depressive sx

A

trazadone

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17
Q

morning headaches

A

can be a sign of OSA

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18
Q

narcolepsy tetrad

A

excessive daytime sleepiness or seep attacks plus REM-related sleep phenomena incl inability to move during transition from sleep to wake, hypnagogic or hypnopompic hallucinations; or a sudden loss of muscle tone evoked by strong emotion

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19
Q

cataplexy

A

sudden loss of muscle tone evoked by strong emotion without loss of consciousness

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20
Q

cataplexy occurs in what percent of people dx with narcalepsy

A

60-80 percent

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21
Q

treatment for narcolepsy

A

daytime naps; get at least 8 hrs of sleep; pharm treatment may incl stimulants and antidepressants

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22
Q

modafinil

A

stimulant effective in the treatment of narcolepsy

23
Q

sodium oxybate

A

treats narcolepsy, and is particularly effective in the treatment of cataplexy

24
Q

narcolepsy features

A

irresistible attacks of refreshing sleep that occur daily for at least 3 mos; cataplexy; hallucinations and/or sleep paralysis at the beginning or end of sleep episodes

25
Q

pathophy of narcolepsy

A

loss of hypothalamic neurons that contain hypocretin; may have autoimmune component

26
Q

treatment for narcolepsy

A

sleep hygiene; scheduled daytime naps; avoidance of shift work; amphetamines, other stimulants

27
Q

treatments for cataplexy

A

sodium oxybate (drug of choice); TCAs; SSRIs, SSNRIs

28
Q

idiopathic hypersomnia

A

excessive daytime sleepiness, prolonged nocturnal sleep episodes, and freq irresistible urges to nap; can be mild or as debilitating as narcolepsy

29
Q

Kleine-Levin syndrome

A

rare disorder characterized by recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hypersexuality, and aggression

30
Q

Circadian rhythm sleep disorders

A

caused by either intrinsic defects in the circadian pacemaker or imapired entrainment (absence of light)

31
Q

subtypes of circadian rhythm sleep disorder

A

delayed sleep phase disorder, shift-work disorder, and jet lage disorder

32
Q

parasomnias

A

abnormal behaviors or experiences that occur during sleep and are often assoc with sleep disruption; sx may include abnormal emotions, movements, dreams, and autonomic activity; common in childhood and adolescence

33
Q

sleepwalking

A

simple to complex behaviors that are initiated in slow wave sleep and result in walking during sleep

34
Q

what dose a sleepwalker look like?

A

eyes are open with a glassy look; difficulty arousing the sleepwalker during an episode; confusion on awakening, amnesia for episode; episodes usually end with patients returning to bed or awakening confused or disoriented

35
Q

sleepwalking occurs more often in kids with wha?

A

obstructive sleep apnea

36
Q

risk factors for sleep walking

A

sleep deprivation, irreg sleep schedules, stress, hyperthyroidism, OSA, seizures, migraines, meds, magnesium def

37
Q

which meds can increase risk of sleep walking

A

sedatives/hypnotics, lithium, and anticholinergics

38
Q

treatment for sleep walking

A

refractory cases may respond to clonazepam or other benzos or TCA

39
Q

sleep terrors

A

episodes of sudden arousal with screaming from slow wave sleep; sympathetic hyperactivation; after episode, patient returns to sleep without awakening; usually amnestic about episode;

40
Q

slow wave sleep

A

stages 3 and 4 on nonREM

41
Q

risk factors for sleep terrors

A

fever, nocturnal asthma, GERD, sleep deprivation, CNS-stimulating medications; other sleep disorder such as sleep apnea

42
Q

treatment for night terrors

A

reassurance that the condition is benign and self-limited; consider low dose short acting benzos in adults with refractory cases; sleep hygeine and psychotherapy

43
Q

nightmare disorder

A

recurrent frightening dreams that tend to terminate in awakening with vivid recall; no confusion or disorientation upon awakening; can lead to signif stress and anxiety

44
Q

treatment for nightmare diosorder

A

imagery rehearsal therapy (IRT) involves the use of mental imagery to modify the outcome of a recurrent nightmare; sever cases may benefit from antidepressants

45
Q

REM sleep behavior disorder

A

muscle atonia during REM slep and complex motor activity assoc with dream mentation (dream enactment); presenting complaint is usually violent behaviors during sleep

46
Q

risk factors for REM sleep behavior disorder

A

older age (between 60 and 70); psych meds like TCAs, SSRIs, and MAOIs; narcolepsy; brain stem lesions; dementis like olivopontocerbellar atrophy and diffuse lewy body disease

47
Q

treatment for REM sleep behavior disorder

A

clonazepam is effective in most patients; other agents incl imipramine, carbamazepine, pramipexole, or levodopa

48
Q

first line therapy from chronic insomnia

A

CBT

49
Q

the best reason to put a patient on longterm benzos

A

insomnia

50
Q

REM sleep autonomic

A

increae in bp, hr, and resp rate; this is counterintutive

51
Q

hypnagogic hallucination

A

when transitioning to sleep

52
Q

hypnopompic hallucination

A

when transitioning FROM sleep

53
Q

what part of the brain coordinates the 24 hour or circadian rhythmicity

A

SCN in the hypothalamus

54
Q

best treatment forrecurrent nightmares in PTSD

A

imagery rehearsal therapy

Psych (23 decks)

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