Sleep Flashcards
Two forces that impact sleep
- circadian rhythm
- sleep debt
Three characteristics of NREM sleep
- decrease in muscle tone
- slow eye movements
- loss of alpha rhythm
REM sleep
- muscle atonia
- rapid eye movement
- B waves like awake state
Stages of wake –> sleep
1) wake
2) NREM 1-3/4
3) REM
Longest stage of sleep
-Stage 2 NREM = 45-55%
followed by REM at 20-25%
When does NREM sleep predominate?
-NREM first 2/3 of night; REM last 1/3
Adult criteria for OSA:
- more than 90% decrease in airflow
- event lasts 10 seconds or greater
- continued respiratory effort
Child criteria for OSA:
same as adult except timing= 2 breath cycles
Most common complaint assc with OSA in adults
daytime sleepiness
Way to improve patient compliance with CPAP
-will increase libido
Med types for OSA
- antidepressants
- nasal steroids
- stimulants
Three common secondary causes of Hypersomnolence
- OSA
- PLMD
- Narcolepsy
Common primary causes of hypersomnolence
- inadequate sleep
- drugs
- chronobiologic
Cause of narcolepsy
-2 hit hypothesis
genetic predisposition, environmental trigger
Definition narcolepsy
-excessive daytime sleepiness + abnormal REM sleep
Diagnostic criteria for Type 1 narcolepsy:
1) excess need to sleep during daytime for at least 3 months
2) cataplexy, sleep latency less than 8 mins, 2 + SOREMP
… or low hypocretin 1 in CSF
Common precipitant of cataplexy in children
-anticipation of a reward
Define cataplexy
Sudden loss of muscle tone with retained consciousness
Diagnostic criteria for Type 2 narcolepsy:
Type 1 minus cataplexy
symptoms not better explained by other causes
Location of hypocretin
perifronical cells of the posterior hypothalamus
Function hypocretin 1
stimulates wakefulness and suppresses REM sleep
Three REM phenomenon that protrude into wakefulness in narcolepsy
hallucinations
sleep paralysis
cataplexy
Three treatments for sleepiness in narcolepsy
- modafinal
- amphetamines
- atomoxetine
Treatment for cataplexy
sodium oxybutate
SSRIs
Parasomnias assc with REM
- REM behavior disorder
- Sleep related painful erections
Define somniloquy
Sleep talking
What causes REM behavior disorder?
-loss of REM atonia
Acute Causes of REM behavior disorder:
- ETOH w/draw
- nitrazepam withdraw
- biperiden intoxication
Disease states assc with chronic REM behavior disorder:
- narcolepsy
- NPH
- extrapyramidal, mitochondrial disease
NREM parasomnias
- confusional arousals
- sleep walking
- sleep terrors
When are NREM parasomnias most common?
-most common in first third of night
Symptom MOST specific for narcolepsy?
-cataplexy
Drug that treats both cataplexy and daytime sleepiness?
-sodium oxybutate
DRug Treatment of enuresis
TCAs (imipramine) or desmopressin
