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MJ- F2 E4- Neuro > Sleep 1- SG > Flashcards

Sleep 1- SG Flashcards

1
Q

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)
A

Rapid Eye Movment (REM)

  • N1
  • absent
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2
Q

Which type of sleep stage?

  • 3 stages (N1, N2, N3)
  • Increased arousal threshold & slowing of corticol EEG as move through the 3 stages
A

Non-rapid eye movement (NREM) sleep

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3
Q
  • 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?
A
  • 90 - 110 mins
  • NREM
  • N3 (most regenerative stage)
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4
Q
  • Body paralysis
  • If awoken, usually vivid recall of dream imagery
A

REM

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5
Q

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
A

N1 of NREM

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6
Q

Which sleep stage?

  • slow wave sleep
  • regenerative
A

N3 of NREM

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7
Q

BP and HR

  • Decrease during _____
  • Large variations during _____
A
  • Decrease: NREM sleep (esp. N3)
  • Variable: REM sleep
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8
Q

Describe respiratory rate in NREM vs REM sleep

A
  • NREM: slower, but regular (esp. N3)
  • REM: irregular during bursts of REM
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9
Q

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
A
  • GH in men at night
  • Prolactin augmented
  • inhibition of TSH & ACTH-cortisol axis
  • endogenous melatonin secretion
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10
Q
  • 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?
A
  • intermittent
  • consistently obtaining a sufficient amount of sleep
  • cognitive performance
  • glucose intolerance –>
    • DM / obesity / metabolic syndrome / impaired immunity / accelerated atherosclerosis / cardiac disease / stroke
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11
Q
  • Average adult needs___ hours of sleep
  • Most teens need ___ hours of sleep
  • Causes what 4 things?
  • Difficulty with what 3 things?
A
  • Adult: 7.5 - 8 hrs
  • Teens: 9+
  • Causes: inattentive, irritable, unmotivated, depressed
  • Difficulty w/: school, work, driving
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12
Q

7 essential components of PE for sleep disorders

A
  • Airway
  • Tonsils
  • Neuro (mental status)
  • Musculoskeletal
  • Cardiac
  • Pulm
  • Abd
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13
Q

Duration of daily sleep log?

A

1-2 weeks

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14
Q

What is the dx tool for sleep disorders?

What medical setting can these tests be done?

  • What are the 3 types?
A

Polysomnography

Sleep lab

  • Electroencephalogram (EEG)
  • Electrooculogram (EOG) –> measures eye mvmnt activity
  • Surface electromyogram (EMG) –> measured on chin, neck, legs
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15
Q

Polysomnography (EEG, EOG, EMG) measures what 5 things?

A
  • Sleep stages
  • Resp effort/airflow
  • O2 sat
  • limb movement
  • heart rhythm
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16
Q

Which test?

  • Focus is on respiratory measures
  • Helpful for Obstructive Sleep Apnea (OSA)
  • *is only appropriate for pt that you think might have OSA)
A

Home sleep test

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17
Q

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?
A

Multiple Sleep Latency Test (MSLT)

  • 8 mins
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18
Q

Which test?

  • Measures ability to sustain wakefulness during daytime
  • Helpful for evaluating efficacy of therapy, narcolepsy, and OSA (Obstructive Sleep Apnea)
A

Maintenance of Wakefulness Test

19
Q

Scoring system used to measure how visible tonsils, uvual, and soft palate are and assesses risk for total collapse of airway (sleep apnea)

A

Mallampati Scoring

20
Q

Scale used for measuring “chance of dozing off”

A

Epworth Sleepiness Scale (ESS)

21
Q

How many diagnoses are there for sleep disorders?

A

60

22
Q

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?
A
  • F>M
  • Older adults
  • Unemployed
  • Lower SES
  • Divorced / widowed separated
  • Medical, psych, substance abuse disorders
  • And meds
23
Q

Dx criteria for Insomnia

  • Sxs at least ___ x / week
  • Sleep ____ or ____ problems
  • Must have adequate ________.
  • Must have ____ consequences
A
  • 3
  • initiation or maintenance of sleep
  • opportunity and circumstance to sleep
  • daytime (impacts life)
24
Q

Short Term Insomnia

  • < ___ months
  • Can be related to ____, but to dx insomnia there should be an independent focus on insomnia
  • Insomnia resolves when ____ resolves
A
  • 3
  • stressor
  • stressor
25
Q
A
26
Q

Chronic Insomnia

  • Lasts ___ months or longer
A

3

27
Q

2 non-pharm tx options for Insomnia

A
  • Sleep hygiene & stimulus control (no phone)
  • Behavioral therapy (relaxation, CBT, sleep restriction therapy)
28
Q

Which drug is not recommended for 1st line tx of Insomnia bc/ may cause dependence?

A

Benzodiazepines (PAM / LAM)

  • Triazolam
  • Estazolam
  • Lorazepam
  • Temazepam
  • Flurazepam
  • Quazepam
29
Q

Insomnia

  • _____ sedatives are a little less likely than benzos to cause dependence
  • Zaleplon, Zolpidem, Escopiclone
A

Non-benzodiazephines

30
Q

What type of drug for insomnia?

  • Not going to get total sedative effect
  • Remalteon
A

Melatonin agonist

31
Q

What type of drug is this? (used for insomnia)

  • Doxepin
A

Tricyclic antidepressant

32
Q

What type of drug for insomnia?

  • Suvorexant
  • Is in the body and keeps you awake
A

Orexin antagonist

(orexin is in body)

33
Q

28% of pts w/ untreated insomnia do what?

A

Self medication w/ ETOH

34
Q

Insomnia is associated w/ what 4 conditions?

A
  • Cardiovascular risk
  • DM
  • Depression
  • Anxiety
35
Q

___ and ____ are caused by repetitive collapse of the upper airway during sleep

A

Obstructive apneas & hypopneas

36
Q
  • 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
A
  • 15
  • 5 (if have a ton of sxs / comorbidities)
37
Q

OSA (obstructive sleep apnea)

  • Greater in men or women?
  • Greater prevalence in which race?
  • Is it increasing or decreasing in prevalence?
A
  • M>F
  • blacks
  • increasing overall
38
Q

5 risk factors for OSA

A
  • 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
39
Q

Clinical presentation of what condition?

  • Excessive daytime sleepiness
  • snoring
  • choking / gasping during sleep
  • Morning headache
A

OSA

40
Q

PE of which condition?

  • obesity
  • crowded / narrow oropharyngeal airway
  • Elevated BP
  • Signs of pulm HTN or cor pulmonale
A

OSA

41
Q

____ classification and _____ posiiton are used for OSA.

A
  • Mallampati classification (visibility of oral cavity)
  • Friedman tongue position
42
Q
  • Dx of OSA is made by what?
  • 5 behavioral tx of OSA
A
  • Polysomnography
  1. weight loss
  2. exercise
  3. sleep position
  4. avoid alcohol
  5. avoid benzos
43
Q
  • 1st line tx of OSA?
  • 3 alternatives
A
  • CPAP (continuous positive airway pressure)
  • Alternatives:
    • oral appliances
    • upper airway surgery
    • hypoglossal nerve stimulation
44
Q

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
A
  • MVC
  • neurocognitive
  • medical outcomes
  • cardiovascular
  • 4

MJ- F2 E4- Neuro (19 decks)

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