Sleep Flashcards
What is the homeostatic process of normal sleep regulation
Dependent on the amount of sleep and wakefulness
• Balance between the need for sleep (sleep pressure) with increasing duration
of wakefulness
What is the circadian process of normal sleep regulation?
Dependent on endogenous circadian pacemaker generating near 24-hour
cycles of behavior
• Regulated by the SCN (suprachiasmatic nucleus) in the hypothalamus to
“consolidate” sleep and wakefulness
What are normal changes in sleep in aging?
↓ in N3 [women preserve w/aging] • ↓ in REM • Sleep efficiency ↓ 80-85% • Ability to sleep in consolidated longer sleep bout(s) decreases (homeostatic dysfunction rather than circadian) • Need for sleep does not decrease • Daytime sleepiness ↑ • Napping may increase • An apparent shift is prevalent w/earlier fall asleep and earlier awakening (melatonin related; SCN aging) • Difficulty tolerating phase shifts
What should be included in sleep assessment?
Any sleep problems? • Sleep schedule • Bedtime • Awakening time • Consistency • Naps • Sleep latency • Awakenings & reasons • Sleep partner’s complaints • Awake schedule • Daily activities • Naps • Refreshed on awakening? • Sleep at inappropriate times? • Abnormal behaviors during sleep/naps • Driving habits • Number hrs/day driven • History of fall asleep accidents/near misses • History of single vehicle accidents • Occupational driving • Sleepiness during activities? • Short-term memory difficulties? • Mood changes? • Relationship and sexual activity changes? • Cognitive changes? • Caffeine, ETOH, tobacco, illicit drugs • Exercise, light exposure, meal times • Evening & late night activities? • Past medical history • Pre-existing sleep disturbances • CV disease • Neurologic disorders, particularly of vascular origin • Family medical history • Medications
What are clinically-valuable sleep symptom & assessment instruments?
- Epworth Sleepiness Scale
- Stanford Sleepiness Scale
- Functional Outcomes of Sleep Questionnaire (copyrighted)
- Sleep Diary (Consensus Diary – recommended)
OSA tools
OSA Screening Tools
• STOP-BANG (Snore, Tired, Observed apnea, high blood Pressure; Bmi, Age,
Neck circumference, Gender)
• Berlin Questionnaire
• OSA Response to Treatment Tools
• Epworth Sleepiness Scale (ESS)
• Functional Outcomes of Sleep Questionnaire (FOSQ
What does STOP BANG stand for?
• STOP-BANG (Snore, Tired, Observed apnea, high blood Pressure; Bmi, Age,
Neck circumference, Gender)
What is the diagnosis for chronic insomnia?
One or more reported: Difficulty initiating sleep, difficulty maintaining sleep, waking
up earlier than desired, resistance to going to bed on appropriate schedule, difficulty
sleeping without intervention
• One or more related to nighttime difficulty: fatigue/malaise; attention, concentration
or memory impairment; impaired social, family, occupational or academic
performance; mood disturbance/irritability; daytime sleepiness; behavioral
problems; reduced motivation/energy/initiative; proneness for errors/accidents;
concerns about or dissatisfaction with sleep
• Sleep/wake complaints cannot be explained purely by inadequate opportunity or
circumstances for sleep
• Sleep disturbance and associated daytime symptoms occur at least 3X/week
• Sleep disturbance and associated daytime symptoms present for at least 3mo
• Sleep/wake difficulty is not better explained by another sleep disorder
diagnosis for acute insomnia?
Report of one or more: difficulty initiating sleep, difficulty maintaining sleep,
waking up earlier than desired, resistance to going to bed on appropriate
schedule, difficulty sleeping without intervention
• Report of one or more related to nighttime sleep difficulty: fatigue/malaise;
attention, concentration or memory impairment; impaired social, family,
vocational or academic performance; mood disturbance/irritability; daytime
sleepiness; behavioral problems; reduced motivation/energy/initiative;
proneness for errors/accidents; concerns about or dissatisfaction with sleep
• Reported sleep/wake complaints not explained purely by inadequate
opportunity or circumstances for sleep
• Disturbance and associated symptoms present for LESS THAN 3 mo
• Sleep/wake difficulty not better explained by another sleep disorder
What does Other Insomnia Disorder entail?
• Complain of difficulty initiating and maintaining sleep BUT DO NOT meet full
criteria for either chronic or short-term insomnia
• May be applied when gathering more sleep information
• Use this diagnosis sparingly
What is included in an insomnia assessment guide?
Circumstances surrounding onset • Type of insomnia relative to diagnostic criteria (sleep/wake symptoms) • Severity, Frequency and Course • Daytime consequences • Past Treatments • Factors that ameliorate • Factors that exacerbate • Medical factors • Pharmacologic considerations (activating drugs, sedating drugs, side effects, history of hypnotic use) • Psychiatric factors • Work factors • Family and social factors • Comorbid sleep disorders • Behavioral factors including routines, sleep practices, cognitive factors (i.e., worry) • Environmental factors
How do you make an insomnia diagnosis?
Clinical Assessment
• Sleep Diary records
• ± PSG to r/o other sleep disorder with high clinical suspicion or no treatment
response
• ± Actigraphy to obtain objectively measured sleep/wake patterns
What is sleep restriction therapy? Contraindications?
Restrict time in bed as close as possible to actual sleep
time, strengthening the homeostatic sleep drive; sleep “window” is then
gradually increased over days/weeks (contraindicated: seizure, parasomnias like
sleepwalking, bipolar; occupational drivers)
What is stimulus control therapy? Contraindications?
Standard set of instructions designed to reinforce the
association between bed and bedroom with sleep and to establish consistent
sleep-wake schedule
• Go to bed only when sleepy
• Get out of bed when unable to sleep (may be contraindicated in older adults d/t falls)
• Use bed/bedroom for sleep only
• Arise at same time every morning
• No napping
What is relaxation therapy?
• Relaxation Therapy: Progressive muscle relaxation, meditation; require some
professional guidance at outset and daily practice for weeks-months
