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MJ- F2 E4- Neuro > Sleep 2- SG > Flashcards

Sleep 2- SG Flashcards

1
Q

Central Disorders of Hypersomnolence

  • Be sure to evaluate for ____ prior to dx
A

Sleep Deprivation

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2
Q

Which condition?

  • Loss of hypothalamic neurons that produce orexin neuropeptides (hypocretins)
  • May have autoimmune component
A

Central DIsorders of Hypersomnolence

Narcolepsy

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3
Q

People w/ narcolepsy have what 3 issues/

A
  • Difficulty sustaining wakefulness
  • Poor regulation of REM sleep (immediately enter REM sleep)
  • Disturbed nocturnal sleep
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4
Q

Which type of narcolepsy?

  • w/ cataplexy
  • w/o cataplexy
A
  • w/ : type 1
  • w/o : type 2
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5
Q

Definition:

Sudden muscle weakness w/o LOC, usually triggered by strong emotions

A

Cataplexy

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6
Q

2 alternative presentations of narcolepsy besides with or without cataplexy

A
  • Hypnagogic hallucinations (dream like hallucinations at sleep onset or upon awakening - hypnopompic)
  • Sleep paralysis - muscle paralysis upon awakening or just before falling asleep
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7
Q

Narcolepsy

  • Excessive daytime sleepiness (usually severe)
  • Feel ____ upon awakening
  • Have episodes of _____
  • Epworth sleepiness scale score is typically > __
  • Besides excessive daytime sleepiness, also associated w/ what 4 things?
A
  • rested
  • “sleep attacks”
  • 15
  1. Fragmented sleep
  2. other sleep disorders
  3. psych comorbidities
  4. obesity
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8
Q

Dx of Narcolepsy

  • Start w/ _____
  • _____ to r/o other causes
    • REM sleep within ___ mins of sleep onset at night
A
  • H&P
  • Polysomnogram
    • 15 mins
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9
Q

Which test for narcolepsy?

  • Sleep latency <8 mins
  • REM episodes in at least 2 of the naps
A

Multiple Sleep Latency Test

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10
Q

Pts w/ Narcolepsy should avoid what 4 things?

A
  • Benzos
  • Opiates
  • Antipsychotics
  • Alcohol

(BOAA)

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11
Q

Pts w/ narcolepsy should get adequate sleep at night, along w/ what type of naps?

A

1 to 2 well timed 20 minute naps

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12
Q

Screen narcolepsy pts for what 3 things?

A
  • depression
  • anxiety
  • CV risk
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13
Q

1st line pharm tx for narcolepsy?

A
  • Wake promoting medication: Modafinil
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14
Q

Which drug for narcolepsy?

  • CNS stimulant
  • Potent wakefulness promoting drug
A

Methylphenidate

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15
Q

Which drug for narcolepsy?

  • CNS stimulant
  • MOST potent wakefulness promoting drug
A

Amphetamines

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16
Q

Which 2 medications should be prescribed for cataplexy?

A
  • Antidepressants (increase noradrenergic / serotonergic tone)
  • Sodium oxybate (CNS depressant)
17
Q

What 3 medications are used in Narcolepsy which suppress REM sleep and Cataplexy?

A
  • Venlafaxine
  • Fluoxetine
  • Tricyclics
18
Q

Which condition?

  • Chronic / recurrent pattern of sleep wake rhythm disruption caused by an alteration in endogenous circadian timing system & desired/required sleep wake schedule
  • Sxs duration of at least 3 months
  • “shift work disorder”
  • Jet lag disorder
A

Circadian rhythm sleep-wake disorders

19
Q

Which condition?

