Sleep Flashcards by Megan Foggia

What are the determinants of sleepiness?

duration of prior wakefulness
circadian
aging
drugs
sleep disorder

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What’s this?
linked to sun
affects most living creatures
occurs even when isolated from time cues

circadian rhythm

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Disruptions of circadiam rhythm is associated with (blank) and shortens life

tumors

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Things contributing to circadian rhythm

wake/sleep
hormonal
temperature
immune
drug metabolism
renal function
airway function

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What % of pts presenting to primary care physicians report sleeping probs?

50%

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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

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What type of sleep is this?
dreaming
inhibition of muscular activity

REM sleep

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What type of sleep is this?
restorative sleep
disinhibition of muscular activity
parasomnias

stage 3 and 4

SLOW WAVE SLEEP

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What happens to periods of REM sleep across the night?

they become longer

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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

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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

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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

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What are the chief complaints of pts concerning sleep?

fatigue
trouble sleeping
poor sleep quality
not enough sleep
abnormal behaviors while sleeping
snoring

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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

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What leads to more car accidents, sleep apnea or insomnia?

insomnia

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What’s this?
Difficulty initiating, maintaining, or non - restorative sleep
Most common sleep disorder

insomnia

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What % of American adults experience insomnia during a 1yr period

30-50%

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What’s this?
Difficulty falling asleep
Longer time to sleep onset

sleep onset insomnia

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What’s this?
Difficulty staying asleep
Frequent nocturnal awakenings

sleep maintenance insomnia

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What’s this?

Waking too early in the morning

sleep offset or late insomnia

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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