Sleep Flashcards
General considerations about sleep
Must be systematically assessed
It’s important to compare the current problem with their baseline
Can be measured with polysomnography
The stages of sleep
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.
Sleep patterns vary with age
Children and adolescents have large amounts of slow wave sleep.
As we age, sleep continuity and depth decreases
Insomnia
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.
Insomnia is associated with these poor outcomes:
Increased mortality
Increased hospitalization
Increased eating
Poor functioning at work
Etiology of insomnia
Dysfunction in sleep-wake circuits in the brainstem
Neurochemical imbalance
May be stress related
Risk factors for insomnia
Female Older Stress Genetic (sleep apnea) Benzos
Hypersomnolence disorder
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
Obstructive Sleep Apnea
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
What lab do you check if they have restless leg syndrome
Ferritin
Avoiding supine sleep position
may alleviate apnea
Melatonin
It’s good for sleep onset issues
Also good for ADHD
Benzos and hypnotics
should not be used in OSA
Flurazepam
Long-acting
May cause excessive drowsiness
Not good for older adults
Temazepam
Intermediate acting
according to Hunter it’s good for older people
Triazolam
Short-acting
Doesn’t cause excess sedation
It can cause impaired memory, efficacy decreases over time, and shouldn’t be used long term
Non benzo hypnotics
Zalephon Zolpidem Eszopiclone Rozerem Suvorexant Orexin
Zaleplon
Ultra-short acting, so it’s good for initial or middle phase
Zolpidem
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
Eszopiclone
Intermediate acting
Rozerem
Melatonin receptor agonist
Suvorexant
Orexin antagonist, suppresses wakefulness
Long acting
Antidepressants used for sleep
Amitriptyline and doxepin (TCAs). Not good for older people
Armodafinil
Used for wakefulness in OSA
Non pharm sleep treatment
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
Insomnia in children
Usually means they’re stressed
Usually they’ve been poor sleepers since birth
Meds are not recommended for children
Insomnia in older people
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
In older people, insomnia often manifests as
confusion and restlessness
