Sleep 1- SG Flashcards
Which type of sleep stage?
- Low amplitude
- Mixed frequency EEG (similar to ____)
- Bursts of rapid eye movements (similar to eyes open wakefulness)
- EMG activity ____ in nearly all skeletal muscle (brainstem mediated muscle atonia)
Rapid Eye Movment (REM)
- N1
- absent
Which type of sleep stage?
- 3 stages (N1, N2, N3)
- Increased arousal threshold & slowing of corticol EEG as move through the 3 stages
Non-rapid eye movement (NREM) sleep
- NREM and REM sleep alternate throughout the night, w/ an avg period of ___ to ___ mins
- Is more time spent in REM or NREM?
- Which stage of NREM gradually decreases throughout life?
- 90 - 110 mins
- NREM
- N3 (most regenerative stage)
- Body paralysis
- If awoken, usually vivid recall of dream imagery
REM
Which sleep stage?
- between wakefulness & deeper sleep
- May respond to faint auditory or visual signals
- Formation of short term memories inhibited
- If awoken, lack situational awareness
N1 of NREM
Which sleep stage?
- slow wave sleep
- regenerative
N3 of NREM
BP and HR
- Decrease during _____
- Large variations during _____
- Decrease: NREM sleep (esp. N3)
- Variable: REM sleep
Describe respiratory rate in NREM vs REM sleep
- NREM: slower, but regular (esp. N3)
- REM: irregular during bursts of REM
Endocrine
- ____ secretion in men which occurs in AM or PM?
- ____ secretion augmented
- Sleep onset & N3 sleep associated w/ inhibition of ___ and ___
- Sleep efficiency is highest when sleep episode coincides w/ endogenous ___ secretion
- GH in men at night
- Prolactin augmented
- inhibition of TSH & ACTH-cortisol axis
- endogenous melatonin secretion
- Over 50% of US adults have at least ____ sleep disturbance
- 30% of US adults report _____
- Sleep deprivation degrades ____ _____.
- Sleep deficiency may cause _____ contributing to development of what 7 things?
- intermittent
- consistently obtaining a sufficient amount of sleep
- cognitive performance
-
glucose intolerance –>
- DM / obesity / metabolic syndrome / impaired immunity / accelerated atherosclerosis / cardiac disease / stroke
- Average adult needs___ hours of sleep
- Most teens need ___ hours of sleep
- Causes what 4 things?
- Difficulty with what 3 things?
- Adult: 7.5 - 8 hrs
- Teens: 9+
- Causes: inattentive, irritable, unmotivated, depressed
- Difficulty w/: school, work, driving
7 essential components of PE for sleep disorders
- Airway
- Tonsils
- Neuro (mental status)
- Musculoskeletal
- Cardiac
- Pulm
- Abd
Duration of daily sleep log?
1-2 weeks
What is the dx tool for sleep disorders?
What medical setting can these tests be done?
- What are the 3 types?
Polysomnography
Sleep lab
- Electroencephalogram (EEG)
- Electrooculogram (EOG) –> measures eye mvmnt activity
- Surface electromyogram (EMG) –> measured on chin, neck, legs
Polysomnography (EEG, EOG, EMG) measures what 5 things?
- Sleep stages
- Resp effort/airflow
- O2 sat
- limb movement
- heart rhythm
Which test?
- Focus is on respiratory measures
- Helpful for Obstructive Sleep Apnea (OSA)
- *is only appropriate for pt that you think might have OSA)
Home sleep test
Which test?
- Measures propensity to sleep during day
- Helpful for narcolepsy (pt goes into REM right away)
- How many minutes within falling asleep is significant for narcolepsy?
Multiple Sleep Latency Test (MSLT)
- 8 mins
Which test?
- Measures ability to sustain wakefulness during daytime
- Helpful for evaluating efficacy of therapy, narcolepsy, and OSA (Obstructive Sleep Apnea)
Maintenance of Wakefulness Test
Scoring system used to measure how visible tonsils, uvual, and soft palate are and assesses risk for total collapse of airway (sleep apnea)
Mallampati Scoring
Scale used for measuring “chance of dozing off”
Epworth Sleepiness Scale (ESS)
How many diagnoses are there for sleep disorders?
