sleep Flashcards
EEG in the awake (eyes open, alert) stage
beta (highest frequency, lowest amplitude)
EEG in the awake (eyes closed, relaxed) stage
alpha
EEG in stage 1 NREM (light sleep) stage
theta
EEG in stage 2 NREM (bruxism) stage
sleep spindles + K complexes
EEG in stage 3 NREM (slow-wave sleep, deepest NREM sleep, sleepwalking, night terrors, nocturnal enuresis) state
delta (opposite beta, lowest frequency, highest amplitude)
conditions with a ↓ stage 3 NREM
BZD
TCA (treat nocturnal enuresis)
alcohol
elderly
EEG in REM (atonia, dreaming, penile erection, memory processing, ↑brain O2 use, occurs in 90 min intervals) stage
beta
what causes the REM in REM stage
PPRF
change in normal sleeping pattern through night
first half: go through all stages
second half: stage 2 NREM → REM
who exhibits these changes:
↓ stage 3 NREM (slow-wave) - stay in stage 1/2 (light sleep)
↓ total REM
↑ REM sleep latency
↑ night time awakenings, early awakenings
sleep changes in elderly
unpleasant parasthesia causing voluntary continuous leg movements through night
restless leg syndrome
secondary causes of restless leg syndrome
iron deficiency end-stage renal disease diabetic neuropathy parkinson disease pregnancy RA caffeine varicose veins
conditions with a ↓ stage 3 NREM
BZD (treat night terrors)
TCA (treat nocturnal enuresis)
alcohol
elderly
night terrors (screaming, speak) occur in
stage 3 NREM sleep (slow-wave)
no memory of dream vs REM nightmares
tx: BZD (↓ stage 3)
condition that causes
collapse of airway (obstruction) during sleep
associated with obesity, loud snoring, short/thick necks
may occur during REM sleep (muscle atonia)
obstructive sleep apnea
condition that causes no respiratory effort during sleep
central sleep apnea
↓ orexin in lateral hypothalamus causes this condition
narcolepsy
excessive daytime sleepiness
hallucinations (hypnaGOgic - GOing to sleep or hypnoPOmpic - POst-sleep; like REM dreams)
sleep episodes: awake → REM right away
cataplexy (atonia (REM finding) following sadness, laughter)
narcolepsy
who exhibits this sleep pattern:
↓ stage 3 NREM (slow-wave) - stay in stage 1/2 (light sleep)
*↓ total REM
*↑ REM sleep latency
↑ night time awakenings, early awakenings
sleep changes in elderly
treatment for nocturnal enuresis
only consider if >7 yo
↓ fluid intake
enuresis startle - alarm
↑ risk of reocurrence after discontinuation of drug:
imipramine (TCA): ↓ stage 3, short-term use
desmopressin (DDAVP, anti-diuretic): oral, ↓urination
indomethacin: ↓ renal blood flow →↓GFR →↓urine output
what age can you diagnose nocturnal enuresis
> 5 yo
who exhibits these sleep patterns: ↓ stage 3 (slow-wave) *↓ REM latency *↑ total REM, ↑ REM early in sleep cycle ↑ nighttime awakenings, early-morning
sleep changes of depression
treatment of narcolepsy
avoid drugs that cause sleepiness scheduled naps to maintain energy level (1-2x/day, 10-20 min) modafinil (stimulant): DOC if cataplexy (atonia): venlafaxine, fluoxetine (antidepressant) or atomexetine (stimulant, ADHD) or sodium oxybate/GHB (treats atonia + sleep)
melatonin
tx: insomnia
non-addictive
vivid dreams
safe for
valerian
tx: insomnia
herbal remedy
no benefit
antihistamines: diphenhydramine (benadryl, tylenol PM), doxylamine
tx: insomnia (first-line by patients)
poor sleep quality
short-term use only
SE: anticholinergic SE - avoid in elderly
trazadone (antidepressant)
tx: insomnia
↑ REM sleep
SE: small risk of priapism
TCA (amitriptyline, doxepin)
tx: insomnia
SE: risk of arrhythmias - need EKG before use
SE: anticholinergic SE - avoid in elderly
long-acting BZD (temazepam, lorazepam, clonazepam, diazepam, chlordiazepoxide)
tx: insomnia
addictive - act at GABA R
short-term use only (
zolpidem (ambien) or zaleplon (sonata)
tx: insomnia
act at BZD R on GABA R - not as addictive as BZDs
short term use only (
eszopiclone (lunesta)
tx: insomnia
may be used long term
ramelteon (rozerem)
tx: insomnia
act at melatonin R instead of GABA/BZD R
non-addictive
contraindication: hepatic insufficiency
