sleep

Question 1

EEG in the awake (eyes open, alert) stage

Answer 1

beta (highest frequency, lowest amplitude)

Question 2

EEG in the awake (eyes closed, relaxed) stage

Answer 2

alpha

Question 3

EEG in stage 1 NREM (light sleep) stage

Answer 3

theta

Question 4

EEG in stage 2 NREM (bruxism) stage

Answer 4

sleep spindles + K complexes

Question 5

EEG in stage 3 NREM (slow-wave sleep, deepest NREM sleep, sleepwalking, night terrors, nocturnal enuresis) state

Answer 5

delta (opposite beta, lowest frequency, highest amplitude)

Question 6

conditions with a ↓ stage 3 NREM

Answer 6

BZD
TCA (treat nocturnal enuresis)
alcohol
elderly

Question 7

EEG in REM (atonia, dreaming, penile erection, memory processing, ↑brain O2 use, occurs in 90 min intervals) stage

Answer 7

beta

Question 8

what causes the REM in REM stage

Answer 8

PPRF

Question 9

change in normal sleeping pattern through night

Answer 9

first half: go through all stages

second half: stage 2 NREM → REM

Question 10

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

Answer 10

sleep changes in elderly

Question 11

unpleasant parasthesia causing voluntary continuous leg movements through night

Answer 11

restless leg syndrome

Question 12

secondary causes of restless leg syndrome

Answer 12

iron deficiency
end-stage renal disease
diabetic neuropathy
parkinson disease
pregnancy
RA
caffeine
varicose veins

Question 13

conditions with a ↓ stage 3 NREM

Answer 13

BZD (treat night terrors)
TCA (treat nocturnal enuresis)
alcohol
elderly

Question 14

night terrors (screaming, speak) occur in

Answer 14

stage 3 NREM sleep (slow-wave)
no memory of dream vs REM nightmares
tx: BZD (↓ stage 3)

Question 15

condition that causes
collapse of airway (obstruction) during sleep
associated with obesity, loud snoring, short/thick necks
may occur during REM sleep (muscle atonia)

Answer 15

obstructive sleep apnea

Question 16

condition that causes no respiratory effort during sleep

Answer 16

central sleep apnea

Question 17

↓ orexin in lateral hypothalamus causes this condition

Answer 17

narcolepsy

Question 18

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)

Answer 18

narcolepsy

Question 19

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

Answer 19

sleep changes in elderly

Question 20

treatment for nocturnal enuresis

Answer 20

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

Question 21

what age can you diagnose nocturnal enuresis

Answer 21

> 5 yo

Question 22

who exhibits these sleep patterns:
↓ stage 3 (slow-wave)
*↓ REM latency
*↑ total REM, ↑ REM early in sleep cycle
↑ nighttime awakenings, early-morning

Answer 22

sleep changes of depression

Question 23

treatment of narcolepsy

Answer 23

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)

Question 24

melatonin

Answer 24

tx: insomnia
non-addictive
vivid dreams
safe for

Question 25

valerian

Answer 25

tx: insomnia
herbal remedy
no benefit

Question 26

antihistamines: diphenhydramine (benadryl, tylenol PM), doxylamine

Answer 26

tx: insomnia (first-line by patients)
poor sleep quality
short-term use only
SE: anticholinergic SE - avoid in elderly

Question 27

trazadone (antidepressant)

Answer 27

tx: insomnia
↑ REM sleep
SE: small risk of priapism

Question 28

TCA (amitriptyline, doxepin)

Answer 28

tx: insomnia
SE: risk of arrhythmias - need EKG before use
SE: anticholinergic SE - avoid in elderly

Question 29

long-acting BZD (temazepam, lorazepam, clonazepam, diazepam, chlordiazepoxide)

Answer 29

tx: insomnia
addictive - act at GABA R
short-term use only (

Question 30

zolpidem (ambien) or zaleplon (sonata)

Answer 30

tx: insomnia
act at BZD R on GABA R - not as addictive as BZDs
short term use only (

Question 31

eszopiclone (lunesta)

Answer 31

tx: insomnia

may be used long term

Question 32

ramelteon (rozerem)

Answer 32

tx: insomnia
act at melatonin R instead of GABA/BZD R
non-addictive
contraindication: hepatic insufficiency