Sleep Flashcards
how many hours of sleep per night
6-9
physiologic functions reduced in
NREM
when does first REM cycle start
90 minutes
if REM cycle occurs in first 90 minutes of sleep
narcolepsy or depression
NREM increases after
exercise or starvation
stages of NREM
1-4 (light to deep)
how are stages of NREM judged
EEG (3 & 4 have delta waves)
when aroused from stages 3-4 of sleep
disorientation amnesia enuresis sleepwalking night terrors
high levels of brain activity and physiological activity similar to wakefulness
REM
poikilothermia
body temperature varies based on environment (shiver and sweats)
occur during NREM
when do erections happen
REM
skeletal muscle paralyzed or active in REM
paralyzed
when do dreams occur?
REM (abstract and surreal)
occurs in NREM (lucid and purposeful)
ratio of NREM to REM
3:1
how often does REM cycle
ever 90-100 minutes
how short does REM start?
10 minutes –> 40 minutes
how much REM does a neonate get?
50:50
lack of serotonin and melatonin results in
sleep reduction
elevated ____ & ____ cause decreased total sleep time
dopa and norepi
increased ____ decreases sleep time and increases REM proportion
acetylcholine
reduced levels of ______ decreases REM sleep
L-tryptophan
most common sleep complaint
insomnia
two forms of insomnia
primary
circadian rhythm disturbances
drugs for primary insomnia
Benzos
Z-Drugs
Melatonin
how long should you use meds to sleep
not usually more than 2 weeks
benzos effect
reduce time to onset of sleep, prolong stage 2 sleep, prolong total sleep time
benzos may decrease
relative REM sleep
benzos may help with underlying
anxiety
short acting benzo
triazolam (halcion)
onset for triazolam
2-3h
intermediate acting benzo
estazolam (prosom)
lorazepam (ativan)
temazepam (restoril)
long acting benzos
flurazepam (dalmane)
quazepam (doral)
Z-drugs affect which receptor
GABA (more selective so no muscle relaxant or anticonvulsant effect like benzos)
are z-drugs metabolized fast or slow
fast
4 Z-drugs
Zalepon (sonata)
Zolpidem (Ambien)
Zolpidem XR (Ambien CR)
Eszopiclone (Lunesta)
which Z drug has the shortest half life
Zalepon (Sonata)
which Z-drug is best for those who have trouble falling asleep
Zalepon
which 2 Z drugs shouldnt be used long-term
Zalepon and Zolpidem
persistent sleepiness or rebound insomnia not in
Zalepon
Z drug that comes in tablet, oral spray, and disolving tablet
ZOlpidem
developed to help improve sleep onset and can be used for maintenance
Zolpidem XR
longest half life of the Z drugs
Eszopiclone (lunesta)
alcohol potentiates effects of this Z drug
Eszopiclone (lunesta)
melatonin agonist
ramelteon (Rozerem)
Rozerem more or less active than melatonin
more
rozerem contraindicated in patients with _____
liver insufficiency
drug with little evidence of insomnia improvement and tends to sedate the next day
benadryl
type of side effect benadryl has
anticholinergic
melatonin secreted by
pineal gland
increased secretion of melatonin with
darkness
melatonin regulates
sleep-wake cycles (circadian rhythm)
how melatonin is made
tryptophan –> serotonin –> melatonin
3 off-label drugs for insomnia
seroquel
remeron
trazadone
major SE of trazadone
priapism
excessive sleepiness and trouble waking up to be functional
hypersomnolence disorder
daytime naps
normal sleep architecture
persistent and progressive sleepiness
hypersomnolence disorder
treatment for hypersomnolence disorder
amphetamines
non-sedating antidepressants (Wellbutrin)
sleep attacks
narcolepsy
how many sleep attacks per day and how long in narcolepsy
2-6 lasting 10-20minutes
when does narcolepsy present
adolesence (before 30)
onset of narcolepsy
abrupt or progressive
treatment for narcolepsy
forced naps
nodanfinil (provigil)
tricyclics or SSRIs
tx social anxieties
class of provigil
alpha blocker
MOA of provigil
unknown
decreases number of attacks
also used for those who must stay awake!!!
