Sleep Flashcards
5 y/o. Screaming, crying for no reason about 1 hr after falling asleep. Sits up in bed w/ eyes open, trembling, sweating. Mother cannot gain his attention for 5 mins. No new stressors. Pt has no memory of event. PE normal.
Dx?
Sleep terror
Paralysis when awakening which lasts several mins. Can see/hear, but cannot move. Disappears spontaneously or when called by his wife.
No hallucinations, nightmares, daytime sleepiness, or history of falls.
Neuro exam normal
Sleep paralysis
REM sleep is first evident during which stage of development?
In utero
What sleep stage is most important in restoring the altered functions that result from prolong sleep deprivation?
Stage 4 - Non rapid eye mvmt
Insomnia secondary to depression will more consistently affect REM sleep in which way?
Reduced latency to REM sleep
Which is a characteristic change on polysomnogram associated w/ major depression?
Short REM latency
Pt presents w/ history of irresistible, episodic sleepiness accompanied by a vivid, dreamlike state at the onset of an episode.
What additional sleep sx likely to be present?
Sleep paralysis
8 y/o w/ persistent delayed sleep onset despite good sleep hygiene. No indication of broader psychopathology.
Which med has best evidence to tx this problem and restore normal circadian rhythm?
Melatonin
REM sleep behavior d/o is commonly associated w/ abnormal inclusions containing what protein?
Synuclein
Med student asks for something to help w/ attention and alertness. Taking a 2 wk board review course and struggles to keep up w/ pace.
Sleeping 4hrs/night, usually sleeps 8hrs/night.
Dx?
Dyssomnia NOS
Age-related sleep pattern change
Greater wakefulness intermixed w/ sleep
What aspect of sleep is increased in older adults
Duration of awakenings
What med is best for decreasing nightmares in PTSD pts?
Prazosin
HPA axis cortisol production is less active in?
Sleep onset
What neuropeptide is decreased in the hypothalamus in narcolepsy?
Orexin A
In narcolepsy, weakness in the arms and legs w/ laughter would respond to which med?
Venlafaxine
Physiological changes during REM sleep
Increased HR, increased eye mvmts
Decreased muscle tone
Brief episodes of sudden loss of muscle tone w/ intense emotions are characteristic of
Narcolepsy
Most common symptoms in narcoleptics?
Sleep attacks
65 y/o M w/ trouble falling asleep secondary to unpleasant aching and drawing sensations in calves and thighs. Also creeping and crawling sensations in legs. Urge to move legs can be suppressed voluntarily for a short while, but is ultimately irresistible.
Dx?
Restless legs syndrome
Pt w/ day time sleepiness and frequent naps.
Sleep studies show pt enters REM sleep within 5 mins and wakes frequently at night.
Tx?
Modafinil giving dose in morning
Sleep changes associated w/ aging
Delta wave amplitude decreases.
Proportionally less time spent in stages 3 and 4.
