Sleep and Related Disorders

Question 1

Define sleep

Answer 1

A state at which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused

Question 2

Sleep disorder and sleep disturbance are terns used to indicate those conditions that result in ______ ______ ______.

Answer 2

Poor sleep quality

Question 3

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.

Answer 3

Reticular activating

Question 4

Sleep behavior is regulated by a variety of neurologic structures. ______ ______ are important in meditating sleepiness and lethargy associated with infectious illness.

Answer 4

Proinflammatory cytokines

Question 5

Peptides, such as ______ released by GI tract after food ingestion following meals creates ______ sleepiness.

Answer 5

Cholecystokinin

Postprandial

Question 6

______ is na endogenous hormone produced by the pineal gland in the brain from the amino acid tryptophan.

Answer 6

Melatonin

Question 7

Melatonin decreases sleep _____ and increases sleep ______. More melatonin is increased in the ______.

Answer 7

Latency

Efficiency

Evening

Question 8

______ ______ persist when people are placed in isolated environments free of external time cues.

Answer 8

Circadian rhythms

Question 9

Circadian rhythms are controlled by ______ clock mechanisms. The suprachiasmatic nucleus in the ______ is the master clock of the body.

Answer 9

Internal

Hypothalamus

Question 10

______ is the strongest time cue for the sleep-wake rhythm.

Answer 10

Light

Question 11

What are the two major states of sleep?

Answer 11

NREM sleep

REM sleep

Question 12

NREM sleep stage 1

Answer 12

Beginning of sleep.
1-7 minutes.
Can be easily awakened.

Question 13

NREM sleep stage 2

Answer 13

Period of sound sleep.
HR slows and body temp drops.
10-25 minutes.

Question 14

NREM sleep stage 3

Answer 14

Deep sleep or slow-wave sleep.
Deepest stage of sleep.
20-40 minutes.
Dreaming more common (than other NREM).

Question 15

REM sleep

Answer 15

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.

Question 16

Insomnia is devined as difficulty ______ asleep, difficulty ______ asleep, waking up too ______, or poor ______ of sleep.

Answer 16

falling
staying
early
quality

Question 17

Acute insomnia refers to difficulties falling asleep or remaining asleep for at least ______ nights per week over a ______ week period.

Answer 17

3

2

Question 18

Chronic insomnia is defined by the same symptoms of acute insomnia and a daytime ______ that persists for ______ month or longer

Answer 18

Complaint (e.g. fatigue, poor concentration)

1

Question 19

Inadequate ______ ______ refers to those practices or behaviors that are inconsistent with quality sleep.

Answer 19

Sleep Hygiene

Question 20

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.

Answer 20

Stimulants
Side Effects
Induce
Naps
Late
Exercise

Question 21

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.

Answer 21

Initiating

Maintaining

Question 22

Secondary incomnia is due to ______ illness, ______ conditions, medications or ______ ______.

Answer 22

Psychiatric
Medical
Substance Abuse

Question 23

Manifestations of insomnia include

1. Difficulty falling asleep. AKA ______
2. Frequent awakenings. AKA ______
3. Prolonged awakenings or awakening too early and not being able to ______ ______ to ______.
4. Feeling unrefreshed on awakening. AKA ______

Answer 23

Long sleep latency
Fragmented sleep
Fall Back to Sleep
Nonrestorative sleep

Question 24

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.

Answer 24

Complaints, Sleep Diary

Actigraphy

Polysomnography

Question 25

Cognitive-Behavioral therapies are effective and should be the ______ line of therapy. These methods inlcude

Answer 25

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

Question 26

______ and ______ medications are effective for the short-term management of insomnia

Answer 26

Hypnotic Anxiolytic

Question 27

______ insomnia is common with abrupt withdrawal of hypnotic medications

Answer 27

Rebound

Question 28

______ work by activating the GABA receptors to promote sleep

Answer 28

Benzodiazepines

Question 29

Benzodiazepine-Receptor-Like agents like ______ , ______ , and ______ are the drugs of first choice for insomnia

Answer 29

Ambien, Sonata, Lunesta

Question 30

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.