TCAS and SSRIs tx narcolepsy by
decreasing cataplexy
4 types of breathing related sleeping disorders
obstructive sleep apnea hypopnea
central sleep apnea
sleep related hypoventilation
comorbid sleep related hypoventilation
who does central sleep apnea occur in and why
elderly because CNS system fails to stimulate
3 types of sleep related hypoventilation
idiopathic
hypoventilation
congenital central hypoventilation (Ondine’s curse)
Ondine’s curse AKA
congenital central hypoventilation
atleast 5 obstructive apneas or hypopneas/hour of sleep AND nocturnal breathing disturbances or daytime sleepiness
obstructive sleep apnea hypopnea
evidence of 15+ obstructive apneas or hyponeas per hour without any symptoms
obstructive sleep apnea hypopnea
when can obstructive sleep apnea hypopnea occur
REM or NREM
mild apnea/hypopnea
moderate
severe
CV effects of obstructive sleep apnea hypopnea
hypotension and arrhythmias
tx
CPAP
weight loss
nasal or oral Surgery
apnea defined by length of
10+ seconds
5+ central apneas per hour
central sleep apnea
idiopathic central sleep apnea
without evidence of airway obstruction
cheyne stokes breathing
type of central sleep apnea
crescendo decrescendo of tidal volume
frequent arousal 5/ hour
central sleep apnea with opioid use
effect respiratory rhythm generators in the medula
central sleep apneas associated with hyperventilation alternating with hypoventilation
idiopathic central sleep apnea
cheyne stoke’s
misalignment between desired and actual sleep periods
circadian rhythm sleep disorder
3 types of circadian rhythm sleep disorder
delayed sleep phase type
non 24h sleep-wake type
shift work type
delayed onset and awakening time
cant fall asleep and wake up at desired times
normal sleep quality and quantity
delayed sleep phase type
wake cycles not synchronized to 24 hour environement
daily drift
non-24 hour sleep wake type
non 24 h sleep wake type most common in
blind or visually impaired
series of disorders of insomnia, hypersomnia, and circadian rhythm issues that don’t meet criteria of another disorder
parasomnia
types of parasomnias
NREM sleep arousal d/o nightmare d/o REM sleep behavior disorder RLS nocturnal myoclonus sleep drunkenness
recurrent episodes of incomplete awakening from sleep in first third of episodes with sleep walking or sleep terrors
non-REM sleep arousal d/o
are sleep terrors remembered
unlikely
sleepwalking occurs during
NREM 3-4 (first third of night)
in childhood sleepwalking more common in
females
in adulthood sleepwalking more common in
men
tx for sleepwalking
prevent injury
when do sleep terrors occur
NREM
sleep terrors most common in
boys
which is more common sleep walking or sleep terrors
terrors
temporal lobe epilepsy associated with
sleep terrors
repeated occurrences of bad dreams in second half of major sleep episode
nightmare disorder
when wake up from dream awake and oriented
nightmare disorder
nightmare disorder occurs during
REM
repeated episodes of arousal during sleep with vocalization, motor hebaviors, during REM, awake and oriented quickly, act out dream
REM sleep behavior disorder
treatment for REM sleep behavior disorder
clonazipine
frequency criteria for RLS
3x/week for 3months
causes of secondary RLS
iron deficiency ESRD DM neuropathy MS parkinson's pregnancy
if discomfort of RLS perceived as painful may tx w/ (3)
Z drugs
benzos
neurontin
what therapy is suggested for all RLS pts
iron replacement
pharmacologic therapy for RLS
ropinerol (requip)
pramipexole (Mirapex)
SE of requip and mirapex
nausea
dizzy
fatigue (resolving in 10-14 days)
impulsive control disorder
onset of requip and mirapex takes
2 hours
