Sleep and Related Disorders Flashcards
Define sleep
A state at which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused
Sleep disorder and sleep disturbance are terns used to indicate those conditions that result in ______ ______ ______.
Poor sleep quality
Wake behavior is associated with an activated cortical brain-wave pattern. The ______ ______ system in the middle of the brainstem is associated with generalized EEG activation and behavioral arousal.
Reticular activating
Sleep behavior is regulated by a variety of neurologic structures. ______ ______ are important in meditating sleepiness and lethargy associated with infectious illness.
Proinflammatory cytokines
Peptides, such as ______ released by GI tract after food ingestion following meals creates ______ sleepiness.
Cholecystokinin
Postprandial
______ is na endogenous hormone produced by the pineal gland in the brain from the amino acid tryptophan.
Melatonin
Melatonin decreases sleep _____ and increases sleep ______. More melatonin is increased in the ______.
Latency
Efficiency
Evening
______ ______ persist when people are placed in isolated environments free of external time cues.
Circadian rhythms
Circadian rhythms are controlled by ______ clock mechanisms. The suprachiasmatic nucleus in the ______ is the master clock of the body.
Internal
Hypothalamus
______ is the strongest time cue for the sleep-wake rhythm.
Light
What are the two major states of sleep?
NREM sleep
REM sleep
NREM sleep stage 1
Beginning of sleep.
1-7 minutes.
Can be easily awakened.
NREM sleep stage 2
Period of sound sleep.
HR slows and body temp drops.
10-25 minutes.
NREM sleep stage 3
Deep sleep or slow-wave sleep.
Deepest stage of sleep.
20-40 minutes.
Dreaming more common (than other NREM).
REM sleep
20-30% of sleep.. 4-5 times during 7-8 hour sleep period. Paradoxic because the brain waves resemble wakefulness. Memory consolidation. Vivid dreaming occurs.
Insomnia is devined as difficulty ______ asleep, difficulty ______ asleep, waking up too ______, or poor ______ of sleep.
falling
staying
early
quality
Acute insomnia refers to difficulties falling asleep or remaining asleep for at least ______ nights per week over a ______ week period.
3
2
Chronic insomnia is defined by the same symptoms of acute insomnia and a daytime ______ that persists for ______ month or longer
Complaint (e.g. fatigue, poor concentration)
1
Inadequate ______ ______ refers to those practices or behaviors that are inconsistent with quality sleep.
Sleep Hygiene
Consumption of ______, ______ ______ of many medicaitons, drinking alcohol to help ______ sleep, ______ close to bedtime, taking long ______ in the afternoon, sleeping ______ in the morning, nightmares, ______ near bedtime, and jet lag can exacerbate insomnia.
Stimulants Side Effects Induce Naps Late Exercise
Chronic insomnia can be classified as primary or secondary. Primary is a lifelong difficulty in ______ and ______ sleep resulting in poor daytime function after med, neuro, psych causes have been excluded.
Initiating
Maintaining
Secondary incomnia is due to ______ illness, ______ conditions, medications or ______ ______.
Psychiatric
Medical
Substance Abuse
Manifestations of insomnia include
- Difficulty falling asleep. AKA ______
- Frequent awakenings. AKA ______
- Prolonged awakenings or awakening too early and not being able to ______ ______ to ______.
- Feeling unrefreshed on awakening. AKA ______
Long sleep latency
Fragmented sleep
Fall Back to Sleep
Nonrestorative sleep
Diagnostic studies.
Self report made on the basis of subjective ______ and on a 1-2 week ______ ______. An ______ that measures gross motor activity. Also a _______ can be done only if there are symptoms or signs of a sleep disorder.