60
Insomnia
- > 5 million office visits / year in US
- Greater prevalence in males or females?
- Younger or older adults?
- Employed or unemployed?
- Lower or higher SES?
- Married or divorced?
- Which 3 disorders?
- F>M
- Older adults
- Unemployed
- Lower SES
- Divorced / widowed separated
- Medical, psych, substance abuse disorders
- And meds
Dx criteria for Insomnia
- Sxs at least ___ x / week
- Sleep ____ or ____ problems
- Must have adequate ________.
- Must have ____ consequences
- 3
- initiation or maintenance of sleep
- opportunity and circumstance to sleep
- daytime (impacts life)
Short Term Insomnia
- < ___ months
- Can be related to ____, but to dx insomnia there should be an independent focus on insomnia
- Insomnia resolves when ____ resolves
- 3
- stressor
- stressor
Chronic Insomnia
- Lasts ___ months or longer
3
2 non-pharm tx options for Insomnia
- Sleep hygiene & stimulus control (no phone)
- Behavioral therapy (relaxation, CBT, sleep restriction therapy)
Which drug is not recommended for 1st line tx of Insomnia bc/ may cause dependence?
Benzodiazepines (PAM / LAM)
- Triazolam
- Estazolam
- Lorazepam
- Temazepam
- Flurazepam
- Quazepam
Insomnia
- _____ sedatives are a little less likely than benzos to cause dependence
- Zaleplon, Zolpidem, Escopiclone
Non-benzodiazephines
What type of drug for insomnia?
- Not going to get total sedative effect
- Remalteon
Melatonin agonist
What type of drug is this? (used for insomnia)
- Doxepin
Tricyclic antidepressant
What type of drug for insomnia?
- Suvorexant
- Is in the body and keeps you awake
Orexin antagonist
(orexin is in body)
28% of pts w/ untreated insomnia do what?
Self medication w/ ETOH
Insomnia is associated w/ what 4 conditions?
- Cardiovascular risk
- DM
- Depression
- Anxiety
___ and ____ are caused by repetitive collapse of the upper airway during sleep
Obstructive apneas & hypopneas
- Need ___ or more obstructive respiratory events per hour to dx OSA
-
Can dx w/ ___ or more events if pt has comorbid conditions
- signs/sxs of excessive sleepiness, fatigue, insomnia
- Waking up w/ breath holding, gasping, choking
- Habitual snoring, breathing interruptions
- HTN, mood disorder, cognitive dysfunction, CAD, stroke, HF, A.fib, DM 2
- 15
- 5 (if have a ton of sxs / comorbidities)
OSA (obstructive sleep apnea)
- Greater in men or women?
- Greater prevalence in which race?
- Is it increasing or decreasing in prevalence?
- M>F
- blacks
- increasing overall
5 risk factors for OSA
- Obesity
- Male sex
- Advanced age
- Craniofacial morphology
-
Upper airway soft tissue abnormalities
- abnormal maxillary or short mandibular size
- wide craniofacial base
- tonsillar hypertrophy
- adenoid hypertrophy
Clinical presentation of what condition?
- Excessive daytime sleepiness
- snoring
- choking / gasping during sleep
- Morning headache
OSA
PE of which condition?
- obesity
- crowded / narrow oropharyngeal airway
- Elevated BP
- Signs of pulm HTN or cor pulmonale
OSA
____ classification and _____ posiiton are used for OSA.
- Mallampati classification (visibility of oral cavity)
- Friedman tongue position
- Dx of OSA is made by what?
- 5 behavioral tx of OSA
- Polysomnography
- weight loss
- exercise
- sleep position
- avoid alcohol
- avoid benzos
- 1st line tx of OSA?
- 3 alternatives
- CPAP (continuous positive airway pressure)
-
Alternatives:
- oral appliances
- upper airway surgery
- hypoglossal nerve stimulation
Prognosis of OSA
- Decreased quality of life
- Impaired daily function
- Increased risk of ____
- Increased risk of poor ____ performance
- Adverse _____
- Associated w/ increased all cause and ____ mortality
- Avg nightly use of CPAP is ___ hours
- MVC
- neurocognitive
- medical outcomes
- cardiovascular
- 4
