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RC Nuggets > Sleep > Flashcards

Sleep Flashcards

1
Q

Percentage of sleep NREM?

A

75%

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2
Q

NREM: hypo or hyperactive state?

A

HYPO

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3
Q

NREM blood flow to brain?

A

DECREASED

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4
Q

Beta

A

NREM
16-25 Hz

Vigilent
Eyes open

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5
Q

Alpha

A

NREM
8-12 Hz

Drowsy
Eyes closed

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6
Q

Theta

A

NREM
3-7 Hz

Stage 1 (5%) = rolling eyes, hypnogogic hallucinations
Stage 2 (45%) = COMPLEX K, SPINDLES
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7
Q

Delta

A

NREM
0.5-3Hz

Stage 3/4 (12%+ 13%) = SLOW WAVE SLEEP
Most stage 4 in 1/3 of night.

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8
Q

Percentage of sleep REM (adults)?

A

25%

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9
Q

REM: hypo or hyperactive state?

A

HYPER

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10
Q

REM blood flow to brain?

A

INCREASED

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11
Q

REM muscle tone?

A

ATONIA

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12
Q

What is paradoxical about REM sleep?

A

EEG activity more closely resembles awake than slow sleep

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13
Q

REM waves?

A

SAWTOOTH

Last 1/3 of sleep

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14
Q

Percentage of sleep REM (neonates)?

A

up to 50%
Fall asleep directly into REM
16H / day with brief periods of wakefulness

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15
Q

Aging sleep changes?

A

(According to K&S summary):
DECREASED TOTAL SLEEP TIME vs. TOTAL REM SLEEP (see below)
Lower efficiency
Higher fragmentation
INCREASED SLEEP LATENCY
Less slow wave AND REM sleep so % stays the same
Need for sleep doesn’t change

(From K&S text…not helpful)
“Changes in sleep structure among persons over 65 years of age involve both REM sleep and nonrapid eye movement (NREM) sleep. The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and LESS TOTAL REM SLEEP. The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.”

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16
Q

Children sleep differences?

A

DECREASED SLEEP LATENCY (5-10 minutes)
Highly efficient sleep
Easy awakening

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17
Q

Dream quality in NREM?

A

LUCID

PURPOSEFUL

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18
Q

Dream quality in REM?

A

ABSTRACT
SURREAL

More REM eye movements associated with vividness of dreaming)

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19
Q

NE in sleep?

A

Firing = wakefulness and NREM

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20
Q

Which neurotransmitter is REM promoting?

A

Acetylcholine

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21
Q

Which is the primary neurotransmitter in reticular activating system?

A

Acetylcholine

Glutamate as well

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22
Q

Where is melatonin produced?

A

Pineal gland

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23
Q

Where is the circadian clock in brain?

A

Suprachiasmatic nucleus

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24
Q

Antidepressants and REM?

A

Serotonin is anti-REM
Antidepressants increase serotonin

Antidepressants DECREASE REM

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25
Q

Process S

A

Accumulates during wakefulness

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26
Q

Process C

A

Think CIRCADIAN
In hypothalamus
Regulates temperature and sleep duration

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27
Q

Histamine and sleep

A

In posterior hypothalamus
Fire while AWAKE but not during REM and NREM
(ANTI-histaminics cause sedation)

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28
Q

Long sleepers how many hours?

A

> 9 hours

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29
Q

Short sleepers how many hours?

A

< 6 hours

30
Q

General timing of sleep disorders?

A

3 nights per week for at least 3 months

31
Q

Strongest risk factor for insomnia disorder?

A

Past episode of primary insomnia

32
Q

Normal REM latency?

A

90 minutes

33
Q

Nocturnal myoclonus often affects which muscle?

A

Anterior tibialis

rare side effect of SSRI

34
Q

Hypersomnolence

A 
At least 7 hour main sleep period 
\+
ONE of:
- recurrent periods of sleep in same day
- non-restorative main sleep > 9 hours
- difficulty being fully awake after abrupt awakening

3x / week x 3 months

Tx with Modafinil (1st line)

35
Q

What is a sign of daytime somnolence in kids?

A

HYPERACTIVITY

being “wired”

36
Q

What is highly specific to hyper somnolence?

