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Behavioral Health > Sleep > Flashcards

Sleep Flashcards

1
Q

how many hours of sleep per night

A

6-9

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2
Q

physiologic functions reduced in

A

NREM

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3
Q

when does first REM cycle start

A

90 minutes

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4
Q

if REM cycle occurs in first 90 minutes of sleep

A

narcolepsy or depression

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5
Q

NREM increases after

A

exercise or starvation

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6
Q

stages of NREM

A

1-4 (light to deep)

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7
Q

how are stages of NREM judged

A

EEG (3 & 4 have delta waves)

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8
Q

when aroused from stages 3-4 of sleep

A 
disorientation
amnesia
enuresis
sleepwalking
night terrors
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9
Q

high levels of brain activity and physiological activity similar to wakefulness

A

REM

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10
Q

poikilothermia

A

body temperature varies based on environment (shiver and sweats)
occur during NREM

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11
Q

when do erections happen

A

REM

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12
Q

skeletal muscle paralyzed or active in REM

A

paralyzed

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13
Q

when do dreams occur?

A

REM (abstract and surreal)

occurs in NREM (lucid and purposeful)

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14
Q

ratio of NREM to REM

A

3:1

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15
Q

how often does REM cycle

A

ever 90-100 minutes

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16
Q

how short does REM start?

A

10 minutes –> 40 minutes

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17
Q

how much REM does a neonate get?

A

50:50

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18
Q

lack of serotonin and melatonin results in

A

sleep reduction

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19
Q

elevated ____ & ____ cause decreased total sleep time

A

dopa and norepi

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20
Q

increased ____ decreases sleep time and increases REM proportion

A

acetylcholine

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21
Q

reduced levels of ______ decreases REM sleep

A

L-tryptophan

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22
Q

most common sleep complaint

A

insomnia

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23
Q

two forms of insomnia

A

primary

circadian rhythm disturbances

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24
Q

drugs for primary insomnia

A

Benzos
Z-Drugs
Melatonin

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25
Q

how long should you use meds to sleep

A

not usually more than 2 weeks

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26
Q

benzos effect

A

reduce time to onset of sleep, prolong stage 2 sleep, prolong total sleep time

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27
Q

benzos may decrease

A

relative REM sleep

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28
Q

benzos may help with underlying

A

anxiety

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29
Q

short acting benzo

A

triazolam (halcion)

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30
Q

onset for triazolam

A

2-3h

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31
Q

intermediate acting benzo

A

estazolam (prosom)
lorazepam (ativan)
temazepam (restoril)

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32
Q

long acting benzos

A

flurazepam (dalmane)

quazepam (doral)

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33
Q

Z-drugs affect which receptor

A

GABA (more selective so no muscle relaxant or anticonvulsant effect like benzos)

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34
Q

are z-drugs metabolized fast or slow

A

fast

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35
Q

4 Z-drugs

A

Zalepon (sonata)
Zolpidem (Ambien)
Zolpidem XR (Ambien CR)
Eszopiclone (Lunesta)

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36
Q

which Z drug has the shortest half life

A

Zalepon (Sonata)

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37
Q

which Z-drug is best for those who have trouble falling asleep

A

Zalepon

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38
Q

which 2 Z drugs shouldnt be used long-term

A

Zalepon and Zolpidem

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39
Q

persistent sleepiness or rebound insomnia not in

A

Zalepon

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40
Q

Z drug that comes in tablet, oral spray, and disolving tablet

A

ZOlpidem

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41
Q

developed to help improve sleep onset and can be used for maintenance

A

Zolpidem XR

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42
Q

longest half life of the Z drugs

A

Eszopiclone (lunesta)

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43
Q

alcohol potentiates effects of this Z drug

A

Eszopiclone (lunesta)

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44
Q

melatonin agonist

A

ramelteon (Rozerem)

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45
Q

Rozerem more or less active than melatonin

A

more

46
Q

rozerem contraindicated in patients with _____

A

liver insufficiency

47
Q

drug with little evidence of insomnia improvement and tends to sedate the next day

A

benadryl

48
Q

type of side effect benadryl has

A

anticholinergic

49
Q

melatonin secreted by

A

pineal gland

50
Q

increased secretion of melatonin with

A

darkness

51
Q

melatonin regulates

A

sleep-wake cycles (circadian rhythm)

52
Q

how melatonin is made

A

tryptophan –> serotonin –> melatonin

53
Q

3 off-label drugs for insomnia

A

seroquel
remeron
trazadone

54
Q

major SE of trazadone

A

priapism

55
Q

excessive sleepiness and trouble waking up to be functional

A

hypersomnolence disorder

56
Q

daytime naps
normal sleep architecture
persistent and progressive sleepiness

A

hypersomnolence disorder

57
Q

treatment for hypersomnolence disorder

A

amphetamines

non-sedating antidepressants (Wellbutrin)

58
Q

sleep attacks

A

narcolepsy

59
Q

how many sleep attacks per day and how long in narcolepsy

A

2-6 lasting 10-20minutes

60
Q

when does narcolepsy present

A

adolesence (before 30)

61
Q

onset of narcolepsy

A

abrupt or progressive

62
Q

treatment for narcolepsy

A

forced naps
nodanfinil (provigil)
tricyclics or SSRIs
tx social anxieties

63
Q

class of provigil

A

alpha blocker

64
Q

MOA of provigil

A

unknown
decreases number of attacks
also used for those who must stay awake!!!