Complaints, Sleep Diary
Actigraphy
Polysomnography
Cognitive-Behavioral therapies are effective and should be the ______ line of therapy. These methods inlcude
First
Relaxation training, Guided imagery, Cognitive strategies to address dysfunctional ideas about sleep, Behavioral strategies that target an individuals poor sleep habits, Education about good sleep hygiene practices, Regular exercise
______ and ______ medications are effective for the short-term management of insomnia
Hypnotic
Anxiolytic
______ insomnia is common with abrupt withdrawal of hypnotic medications
Rebound
______ work by activating the GABA receptors to promote sleep
Benzodiazepines
Benzodiazepine-Receptor-Like agents like ______ , ______ , and ______ are the drugs of first choice for insomnia
Ambien, Sonata, Lunesta
Melatonin receptor agonists (Ramelton (Rozerem)) do not appear to cause ______. Antidepressants like Trazodone (Deseryl) have ______ properties. Many individuals self medicate with OTC sleep aids like ______ but tolerance develops quickly.
Tolerance
Sedative
Antihistamines like Diphenhydramine (Benadryl)
Complementary and Alternative therapies include ______ and ______.
Melatonin
Valerian
Define narcolepsy
The behavioral therapies for insomnia are also used for patients with narcolepsy
A chronic neurologic disorder caused by the brains inability tto regulate sleep-wake cycles normally
What are the two categories of narcolepsy
With or without cataplexy
Define cataplexy
a brief and sudden loss of skeletal muscle tone
Narcolepsy ______ be cured, but excessive daytime sleepiness and cataplexy can be controlled in most paitents by ______ treatment.
Cannot
Drug
Drug management of narcolepsy includes ______ like stimulants for daytime sleepiness and ______ drug therapy to control cataplexy.
Amphetamine
Antidepressant
Circadian rhythm disorders can occur when the circadian time-keeping system loses synchrony with the ______. The two most common symptoms are ______ and ______.
Environment
Insomnia, Excessive sleepiness
______ ______ disorder is when an individuals travel results in the crossing of multiple time zones and ones body time is not synchronized with environmental time.
Jet lag
Define sleep-disordered breathing (SDB)
Abnormal respiratory patterns associated with sleep. (Snoring, apnea, hypopnea)
Obstructive sleep apnea (OSA) is characterized by ______ or ______ ______ ______ during sleep.
Partial
Complete airway obstruction
______ is the cessation of spontaneous respirations lasting longer than 10 seconds
Apnea
______ is a condition characterized by shallow respirations (30-50% reduction in airflow)
Hypopnea
During the apnic period the patient can experinence ______ and ______.
Hypercapnia - Increased PaCO2
Hypoxemia - Decreased PaO2 or SpO2
______ sleep apnea (5-10 apnea/hypopnea events per hour) may respond to simple measures like ______ on ones side, elevating _______, Avodiing ______ and consumption of ______ 3-4 hours prior to sleep. Sleep meds often make OSA worse, ______ loss reduces sleep apnea.
Mild Sleeping Head of Bed Sedatives Alcohol Weight
Sx may resolve in up to half of patients with OSA who use a special mouth guard called an ______ ______.
Oral Appliance
In patients with more severe Sx (more than 15 apnea/hypopnea events per hour) ______ ______ ______ ______ by mask is the treatment of choice.
Continuous Positive Airway Pressure (CPAP)
Bilevel positive airway pressure (BiPAP) can deliver a ______ ______ pressure and a ______ ______ during expiration.
Higher inspiration
Lower pressure
______ ______ ______ ______ is characterized by involuntary, continual movement of the legs and/or arms that only affects people during sleep
Periodic limb movement disorder (PLMD)
PLMD and ______ ______ syndrome often occur simultaneously, but they are distinct disorders
Restless leg syndrome
______ are defined as unusual and often undesirable behaviors that occur with sleep or during arousal from sleep
Parasomnias
Enuresis, hallucinations, and eating are parasomnias that occur during ______ sleep
REM
Sleepwalking and sleep terrors are ______ parasomnias that occur during ______ sleep
Arousal
NREM
______ behaviors range from sitting up in bed, moving objects, and walking around the room to driving a car
Sleepwalking
______ ______ are characterized by a sudden awakening from sleep along with a loud cry and signs of panic
Sleep terrors
______ are a parasomnia characterized by recurrent awakening with recall of the frightful or disturbing dream
Nightmares
