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Lifestyle Medicine > Sleep > Flashcards

Sleep Flashcards

1
Q

Ways to define sleep?

A

Duration
Timing
Quality

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2
Q

Having a sleep disorder increases mortality by how much?

A

1.5 x

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2
Q

What is the body’s master circadian clock?
ie control center for sleep and arousal

Where is it located?

A

Suprachiasmatic nucleus (SCN)

in the hypothalamus

oscillator and pacemaker

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3
Q

What are ‘zeitgebers’?

A

internal and external stimuli
- that entrain the master clock

Most potent –>Light

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4
Q

Melatonin is produced by what?

What does it do?

A

Pineal gland
- night hormone
Promotes night time things and sleep

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5
Q

Melatonin peaks when?

A

30 mins before anticipated bedtime

Plateaus for rest of night
Rapidly decreases close to subjective day
Melatonin ceases at first light exposure, approx 30 min after wake

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6
Q

What does melatonin inhibit?

A

SERT
- sodium dependent serotonin transporter

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7
Q

Physiologic changes induced by healthy sleep?

A

Lower cortisol
Lower glucose
Greater insulin sensitivity
Higher daytime leptin
- reduced food seeking behav

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8
Q

Healthy sleep impact on CV disorders

A

Lower sympathetic tone
Low BP
Greater night peripheral perfusion
Core body temp cooling (night)
Increased stamina
Faster CV recovery time

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9
Q

Appropriate duration and timing of REM is associated with…?

A
  • enhanced learning and memory
  • faster cognitive processing
  • greater extinguishment of anxiety and fear
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10
Q

When should you order a PSG study?
ie for which disorders?

A

Breathing-related sleep disorder
Narcolepsy
Nocturnal seizures
Periodic limb movement disorder
REM sleep behaviour disorder

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11
Q

For what conditions is a PSG not required?

A

Circiadian rhythm disorder
Insomnia disorder
NREM partial arousal parasomnia
Nightmare disorder
Restless legs syndrome

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12
Q

NREM stages

A

Stage 1.
- slow brain waves
- 2% of night
- enter sleep

Stage 2.
- 50% of night
- logical dreams

Stage 3.
- 20-25% of night
- deep sleep (good for memory)
- delta waves
- first half of the night
- restorative

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13
Q

Features of NREM sleep?

  • sensation/perception
  • thoughts
  • movement
A

sensation and perception
- dulled/absent

thoughts
- logical and perseverative

movement
- episodic and involuntary

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14
Q

Features of REM sleep?

  • sensation/perception
  • thoughts
  • movement
A

sensation and perception
- vivid
- internally generated

thoughts
- illogical and bizarre

movement
- inhibited

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15
Q

How long in REM?
First episode how long after sleep?
Most of REM occurs when?
REM important for?

Dreaming?

A

20-25% of night
90-120 min
2nd half
memory, brain dev, emotional consolidation
Most dreaming occurs here

16
Q

Sleep assessment tools?

A

Sleep diary
Retrospective mini sleep ass’t
SQS (single item sleep quality scale)
Pittsburgh Sleep Quality Index
STOP-BANG
ESS
ASHS (adolescent sl hygeine survey)

17
Q

STOP-BANG

A

Snoring
Tired, often
Observed apnoea
Pressure, elevated
BMI > 35
Age > 50
Neck size > 43cm
Gender, male

18
Q

How to manage:

Delayed sleep onset or
Difficulty with sleep initiation

A

Enviro: bed only for sleep and sex, min noise and light , warm extremeties at bedtime

Light exp: early morning sun, afternoon activity, less light at night

Diet: reduce caffeine, etoh, sodium at night, carb rich bf and low carb dinner

Exercise: morning or afternoon

Stress: start winding down > 1 hr before bed; bath, meditation

19
Q

How to manage:

Sleep fragmentation or
Difficulty maintaining sleep

A

Enviro: darken bedroom, cool room during night, keep glass of cool water at bedside

Light exp: imcrease morning and mid-afternoon sunlight exposure, activity outdoors, avoid turning on light for middle of night wakings

Diet: increase late afternoon hydration, avoid evening diuretics (soda, caffeine, alcohol)

Exercise: without pain

Stress: mitigate worrying, planing, ruminatin

20
Q

How to manage:

Sleep deficiency from waking too early

A

Enviro: sufficient bedcovers to be warm in early morning

Light exp: avoid bright light until ideal wake time, increase late afternoon / evening sunlight (to increase melatonin prod); use blue spectrum lights until 1hr before bedtime

Diet: avoid caffeineuntil 30-60 mins after ideal wake time; have more carbs at dinner (not bf)

Exercise: increase evening physical activity

21
Q

How to manage:

Jetlag traveling east

A

Light exp: exposure to bright light (pref outside) close to new ideal wake time; only dim light starting 1 hour before new bedtime

Diet: hearty bf within 30-45 min of new ideal wake time

Melatonin may assist

22
Q

How to manage:

Jetlag traveling east

A

Enviro: darken bedroom, cool room during night, keep glass of cool water at bedside

Light exp: imcrease morning and mid-afternoon sunlight exposure, activity outdoors, avoid turning on light for middle of night wakings

Diet: increase late afternoon hydration, avoid evening diuretics (soda, caffeine, alcohol)

Exercise: without pain

Stress: mitigate worrying, planing, ruminating

23
Q

How to manage:

Sleep deficiency from waking too early

A

Enviro: sufficient bedcovers to be warm in early morning

Light exp: avoid bright light until ideal wake time, increase late afternoon / evening sunlight (to increase melatonin prod); use blue spectrum lights until 1hr before bedtime

Diet: avoid caffeineuntil 30-60 mins after ideal wake time; have more carbs at dinner (not bf)

Exercise: increase evening physical activity

24
Q

How to manage:

Jetlag traveling east

A

Light exp: exposure to bright light (pref outside) close to new ideal wake time; only dim light starting 1 hour before new bedtime

Diet: hearty bf within 30-45 min of new ideal wake time

Melatonin may assist

25
Q

How to manage:

Jetlag traveling west

A

Light exp: late afternoon and early evening bright light, pref outside; avoid dim light until 1 hour before ideal sleep time

Diet: hearty bf within 30-45 min of new ideal wake time; complex carb rich dinner 2-3 hrs before new ideal sleep time

Melatonin may assist

26
Q

OSA severity (AHI)

Mild
Mod
Severe

A

Mild 5 < 15
Mod 15 < 30
Severe 30+

27
Q

Indications for a sleep specialist referral

A

Requires PSG
RLS
Narcolepsy
Periodic limb movement

28
Q

CBT-i

when?

A

If doesn’t need PSG
If non adherent to CPAP

29
Q

Methods of CBT-i

A
  1. Behavioural therapies (SCT)
  2. Sleep restriction therapy
  3. Relaxation training therapy
30
Q

Stimulus control therapy

A

Limit bed to sleep and sex
If unable to sleep in 15-20 min, get out of bed and do low-key activity until feeling sleepy
Return to bed to attempt sleep
Repeat until sleep occurs

31
Q

Sleep Restriction therapy

A

Stable bedtime / wake time
- strengthen circadian rhythm

Lifestyle Medicine (9 decks)

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