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NEURO CLERKSHIP > Sleep > Flashcards

Sleep Flashcards

1
Q

What are the physiological levels of consciousness?

A
  1. Awake
  2. NREM Sleep
  3. REM Sleep
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2
Q

What is sleep?

A

Behavioral state of perceptual disengagement from and unresponsiveness to the environment

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3
Q

Which two forces impact sleep?

A
  1. Circadian Rhythm

2. Sleep debt

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4
Q

How is sleep onset typically reached?

A

Through NREM Sleep

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5
Q

What are the features of NREM Sleep?

A
  1. Decreased muscle tone
  2. Slow eye movements, possibly asynchronous
  3. Loss of alpha rhythm, mixed low voltage frequency
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6
Q

What is the electrographic background for REM sleep?

A

Similar to Stage 1 NREM or relaxed awake

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7
Q

What are features of REM sleep?

A
  1. Muscle atonia
  2. Intermittent twitched
  3. Rapid eye movement
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8
Q

How is the sleep cycle entered?

A

NREM Sleep

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9
Q

How long are average cycles between NREM and REM?

A

90 minutes

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10
Q

Which type of sleep makes up most of the night?

A

NREM (stage 2)

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11
Q

Which type of sleep predominates the last 1/3 of the night?

A

REM sleep

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12
Q

What is the classical distribution of stages of sleep?

A 
Stage 1- 2-5%
Stage 2- 45-55%
Stage 3- 3-8%
Stage 4- 10-15%
REM- 20-25%
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13
Q

What are the three types of sleep apnea?

A
  1. Central
  2. Obstructive
  3. Mixed
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14
Q

Describe Central Sleep Apnea

A

No effort to breath, No air movement

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15
Q

Describe Obstructive Sleep Apnea

A

Effort to breath, No air movement

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16
Q

Describe Mixed Sleep Apnea

A

Initially No effort to breath, then effort but No air movement

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17
Q

How does airflow change in OSA?

A

Decreased by 90%

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18
Q

How long does an episode of OSA last?

A

10 seconds

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19
Q

Describe the respiratory effort during an OSA episode

A

Increasing effort

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20
Q

How long does an episode of OSA have to last in a child?

A

Length of two breaths

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21
Q

What are the symptoms of OSA?

A
  1. Loud snoring
  2. Periods of silence with gasps and snorts
  3. Observed apneas (reported by partner)
  4. Restless sleep, daytime sleepiness and fatigue
  5. Nocturia (4-7 trips to bathroom)
  6. Nocturnal GERD
  7. Personality changes (aggressive, irritable, anxiety or depression)
  8. Decreased libido, impotence, erectile dysfunction
  9. Nocturnal HA
  10. Poor attention and impulse control (children)
22
Q

What are the treatment options of OSA?

A
  1. Behavioral (weight loss, smoking cessation, body positioning)
  2. CPAP/BIPAP
  3. Devices (snore ball, oral appliances, nasal dilators)
  4. Nasal Steroids
  5. Antidepressants
  6. Stimulants
23
Q

What are surgical treatment options for OSA?

A
  1. Tonsillectomy/Adenoidectomy
  2. UPPP (uvulopalatopharyngoplasty)
  3. Mandibular Advancement
  4. Tracheostomy
24
Q

What are the possible causes of hypersomnolence?

A
  1. Disrupted sleep (OSA, PLMD)
  2. Inadequate Sleep
  3. Drugs
  4. Sleep Phase Disorders
  5. Narcolepsy
  6. Hypothyroidism
25
Q

What is Narcolepsy?

A

Excessive daytime sleepiness w/ abnormal REM sleep phenomenon

26
Q

What is the sleep latency in Narcolepsy?

A

Less than 8 minutes

27
Q

What is Type I Narcolepsy?

A

Narcolepsy w/ Cataplexy

28
Q

What are the required criteria for Type I Narcolepsy?

A
  1. Irresistible need to sleep during the day OR daytime lapses into sleep for 3 months
  2. Presence of any of A) Cataplexy, B) Sleep latency < 8mins, C) Two or more SOREMs within 15 mins of sleep onset, D) CSF Hypercretin-1 < 110pg/mL (less than 1/3 normal)
29
Q

What is Cataplexy?