65
Q

TCAS and SSRIs tx narcolepsy by

A

decreasing cataplexy

66
Q

4 types of breathing related sleeping disorders

A

obstructive sleep apnea hypopnea
central sleep apnea
sleep related hypoventilation
comorbid sleep related hypoventilation

67
Q

who does central sleep apnea occur in and why

A

elderly because CNS system fails to stimulate

68
Q

3 types of sleep related hypoventilation

A

idiopathic
hypoventilation
congenital central hypoventilation (Ondine’s curse)

69
Q

Ondine’s curse AKA

A

congenital central hypoventilation

70
Q

atleast 5 obstructive apneas or hypopneas/hour of sleep AND nocturnal breathing disturbances or daytime sleepiness

A

obstructive sleep apnea hypopnea

71
Q

evidence of 15+ obstructive apneas or hyponeas per hour without any symptoms

A

obstructive sleep apnea hypopnea

72
Q

when can obstructive sleep apnea hypopnea occur

A

REM or NREM

73
Q

mild apnea/hypopnea
moderate
severe

A
74
Q

CV effects of obstructive sleep apnea hypopnea

A

hypotension and arrhythmias

75
Q

tx

A

CPAP
weight loss
nasal or oral Surgery

76
Q

apnea defined by length of

A

10+ seconds

77
Q

5+ central apneas per hour

A

central sleep apnea

78
Q

idiopathic central sleep apnea

A

without evidence of airway obstruction

79
Q

cheyne stokes breathing

A

type of central sleep apnea
crescendo decrescendo of tidal volume
frequent arousal 5/ hour

80
Q

central sleep apnea with opioid use

A

effect respiratory rhythm generators in the medula

81
Q

central sleep apneas associated with hyperventilation alternating with hypoventilation

A

idiopathic central sleep apnea

cheyne stoke’s

82
Q

misalignment between desired and actual sleep periods

A

circadian rhythm sleep disorder

83
Q

3 types of circadian rhythm sleep disorder

A

delayed sleep phase type
non 24h sleep-wake type
shift work type

84
Q

delayed onset and awakening time
cant fall asleep and wake up at desired times
normal sleep quality and quantity

A

delayed sleep phase type

85
Q

wake cycles not synchronized to 24 hour environement

daily drift

A

non-24 hour sleep wake type

86
Q

non 24 h sleep wake type most common in

A

blind or visually impaired

87
Q

series of disorders of insomnia, hypersomnia, and circadian rhythm issues that don’t meet criteria of another disorder

A

parasomnia

88
Q

types of parasomnias

A 
NREM sleep arousal d/o
nightmare d/o
REM sleep behavior disorder
RLS
nocturnal myoclonus
sleep drunkenness
89
Q

recurrent episodes of incomplete awakening from sleep in first third of episodes with sleep walking or sleep terrors

A

non-REM sleep arousal d/o

90
Q

are sleep terrors remembered

A

unlikely

91
Q

sleepwalking occurs during

A

NREM 3-4 (first third of night)

92
Q

in childhood sleepwalking more common in

A

females

93
Q

in adulthood sleepwalking more common in

A

men

94
Q

tx for sleepwalking

A

prevent injury

95
Q

when do sleep terrors occur

A

NREM

96
Q

sleep terrors most common in

A

boys

97
Q

which is more common sleep walking or sleep terrors

A

terrors

98
Q

temporal lobe epilepsy associated with

A

sleep terrors

99
Q

repeated occurrences of bad dreams in second half of major sleep episode

A

nightmare disorder

100
Q

when wake up from dream awake and oriented

A

nightmare disorder

101
Q

nightmare disorder occurs during

A

REM

102
Q

repeated episodes of arousal during sleep with vocalization, motor hebaviors, during REM, awake and oriented quickly, act out dream

A

REM sleep behavior disorder

103
Q

treatment for REM sleep behavior disorder

A

clonazipine

104
Q

frequency criteria for RLS

A

3x/week for 3months

105
Q

causes of secondary RLS

A 
iron deficiency
ESRD
DM neuropathy
MS
parkinson's 
pregnancy
106
Q

if discomfort of RLS perceived as painful may tx w/ (3)

A

Z drugs
benzos
neurontin

107
Q

what therapy is suggested for all RLS pts

A

iron replacement

108
Q

pharmacologic therapy for RLS

A

ropinerol (requip)

pramipexole (Mirapex)

109
Q

SE of requip and mirapex

A

nausea
dizzy
fatigue (resolving in 10-14 days)
impulsive control disorder

110
Q

onset of requip and mirapex takes

A

2 hours

Behavioral Health (4 decks)

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