Sleep

Question 1

General considerations about sleep

Answer 1

Must be systematically assessed

It’s important to compare the current problem with their baseline

Can be measured with polysomnography

Question 2

The stages of sleep

Answer 2

There are 4 stages:

Stage 1 is when you are falling asleep. 5% of the cycle.
Stage 2 has specific EEG waves. It’s 50% of the cycle.
Stage 3 and 4 are the slow wave sleep periods. These are the deepest sleep. It’s 20 to 25% of the cycle.

REM sleep occurs throughout the night; alternating between REM and NREM every 80 to 100 minutes.

REM increases in duration toward morning.

Question 3

Sleep patterns vary with age

Answer 3

Children and adolescents have large amounts of slow wave sleep.

As we age, sleep continuity and depth decreases

Question 4

Insomnia

Answer 4

It’s the inability to get enough sleep to function efficiently

The interruption can be in any phase of sleep

It occurs at least 3 times a week for at least a month. If it goes for at least a month, it’s episodic, if it goes for more than 3 months, it’s persistent.

It’s not better explained by another sleep disorder.

Question 5

Insomnia is associated with these poor outcomes:

Answer 5

Increased mortality
Increased hospitalization
Increased eating
Poor functioning at work

Question 6

Etiology of insomnia

Answer 6

Dysfunction in sleep-wake circuits in the brainstem

Neurochemical imbalance

May be stress related

Question 7

Risk factors for insomnia

Answer 7

Female
Older
Stress
Genetic (sleep apnea)
Benzos

Question 8

Hypersomnolence disorder

Answer 8

It’s when you’re too sleepy even though you sleep enough at night

Occurs at least 3 times a week for several months

May occur within 18 months of a head trauma

Question 9

Obstructive Sleep Apnea

Answer 9

Like hypersomnolence, you’re sleepy despite sleeping, but with OSA you have snoring and apnea.

Common to have a headache in the morning, panic attacks, wake up gasping, ADHD, depression, HTN, accidents.

It’s caused by an abnormally small nasopharynx, tonsillar problems in kids, and obesity

Question 10

What lab do you check if they have restless leg syndrome

Answer 10

Ferritin

Question 11

Avoiding supine sleep position

Answer 11

may alleviate apnea

Question 12

Melatonin

Answer 12

It’s good for sleep onset issues

Also good for ADHD

Question 13

Benzos and hypnotics

Answer 13

should not be used in OSA

Question 14

Flurazepam

Answer 14

Long-acting

May cause excessive drowsiness

Not good for older adults

Question 15

Temazepam

Answer 15

Intermediate acting

according to Hunter it’s good for older people

Question 16

Triazolam

Answer 16

Short-acting

Doesn’t cause excess sedation

It can cause impaired memory, efficacy decreases over time, and shouldn’t be used long term

Question 17

Non benzo hypnotics

Answer 17

Zalephon
Zolpidem
Eszopiclone
Rozerem
Suvorexant
Orexin

Question 18

Zaleplon

Answer 18

Ultra-short acting, so it’s good for initial or middle phase

Question 19

Zolpidem

Answer 19

Short-acting, but it can still make you sleepy the next day.

You need to have 8 hours to spare and you need to take it on an empty stomach

Question 20

Eszopiclone

Answer 20

Intermediate acting

Question 21

Rozerem

Answer 21

Melatonin receptor agonist

Question 22

Suvorexant

Answer 22

Orexin antagonist, suppresses wakefulness

Long acting

Question 23

Antidepressants used for sleep

Answer 23

Amitriptyline and doxepin (TCAs). Not good for older people

Question 24

Armodafinil

Answer 24

Used for wakefulness in OSA

Question 25

Non pharm sleep treatment

Answer 25

Don’t lay awake for more than 15 minutes

Don’t exercise late in the day

Biofeedback

Sleep curtailment

Light therapy

Warm bath, warm milk

Question 26

Insomnia in children

Answer 26

Usually means they’re stressed

Usually they’ve been poor sleepers since birth

Meds are not recommended for children

Question 27

Insomnia in older people

Answer 27

If the problem doesn’t begin until old age, it’s usually from a change in chronobiological rhythms

Sleep latency, decreased REM, and increased fragmentation are common,

The insomnia could be related to an underlying disorder, like alzheimers

Question 28

In older people, insomnia often manifests as

Answer 28

confusion and restlessness