Sleep Flashcards
What are the determinants of sleepiness?
duration of prior wakefulness circadian aging drugs sleep disorder
What’s this?
linked to sun
affects most living creatures
occurs even when isolated from time cues
circadian rhythm
Disruptions of circadiam rhythm is associated with (blank) and shortens life
tumors
Things contributing to circadian rhythm
wake/sleep hormonal temperature immune drug metabolism renal function airway function
What % of pts presenting to primary care physicians report sleeping probs?
50%
How many non-REM stages of sleep are there? How many REM stages? What is the order? How often does it repeat?
4 non-REM; 1 REM
1, 2, 3, 4, 4, 3, 2, REM
repeats every 80-100mins
What type of sleep is this?
dreaming
inhibition of muscular activity
REM sleep
What type of sleep is this?
restorative sleep
disinhibition of muscular activity
parasomnias
stage 3 and 4
SLOW WAVE SLEEP
What happens to periods of REM sleep across the night?
they become longer
When does slow wave sleep typically occur? When does REM sleep typically occur?
during the earlier portions of the night; REM sleep in the last 1/3 of the night
In what sleep stage do we spend most of our time? How much time is spent in REM sleep?
50% of time in stage 2
25% of time in REM
As we age, what are some changes to our sleep?
Just think: overall, bad changes increased light/transitional sleep reduced slow wave sleep reduced sleep time increased awakenings decreased REM reduced sleep efficiency
What are the chief complaints of pts concerning sleep?
fatigue trouble sleeping poor sleep quality not enough sleep abnormal behaviors while sleeping snoring
Why is it important to take a sleep history?
sleep disorders are underdiagnosed
*sleeping probs are one of the most common problems presented to PCPs
What leads to more car accidents, sleep apnea or insomnia?
insomnia
What’s this?
Difficulty initiating, maintaining, or non - restorative sleep
Most common sleep disorder
insomnia
What % of American adults experience insomnia during a 1yr period
30-50%
What’s this?
Difficulty falling asleep
Longer time to sleep onset
sleep onset insomnia
What’s this?
Difficulty staying asleep
Frequent nocturnal awakenings
sleep maintenance insomnia
What’s this?
Waking too early in the morning
sleep offset or late insomnia
What’s this?
Fatigue despite adequate sleep duration
nonrestorative sleep
What are some things that can lead to transient/episodic insomnia?
acute illness
jet lag
shift change
What defines the time limit for short-term insomnia? What are some things that can lead to short-term insomnia?
few days - 3 weeks;
major life event
substance abuse
What time span defines chronic insomnia? What are some things that can lead to chronic insomnia?
> 3 weeks;
chronic illness, psychiatric illness
Total annual cost of insomnia?
$30-107 billion
What is the most common treatment approach to insomnia?
medication
Is medication effective for chronic insomnia?
NO, tolerance and dependency may develop, as well as withdrawal and relapse
**despite these effects, still commonly used
What can these factors lead to:
Circadian dysregulation
The arousal system working too well at the wrong time, and
Sleep-incompatible conditioning to interfere with wake->sleep transition
Sleep fragmentations
chronic insomnia
What is the first step to getting “sleep organized?”
anchoring the body clock
*wake up each day at the same time, even on weekends
What are some non-pharm strategies to better sleep?
promote sleep hygiene
stimulus control *correlate bed w sleep only
sleep restriction *limit time in bed
relaxation training
cognitive therapy *address thoughts that interfere w sleep
CBT
What are these components of?
- reduce arousal (eliminate stimulants, exercise, create sleep conducive environment, avoid clock watching)
- regulate sleep and circadian rhythm
proper sleep hygiene
What are these? Progressive muscle relaxation (PMR) Tense release exercises Passive muscle relaxation Body scan Imagery Meditation (Mindfulness) Biofeedback Diaphragmatic Breathing Slow, deep breathing
relaxation techniques
What are these? wind down time before bed review to do lists and set plans for tomorrow schedule worry time stress management
other methods to reduce arousal
What’s this?
Wake up at the same time (including weekends). Set alarm.
Go to bed only when sleepy
Use bed only for sleep and sex.
Get out of bed when unable to fall asleep
Avoid daytime napping
stimulus control
What are these? Erratic, variable schedule Lack of consistent time cue anchors Get up time Meal times Routine Sedentary Shiftwork Presence of “jet lag” symptoms Sleep disturbance Daytime fatigue or waves of sleepiness Gastrointestinal distress Tired muscles Headaches Reduced cognitive skills Poor psychomotor coordination Moodiness General malaise
indicators of circadian dysregulation
What’s this? Who is it more common in?
Pattern of delayed sleep onset and awakening times with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time
delayed sleep phase; more common in young adults
What’s this? Who is it more common in?
Pattern of advance sleep onset and awakening times with an inability to remain awake or sleep until the desired or conventionally acceptable later sleep or wake time
More common in older adults
advanced sleep phase; more common in adults
What’s this?
Morning light exposure for delayed sleep, to improve ease of falling asleep at beginning of night, and getting alert quicker in the morning
Evening light exposure for advanced sleep phase, to improve ability to stay up later and sleep continuation in the 2nd half of the night
light therapy
What’s this?
Recurrent periods of irrepressible need to sleep, lapsing into sleep or napping occurring within the same day.
narcolepsy
4 symptoms of narcolepsy?
excessive daytime sleepiness
cataplexy: sudden loss of muscle tone triggered by strong emotions
sleep paralysis: inability to move at sleep onset or when awaken
hypnagogic hallucinations: REM sleep during wakefulness
This is a structural/anatomical problem w physiological consequences. It is treated with CPAP or surgery, or else the person will continue to present w fatigue/sleepiness despite insomnia treatment.
Obstructive sleep apnea
What scale is used to assess sleepiness? Pts w obstructive sleep apnea have a high score!
epworth sleepiness scale
What’s this?
More common than central
Patient has recurrent obstruction of upper airway during sleep produces apnea (cessation of airflow for 10 seconds or more)
Risk factors include age, gender (more common in middle aged men and post-menopausal women), neck circumference, and structural abnormalities
obstructive sleep apnea
What’s this?
Symptoms include insomnia, mild or absent snoring, no obstruction, but absence of venilatory effort = cessation of airflow
central sleep apnea
Risk factors for OSA?
age gender *middle aged man and post-menopausal woman at high risk neck circumference *obese pt at high risk structural abnormalities
What’s this?
Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions
Typically do not cause insomnia or excessive sleepiness (i.e., sleepwalking)
parasomnias
What’s this?
terrifying dreams occurs during REM
More often during the 2nd half of night closer to morning
Common in children and decrease with age
nightmares
What’s this?
confused arousals, person may cry out
Occur during slow wave sleep, More often in the first half of the night
Unlike nightmares often do not remember
Common in children under 10 years old, often disappear with age
night terror
Disturbed sleep is one of the most common complaints of patients with (blank) disorders
Sleep disturbance is a diagnostic criteria of (blank) disorders and anxiety disorders.
mood; mood
When should you refer a pt w sleep problems?
those w suspected sleep apnea and narcolepsy for sure
You should refer patients with insomnia for non-medication treatment, including (blank)
CBT