A

Brief, bilateral loss of muscle tone w/ retained consciousness (precipitated by strong emotions). Associated w/ loss of DTRs.

30
Q

How does cataplexy present in children?

A

Facial hypotonia w/ droopy eyelids, mouth opening and protruded tongue. Possible gait unsteadiness

31
Q

What is Type II Narcolepsy?

A

Narcolepsy w/o Cataplexy

32
Q

What are the required criteria for Type II Narcolepsy?

A
  1. Irresistible need to sleep during the day OR daytime lapses into sleep for 3 months
  2. Sleep latency < 8mins. Two or more SOREMs within 15 mins of sleep onset
  3. NO Cataplexy
  4. CSF Hypercretin-1 <>110pg/mL (greater than 1/3 normal)
  5. Hypersomnolence is not better explained by insufficient sleep, meds, OSA or delayed sleep phase
33
Q

What are Hypocretin/Orexin?

A

Neuropeptides found in cells of the perifornical area of the posterior hypothalamus

34
Q

Where are the projections from Hypocretin/Orexin cells?

A
  1. Limbic System
  2. Monoaminergic Cell Group
  3. Intrahypothalamic Nuclei
  4. Cerebral Cortex
  5. Spinal Cortex and Thalamus
35
Q

What happens after central administration of Hypocretin I?

A

Stimulates Wakefullness and suppresses REM sleep

36
Q

What modulates Hypocretin levels during a 24hr period?

A
  1. Sleep Debt

2. Circadian Rhythm

37
Q

What is the Narcolepsy Tetrad?

A
  1. Sleep Attacks
  2. Hypnagogic/Hypnopompic Hallucinations
  3. Sleep Paralysis
  4. Cataplexy
38
Q

Which features of Narcolepsy are features of REM intruding into wakefulness?

A
  1. Hypnagogic/Hypnopompic Hallucinations
  2. Sleep Paralysis
  3. Cataplexy
39
Q

List the features associated with Narcolepsy

A
  1. Disrupted Sleep
  2. Obesity
  3. Anxiety/Panic Attacks
40
Q

What studies should be done in the diagnostic evaluation of Narcolepsy?

A
  1. NPSG- evaluation of nighttime sleep/adequate sleep

2. MSLT- document daytime sleepiness and SOREMPs

41
Q

What is the treatment for Narcolepsy?

A
  1. Behavioral (adequate nighttime sleep, daytime naps and keeping physically active- standing)
  2. Meds:
    Sleepiness- Modafanil, amphetamines and atomoxetine
    Cataplexy- Sodium Oxybate, SSRIs
42
Q

What are the Non-REM parasomnias?

A
  1. Confusional arousals
  2. Sleep walking
  3. Sleep terrors
43
Q

What are some examples of Parasomnias?

A
  1. Bruxisms
  2. Groaning/Moaning
  3. Rhythmic Movement Disorder
  4. Enuresis
  5. Somniloquy
44
Q

What are the REM parasomnias?

A
  1. REM behavioral disorders

2. Painful Sleep Related erections

45
Q

What is REM Behavior Disorder?

A

Loss of REM atonia (pt acts out dreams)

46
Q

What are the acute causes of REM Behavior Disorder?

A

Toxic (alcohol withdrawal, benzo withdrawal, biperiden intoxication) or metabolic derangement

47
Q

What are the chronic causes of REM Behavior Disorder?

A
  1. Idiopathic
  2. Narcolepsy
  3. Extrapyramidal Disease (PD)
  4. Normal Pressure Hydrocephalus
  5. Mitochondrial Disease
48
Q

When do NREM parasomnias tend to occur?

A

Stages 3 and 4 of NREM sleep during the first 1/3 of the night

49
Q

Which patient population is more likely to have NREM parasomnias?

A

Children, positive family history

50
Q

What can induce a NREM parasomnia episode?

A
  1. Medications
  2. Arousal from sleep
  3. Increased tiredness, sleeping in unfamiliar place

NEURO CLERKSHIP (10 decks)

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