A

SLEEP INERTIA = drunkenness at sleep-wake transition

37
Q

Who is at his for non-24-hour sleep-wake type?

A

Up to 50% in BLIND people

TBI

38
Q

Most common circadian rhythm sleep disorder?

A

Delayed phase

39
Q

Impact of Lithium on circadian period?

A

LENGTHENS

40
Q

Most common single symptom of insomnia disorder?

A

MAINTENANCE

awake for total 20-30 minutes in the night

41
Q

Most common presentation of insomnia disorder?

A

COMBINATION of initiation/maintenance/early awakening

42
Q

Gene associated with advanced sleep phase type?

A

PER2 gene

Autosomal DOMINANT

43
Q

Percentage of night workers with shift work type?

A

5-10%

Reverses after 2 weeks of normal schedule

44
Q

Irregular sleep-wake type associated with?

A

Neurodegenerative disorders

45
Q

Narcolepsy criteria

A

3x / week x. months

ONE OF:

  • cataplexy a few times per month
  • HYPOCRETIN deficiency using CSF
  • polysomnography showing REM LATENCY < 15 minutes or MULTIPLE SLEEP LATENCY TEST showing mean sleep latency < 8 minutes + at least 2 sleep-onset REM periods
46
Q

Hypocretin

A

Excitatory hormone in hypothalamus (stimulates appetite and alertness)

With cataplexy but no hypocretin rare (< 5%)

47
Q

Cerebellar ataxia + deadness + narcolepsy?

A

EXON 21 DNA mutation

Autosomal dominant

48
Q

Narcolepsy + obesity + DM2?

A

Mutation in the myelin oligodendrocyte glycoprotein gene

Autosomal dominant

49
Q

Genetic marker narcolepsy?

A

HLA-DR2 positive in 90-100%

50
Q

What percentage of narcolepsy have cataplexy?

A

50%

51
Q

How to differentiate cataplexy from conversion?

A

ABOLISHED REFLEXES during cataplexy

52
Q

What percentage have hypnagogic/hypnopompic hallucinations?

A

20-60%

53
Q

What percentage have sleep paralysis?

A

20-60%

54
Q

Narcolepsy treatment for daytime somnolence?

A

Modafinil

Sodium oxybate

55
Q

Narcolepsy treatment for cataplexy/sleep paralysis/hallucinations?

A

SSRIs/TCA

Sodium oxybate

56
Q

Apnea criteria in OSA?

A

> 5/hr + symptoms
OR
15/hr

57
Q

Apnea definition?

A

At least 10 seconds of O2 sat decrease by 3%

58
Q

Central sleep apnea criteria?

A

At least 5/hr

59
Q

Congenital hypoventilation gene?

A

PHOX2B gene

60
Q

REM parasomnias?

A

Nightmares

REM sleep behaviour disorder

61
Q

NON-REM sleep arousal disorders?

A

Sleepwalking
Sleep terrors

No memory usually

62
Q

Nightmares

A

SECOND HALF OF THE NIGHT (because REM)
No movement or vocalization

Can be caused by:
L-dopa
B-blockers

63
Q

REM sleep behaviour disorder

A

END OF NIGHT
PRECURSOR OF LBD/PARKINSON (synuclein)
Can be unmasked by antidepressants

Dreams acted out, no paralysis
Injury to partner
Alert, not confused on waking

Tx with CLONAZEPAM (80-90% respond)

64
Q

What is a black box warning on some sedatives?

A

SLEEPWALKING

65
Q

Sleep terror

A

Occurs during FIRST 3RD OF NIGHT (because NON-REM)

66
Q

What to rule out medically with sleep terror?

A

Temporal lobe epilepsy

67
Q

Other name for restless leg syndrome?

A

WILLIS-EKBOM

68
Q

Restless leg syndrome criteria?

A

Urge to move legs
Need all 3

  1. Worse during rest
  2. Relieved by movement
  3. Worst at evening
69
Q

What can you give to test if restless leg syndrome?

A

Dopamine agonist
Levo-dopa (+ if 50% improvement in sx)

Treat with dopamine agonist, benzos, opiates, anti-epileptics

70
Q

What is not a recognized ethology of restless leg syndrome?

A

Menopause

RC Nuggets (20 decks)

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