Sleep and Medicolegal Issues - Rothrock Flashcards by Colt Williams

what part of the brain regulates sleep? (be specific!!)

suprachiasmatic nuclei of the hypothalamus

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What is the average sleep time in a newborn/

10-12 hours

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What is the sleep time in an adolescent?

7-7.5 hours

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What is the sleep time in late adult life?

6.5 hours

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What two hormones drop with sleep onset?

Cortisol and TSH secretion

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What two hormones increase during sleep/

growth hormone and prolactin

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What hormone production begins at sleep onset and ceases with sunlight?

melatonin

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T/F: sleep deprivation is lethal

true

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How many stages of Non-rem NREM sleep are there?

4 “stages”

3 NREM

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How many REM stages are there?

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Stage (blank) is drowsiness, slow, roving horizontal eye movements and reduced EEG voltage

stage 1

NREM 1

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Stage (blank) shows EEG SLEEP SPINDLES and slow VERTEX WAVES

stage 2

NREM 2

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Stages (blank and blank) shows high amplitude slow waves

stage 3 and 4

NREM 3

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In what stages is the EEG synchronized?

stages 1-4

NREM 1-3

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In what stage is the EEG nonsynchronized?

stage 5/REM

shows fast waves and bursts of REM

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How many NREM-REM cycles do we do in a night?

4-6

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NREM-NREM2 happens during what portion of the night?

later portion of the night

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How long is a REM cycle?

60-90 mins

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How long after sleep onset does the first REM cycle begin?

70-100 minutes

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T/F: all dreaming occurs during REM sleep

false; just most of it

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T/F: you are easily aroused from REM sleep

true

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In what stage of sleep are you hard to wake from?

NREM 3

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what stage of sleep decreases with age?

NREM 3

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REM has minimal (tonic/phasic) muscle activity

tonic

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What are the effects of sleep deprivation for >60 hours

1. increasing sleepiness, fatigue, irritability 2. difficulty concentrating 3. impaired skilled motor function (esp if require speed, perseverance) 4. inattention 5. impaired judgement 6. nystagmus, loss of accomodation, bilat hand tremor, ptosis, expressionless face, thick speech, mispronunciations, word substit. 7. if persists: visual/tactile hallucinations, psychosis, seizure activity

What are the long term complications of chronic sleep deprivation?

``` hypertension stroke MI pulmonary HTN early death ```

what are primary sleep disturbances?

sleep disturbances for prolonged periods of time in the absence of any psychiatric or medical disorders aka sleep hypochondriacs i.e. the sleep disorder itself causes insomnia

(Primary/secondary) sleep disturbances are often transitory

secondary

What are some non-medical causes of secondary insomnia?

EtOH or drug abuse | psychological

What are some medical causes of secondary insomnia?

arthritic pain GERD, PUD prostatism, nocturia

What is your firstline sleep diagnostic/

sleep journal

What things do you include in a sleep journal?

``` 7 consecutive days bedtime, awakening, out of bed naps use of sedatives and stims symptoms ```

What are the two validated symptom assessment systems?

epworth sleepiness score | stanford sleepiness score

What are the two polysomnography tests?

multiple sleep latency test | maintenance of wakefulness test

if secondary insomnia, then you treat....

the underlying disorder

What makes good sleep hygeine?

Re-set sleep cycle: no naps; dec non-sleep time in bed; exercise Re-set circadian rhythm: lights out, quiet time Avoid caffeine, alcohol, tobacco Bedroom: quiet, dark, rituals, no clock

What are the components of CBT for insomnia

Relaxation, stimulus control

What are the three Rx for primary insomnia?

Sleep hygeine CBT Meds

What type of test is essential for diagnosing sleep breathing disorders?

polysomnography

Ondine's curse is (primary/secondary) apnea

primary

Secondary sleep apnea is cuased by abnormalities in what area of the brain?

lower brain stem

In obstructive sleep apnea, the (ant/post) pharyngeal muscles collapse and narrow the airway

posterior

What is the snoring like in OSA?

noisy, cyclic snoring

T/F: OSA only occurs during NREM

false, in both NREM and REM

What is the usual presentation of OSA?

excessive daytime sleepiness

what is your clinical phenotype for OSA?

overweight, middle aged man

what is THE best screening tool for OSA?

STOP-BANG

Da fuck is STOP-BANG?

Snoring Tired Observed stopped breathign Pressure--HTN BMI >35 Age over 50 Neck circumfrence >40cm Gender male

How many yes's do you need to be at high risk of OSA based on STOP-BANG?

three or more

how many yes's do you need to be at low risk of OSA based on STOP-BANG?

yes to less than three items

What are the components of polysomnography?

``` EMG Airflow EEG Oxygen Saturation Cardiac Rhythm Leg Movements ```

what are the potential pathophys etiologies of OSA?

``` Findings in Obstruction: Nasal obstruction Long, thick soft palate Retrodisplaced mandible Narrowed oropharynx Redundant pharyngeal tissues Large lingual tonsil Large tongue Large or floppy epiglottis Retro-displaced hyoid complex ```

What are the Tx for CENTRAL sleep apnea?

Tx underlying cause (like CHF) | low flow oxygen

T/F: meds are first line therapy for sleep apnea

false; little to no help

What are the non-surgical non-behavioral treatments for sleep apnea?

CPAP, BiPAP, dental appliances

What are the surgical options for OSA?

uvulectomy | mandibular advancement

What are the behavioral treatments for OSA?

``` weight loss avoidance of alcohol avoidance of sedatives avoidance of smoking non-supine sleep ```

How common is RLS?

prevalence >2%

what diseases is RLS associated with?

Fe def. anemia dysthryroidism pregnancy certain drugs(anti-histamines, TCAs)

Is most RLS idiopathic or cuased by an underlying dz?

idiopathic

what is the MOA of TCA related RLS?

decreased dopamine production and binding

What are the Tx for RLS

``` Fe supps if Fe def dopamine agonissts long acting carbidopa/ L-dopa gabapentin clonazepam ```

What is the narcoleptic tetrad?

1. recurrent attacks of irresitible sleep 2. cataplexy (70%) 3. sleep paralysis 4. hallucinations (hynagogic)

When does narcolepsy onset?

15-35

how long are the sleep periods in narcolepsy?

<15 mins 2-6x per day

T/F: narcoleptics are generally pretty sleepy during the day

true

Narcolepsy is often familial but not (blank)

mendelian

the hypothalamic neuropeptide implicated in narcolepsy is...

hyocretin

To what structures does hypocretin project?

locus ceruleus ventral tegmentum aka sleep structures

the really weird thing about REM and NREM in narcolepsy is...

reversal of REM and NREM sleep

In narcolepsy the sleep latency is greatly (inc/dec)

decreased

How do you Dx narcolepsy?

overnight polysomnography followed by MSLT MSLT: naps at 2 hour intervals and detect REM w/i 15 minutes of sleep onset measure CSF levels of hypocretin

what are the Tx strategies for narcolepsy?

strategically placed short naps stimulant drugs (provigil) TCAs Ig infusions