Sleep Flashcards
a physiologic state of relative unconciousness and inaction of the voluntary muscles, the need for which recurs periodically
sleep
stage 1 sleep
light sleep
stage 2 sleep
K complexes and sleep spindles
stage 3-4 sleep
slow wave sleep; restorative sleep
REM sleep
rapid eye movement sleep; dream sleep
elderly sleep patterns
more stage II and less REM
the biological clock is located in what part of the brain
suprachiasmatic nucleus
what two other things are regulated by circadian rhythm besides sleep
body temperature and cortisol secretion
what structures within the brain are important for sleep
basal forebrain
anterior hypothalamus
dorsolateral medullary reticular formation
chemicals that are important for sleep
serotonin
melanocyte stimulating hormone
prostaglandin D2
uridine
what is the most common sleep disorder
insomnia
is the inability to fall asleep or to maintain sleep
insomnia
insomnia prevalence increases with
age, medical psychatric and substance abuse problems
insomnia is more prevalent in men or women
women
examples of predisposing factors for insomnia
sleep wake cycle
circadian rhythm
coping mechanism
age
examples of precipitating factors of insomnia
situational environmental, medical, psychiatric and medication
examples of perpetuating factors of insomnia
conditioning
substance abuse
performance anxiety
poor sleep hygiene
what is transient insonia
last for SEVERAL days and results from acute stress or environmental changes
what is short term insonia
can last up to 3 weeks duration and results from more severe causes such as bereavement, emotional trauma, hospitalization and pain
what is chronic insomnia
last greater than 3 weeks in duration and is associated with physical and emotional illnesses as well as medications, alcohol or illicit drugs (only 10% however are substance abusers)
what are the goals in treatment of insomnia
resolve underlying problems
improve quality of life
prevent progression of transient insomnia to chronic insomnia
examples of sleep hygiene
do something enjoyable and relaxing avoid taking trouble to bed make bedroom comfortable use bedroom for sleep or sex avoid alcohol/caffeine avoid napping avoid exercising too late maintain regular schedule
examples of stimulus control
go to bed only when your sleepy and get out of bed when you are unable to sleep, darken the room and reduce noise
examples of thought therapy
yells “stop”—>thought stopping
combined therapy
non-pharmacologic therapy lowest dose of sleeper short term use of sleeper psychiatric care drug withdrawal or rehabilitation assess for other causes
sedating antidepressants are contraindicated with
BPH or cardiovascular disease
example of a sedating antidepressant
amytriptaline
caution in what popuatlion should be used in patients with sedating antidepressants
elderly (at risk for falling)
examples of antihistamines
hydroxyzine and diphenhydramine
antihistamines may do what to insonia
worsen or cause insomnia
side effects of antihistamines include
anticholinergic side effects
causes of restless leg syndrome
idiopathic, pregnancy, uremia, RA, iron deficiency, peripheral neuropathy, drug withdrawal and myelopathy
treatment of restless leg syndrome
anti-parkinson meds
benzodiazepine (chlonafin, lorazapam, chlorazapam)
opiates
tricyclic antidepressants such as amytriptaline, neurotin, and GABA pentin
most common disorder of excessive daytime somnolence
sleep apnea
patients are sleepy and have headaches, insomnia, memory trouble, irritable, slow reaction time, hypertension, and nocturia
sleep apnea
what is the etiology of sleep apnea
obesity and possibly altered nasopharyngeal structures
how do you diagnose sleep apnea
sleep apnea
what is the treatment for sleep apnea
lose weight CPAP tennis balls surgery-UPPP avoid taking sleepers and alcohol
what chromosome is associated with narcolepsy
chromosome 6 (HLA-DR2/DQ1*0602)
first symptoms of nacrolepsy begin when
second decade
deficiency of hypocretin 2 (orexin B) is associated with
nacrolepsy
what is the tetrad associated with narcolepsy
excessive daytime sleepiness
cataplexy
sleep paralysis
hypnagogic hallucinations
the differential diagnosis for narcolepsy include
disorders of excessive insomence and epilepsy
how do you diagnose narcolepsy
history and physical and sleep study
treatment of narcolepsy
education
scheduled naps
exercise
medications
what are some common medications for treatment of nacrolepsy
caffeine pemoline methyphenidate tricycclin antidepressants (decream REM) modafil, armodafinil sodium oxybate (good drug for cataplexy part)
REM suppression and rebound
alcohol, drugs such as MAOI, tricyclic antidepresants and sleep deprivation
when does somnabulism occur
stage III and IV
somnabiulism
sleep walking
pavor noturnus
night terros
age group affected by pavor notrunus
2-12 years of age
what are pavor notrunus characterized by
screaming, crying, or intense fear; stage III and IV sleep which lasts 3-5 minutes
stages of sleep affected by night terrors
III and IV
what is treatment for night terros
psychological
guard against injury
benzodiazepines
avoid precipitating causes like loud noises, medications, full bladder and sleep deprivation
age group affected by nocturnal enuresis
age 4-14
are boys or girls more susceptible for bedwetting
boys>girls
what things should you rule out with nocturnal enuresis
diabetes mellitus
urinary tract infection
diabetes insipidus
seizure and myelopathy
medications for nocturnal enuresis
imipramine for 5 months
DDAVP (desmopressin) usually short term