  • Fragmented sleep
  • Difficulty falling asleep
  • Difficulty staying asleep
  • Poor sleep quality
  • Reduced sleep duration
A

Circadian Rhythm Sleep Wake Disorders

(shift work disorder)

20
Q

2 types of therapies for Circadian Rhythm Sleep-Wake Disorders (shift work disorder)

A
  • CBT
  • Therapeutics such as: short acting hypnotic agent, exogenous melatonin, caffeine, wake promoting agents
21
Q

Circadian rhythm sleep wake disorder (shift work disorder)

Prognosis

  • RIsk of ____
  • Negative impact on ___ resulting in what 4 things?
  • ___ concerns
A
  • insomnia
  • work ->
    • absenteeism
    • reduced productivity
    • increased injuries
    • increased illnesses
  • Safety
22
Q

Which condition?

  • Undesirable physical events (movements/behaviors)
  • Undesirable experiences (emotions, perceptions, dreams)
  • More common in _____
A

Parasomnias

  • Children
23
Q

4 NREM related disorders of arousal w/ Parasomnias?

A
  • Confusional arousal
  • Sleepwalking
  • Sleep terrors
  • Sleep-related eating disorder

(TWEC)

24
Q

REM related Parasomnias involve intrusion of the features of REM sleep into wakefulness

  • 3 disorders of this?
  • What is NOT a parasomnia, but is mistaken as such?
A
  • Sleep paralysis
  • Exaggerated features of REM sleep (nightmare disorder)
  • Aberrations of REM sleep physiology (lack of atonia) atonia = muscles completely relaxed during REM
  • Sleep talking (NOT a parasomnia)
25
Q

Which condition?

  • Dysfunction in orchestration of neural pathways regulating wake, NREM, and REM –> leads to state dissociation
A

NREM related Parasomnias

26
Q

NREM related parasomnias usually occur during which stage?

A

N3 in the first 1/3 of major sleep period

27
Q

Criteria for what disorder?

  • Recurrent episodes of incomplete awakening
  • Absent / inappropriate responsiveness
  • Limited or no cognition or dream report
  • Partial or complete amnesia for event
A

NREM related parasomnias

28
Q

Dx of NREM related parasomnias is made by what 2 things?

A
  • History
  • PSG (if comorbid sleep disorder is suspected) -Polysomnography
29
Q

Precipitating factors of what?

  • Sleep deprivation
  • Emotional stress
  • Fever, menses, environmental / internal stimuli
  • Comorbid sleep disorders (OSA, periodic limb movement)
  • Medications / substances
A

NREM related parasomnias

30
Q

Which condition?

  • Sudden arousal from sleep associated w/ sitting up in bed, intense fear, piercing scream
  • Intense autonomic activation (tachycardia, tachypnea, diaphoresis, facial flushing, mydriasis)
  • Appear frightened / confused / inconsolable
  • Difficult to arouse
  • Usually no recollection of events
  • Lasts ____ mins
  • Calmly, quietyly return to sleep (do not interfere / try to wake pt)
A

Sleep Terrors

(NREM related Parasomnia)

31
Q

Which condition?

  • Slow quiet ambulation w/ eye open
  • Possible activities: such as what?
  • How does the episode end?
  • Appears confused
  • _____ when aroused
  • Self injury common or not common?
A

Sleep Walking (NREM parasomnia)

  • preparing food, eating, cleaning, rearranging furniture, driving, inappropriate behavior (urinating in closet)
  • Terminates spontaneously
  • agitated/aggressive when aroused
  • Self injury is NOT uncommon
32
Q

Which condition?

  • Variant of sleepwalking
  • Involuntary eating associated w/ diminished LOC during an arousal from sleep
  • NOT linked o daytime eating disturbances
A

Sleep related eating disorder (NREM parasomnias)

33
Q

How do you manage a pt w/ NREM parasomnias?

A
  • Avoid sleep deprivation
  • Avoid ETOH
    Avoid certain meds
  • Maintain consistent, regular sleep-wake cycles
  • Safety interventions
  • Bystanders should allow pt to move freely
  • Bystanders should ensure safety w/o yelling, screaming, or arousing pt (gently coax pt back to bed)
  • Anticipatory awakening (wake pt before sleep terror bc you shouldn’t wake pt during)

MJ- F2 E4- Neuro (19 decks)

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