Sleep Flashcards

1
Q

Stages of Sleep

A

Awake - open eyes, active concentration
-Beta waves

Awake - eyes closed, relaxation
-alpha waves

Stage N1- light sleep
-Theta waves

Stage N2 - deeper sleep, bruxism
-sleep spindles and K complexes

Stage N3 - Deep sleep, sleep walking, night terrors, bed wetting
-Delta waves

REM - dream, loss of motor tone, erections, vagal tone, active PPRF

  • Beta waves
  • 90 min intervals

1st half - in order, 2nd half alt between stage N2 and REM

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2
Q

Sleep pattern in elderly

A

decreased slow-wave sleep - N3
Decreased REM
Increased REM latency - longer to get there if they even do

More time in light sleep

frequently wake up

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3
Q

Sleep patterns in depressed

A

decreased slow wave sleep N3
increased REM
decreased REM latency

repeated awakenings throughout night
early morning awakening

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4
Q

Restless leg syndrome

A

causes: iron deficiency, ESRD, DM neuropathy, PD, pregnancy, RA, varicose veins/venous insufficiency, caffeine intake

Tx: check iron, replace
Pramipexole
Ropinirole

If comorbid pain: gabapentin, pregabalin

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5
Q

Night terrors

A

occur during N3
no memory of event
difficulty to get into wake cycle

Tx: benzodiazepines to decrease N3 stage

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6
Q

Obstructive sleep apnea

A

occurs in REM, obesity esp with short thick necks

tx: CPAP and wt loss

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7
Q

Nocturnal enuresis

A

not dx until 5 yo, tx delayed until 7 yo

  • behavior interventions
  • enuresis alarms

Desmopressin -DDAVP

  • ADH - decrease need to urinate
  • returns when stopped

Imipramine - TCA

  • decrease time in N3
  • short term, up to 6 weeks
  • returns when stopped

Indomethacin
-decreased renal blood flow, decreases GFR, don’t make as much urine

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8
Q

Melatonin as insomnia treatment

A

nonaddictive
otc
good safety profile
questionable efficacy

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9
Q

Antihistamines (diphenhydramine) as insomnia treatment

A

commonly used OTC by its first line “PM” meds
anticholinergic side effects - avoid in elderly
next day fatigue

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10
Q

Benzodiazepines (triazolam, temazepam, lorazepam) as insomnia treatment

A

increase GABA, addictive, short term only

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11
Q

Zolipidem, zaleplon as insomnia treatment

A

act at benzo receptor, short term only (less than 35 days)
rebound insomnia when stopped
assoc w/ sleep walking

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12
Q

Eszopiclone as insomnia treatment

A

longer half-life than zolpidem, may be used long term

sleep maintenance

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13
Q

ramelteon as insomnia treatment

A

nonaddictive, works at melatonin receptors
avoid if hepatic insufficiency
safe in geriatric its
long term studies lacking

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14
Q

Orexin receptor antagonists (suvorexant) as insomnia treatment

A

block effects of orexin A and B which promote wakefulness

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15
Q

Narcolepsy

A

excessive daytime sleepiness
awake –> REM

hallucinations, cataplexy

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16
Q

treatment of narcolepsy

A

avoid drugs that cause sleepiness
scheduled naps - once or twice/day for 10-20 min
stimulants - modafinil, methylphenidate

if cataplexy - use venlafaxine, fluoxetine, or atomoxetine - suppress REM

Sodium oxybate (GHB) last line for cataplexy