Answer 30

Tolerance Sedative Antihistamines like Diphenhydramine (Benadryl)

Question 31

Complementary and Alternative therapies include ______ and ______.

Answer 31

Melatonin Valerian

Question 32

Define narcolepsy | The behavioral therapies for insomnia are also used for patients with narcolepsy

Answer 32

A chronic neurologic disorder caused by the brains inability tto regulate sleep-wake cycles normally

Question 33

What are the two categories of narcolepsy

Answer 33

With or without cataplexy

Question 34

Define cataplexy

Answer 34

a brief and sudden loss of skeletal muscle tone

Question 35

Narcolepsy ______ be cured, but excessive daytime sleepiness and cataplexy can be controlled in most paitents by ______ treatment.

Answer 35

Cannot | Drug

Question 36

Drug management of narcolepsy includes ______ like stimulants for daytime sleepiness and ______ drug therapy to control cataplexy.

Answer 36

Amphetamine | Antidepressant

Question 37

Circadian rhythm disorders can occur when the circadian time-keeping system loses synchrony with the ______. The two most common symptoms are ______ and ______.

Answer 37

Environment | Insomnia, Excessive sleepiness

Question 38

______ ______ disorder is when an individuals travel results in the crossing of multiple time zones and ones body time is not synchronized with environmental time.

Answer 38

Jet lag

Question 39

Define sleep-disordered breathing (SDB)

Answer 39

Abnormal respiratory patterns associated with sleep. (Snoring, apnea, hypopnea)

Question 40

Obstructive sleep apnea (OSA) is characterized by ______ or ______ ______ ______ during sleep.

Answer 40

Partial | Complete airway obstruction

Question 41

______ is the cessation of spontaneous respirations lasting longer than 10 seconds

Answer 41

Apnea

Question 42

______ is a condition characterized by shallow respirations (30-50% reduction in airflow)

Answer 42

Hypopnea

Question 43

During the apnic period the patient can experinence ______ and ______.

Answer 43

Hypercapnia - Increased PaCO2 | Hypoxemia - Decreased PaO2 or SpO2

Question 44

______ 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.

Answer 44

``` Mild Sleeping Head of Bed Sedatives Alcohol Weight ```

Question 45

Sx may resolve in up to half of patients with OSA who use a special mouth guard called an ______ ______.

Answer 45

Oral Appliance

Question 46

In patients with more severe Sx (more than 15 apnea/hypopnea events per hour) ______ ______ ______ ______ by mask is the treatment of choice.

Answer 46

Continuous Positive Airway Pressure (CPAP)

Question 47

Bilevel positive airway pressure (BiPAP) can deliver a ______ ______ pressure and a ______ ______ during expiration.

Answer 47

Higher inspiration Lower pressure

Question 48

______ ______ ______ ______ is characterized by involuntary, continual movement of the legs and/or arms that only affects people during sleep

Answer 48

Periodic limb movement disorder (PLMD)

Question 49

PLMD and ______ ______ syndrome often occur simultaneously, but they are distinct disorders

Answer 49

Restless leg syndrome

Question 50

______ are defined as unusual and often undesirable behaviors that occur with sleep or during arousal from sleep

Answer 50

Parasomnias

Question 51

Enuresis, hallucinations, and eating are parasomnias that occur during ______ sleep

Answer 51

REM

Question 52

Sleepwalking and sleep terrors are ______ parasomnias that occur during ______ sleep

Answer 52

Arousal NREM

Question 53

______ behaviors range from sitting up in bed, moving objects, and walking around the room to driving a car

Answer 53

Sleepwalking

Question 54

______ ______ are characterized by a sudden awakening from sleep along with a loud cry and signs of panic

Answer 54

Sleep terrors

Question 55

______ are a parasomnia characterized by recurrent awakening with recall of the frightful or disturbing dream

Answer 55

Nightmares