Sleep and Sleep D/o Flashcards
What % of life is spent sleeping?
33%
What would getting no sleep lead to physiologically? (x3)
neurocognitive impairment, lower immune fxn, and physiological dysfxn
(Young/old) people need more sleep than (young/old) people.
young, old
What are the 4 stages of sleep and what are they characterized by?
Stage 1: 5% of total sleep, alpha/beta waves
Stage 2: 45-55% of total sleep, theta waves, sleep spindles, k-complex
Stage 3: 15-20% of sleep, delta waves, slow wave, deep sleep high voltage, low frequency
Stage 4: REM, 20-25% of sleep, EEG similar to Stage 1, desynchronized
How long do sleep stages usually last for? How many NREM/REM cycles occur nightly?
70-120 minutes
3-6 cycles
First REM period lasts ____ minutes and each successive cycle (decreases/increases) in length and frequency so the “density” of REM sleep (decreases/increases) over the night
~5-10
increases, increases
What is Stage 0 of the sleep cycle?
Considered wakefulness with eyes closed, occurs just before sleep onset
In wakefulness, there is more ______ brain activity, ____ waves predominate (___ amplitude, ____ frequency).
When more relaxed and during sleep, brain activity is more _____–> closing eyes will result in ____ waves predominating (____amplitude, ____ frequency)
desynchronous
beta
low
high
synchronous
alpha
high
slower/lower
In what parts of the brain is wakefulness regulated? (x4)
Brainstem, thalamus, hypothalamus, basal forebrain
What is the one area of the brain in the hypothalamus that is particularly involved in the switch between wakefulness and sleep (inhibits wakefulness regions in the _____)
Ventrolateral preoptic nucleus (VLPN/VLPO)
brainstem
What are some neurotransmitters that are involved in wakefulness?
ACh, histamine, DA, NorEpi, and serotonin
Located in the _______, the Perifornical Area contains neurons that secrete _________, which stimulate VLPO and promote ________, “unique” to the phenomenon of wakefulness
lateral hypothalamus
hypocretin/orexin
wakefulness
What is included as part of a polysomnography sleep study? (x4)
EEG (electroencephalography)
EOG (electrooculography)
EMG (electromyography)
Vitals (SpO2, HR, RR, EKG)
What is the multiple sleep latency test used for?
How is it performed?
Excessive sleepiness
Performed during normal period of wakefulness
Every 2 hrs pt is placed in a dark room
Given opportunity to fall asleep for 20 mins
Latency to sleep is measured w/ full polysomnography
If a pt’s average sleep latency _____ (time), they are dx with excessive daytime sleepiness
<5 min
Insomnia is more common in (adolescents/middle age/elderly), (men/women), and in individuals with chronic ____ issues, (low/high) income, and (low/high) levels of education
elderly women medication low low
Insomnia is defined as inability to sleep at least ____ nights/week for at least ___ months
3, 3
For a formal dx of insomnia, a pt must have difficulty with _____, _____, or have _____
initiating sleep, maintaining sleep, early awakening and cannot fall back asleep
What is the tx for insomnia? What should be started with?
Start with sleep hygiene Sleep Rx (avoid BZDs) --> use Zolpidem, Eszopiclone, Doxepin, Ramelteon
_____ medications can be habit forming, but will not form dependence or tolerance to in the tx of insominia
hypnotic
____ have sleep promoting effects, but tolerance can develop over time, same with ____ medications (tx of insomnia)
BZD
antihistamines
Hyper-somnolence d/o occurs in ___% of the population
5%
For at least ___ nights per week, for at least ___ months, a patient must have excessive daytime sleepiness/somnolence for dx of Hyper-somnolence d/o
3, 3
Hyper-somnolence d/o is characterized by prolonged ____ and continual _____
nocturnal sleep, daytime drowsiness
Often , pts with Hyper-somnolence d/o will take ____ naps per day, lasting ____
1-2
1 hour
T/F: Hyper-somnolence d/o is a dx of exclusion
True
pts with Hyper-somnolence d/o have a diminished ____ sleep stage and short latency to ____
delta stage 3
REM
How to tx Hyper-somnolence d/o?
No effective cure, sx tx
sleep hygiene and sleep therapy
Stimulant medications i.e. Dextroamphetamine and Methylphenidate (multiple divided doses throughout the day)
Is Narcolepsy more common in males or females?
Equal
Does narcolepsy run in families?
Yes
What is the definition of narcolepsy?
recurrent episodes of an irrepressible need to sleep
T/F: Narcolepsy is one of the only dx with a known etiology
true
In pts w/ narcolepsy, they experience sleep attacks that can last from ___ to ____, and occur with one of the following:
- _______, most severe
- ____ deficiency
- Nocturnal polysomnography with ____ latency ___ min or a ____ sleep latency of ____ min
seconds to 30 min Cataplexy CSF hypocretin (Orexin) REM <15 min MSLT <8 min
How to tx narcolepsy?
Tx Cataplexy?
Stimulants–> Dextroamphetamine and Methylphenidate (multiple divided doses throughout the day)
Modafinil single dose in AM
Cataplexy–> Sodium oxybate (can decrease frequency of episodes)
May require naps at work/during day to reduce sx
What are the three breathing related sleep d/o?
Obstructive sleep apnea hypopnea d/o
Central Sleep Apnea d/o
Sleep related hypoventilation d/o
What is the most common breathing related sleep d/o?
Obstructive sleep apnea hypopnea d/o
Obstructive sleep apnea hypopnea d/o is most common in pts who are ____ and ____
overweight, middle aged/older adults
In Obstructive sleep apnea hypopnea d/o, breathing reportedly does what?
Stops and starts during sleep
What is apnea?
pause in breathing, breathing stops
What is hypopnea?
decrease in airflow during breathing
In Obstructive sleep apnea hypopnea d/o, patients are (aware/unaware) that they stop breathing?
unaware
In Obstructive sleep apnea hypopnea d/o, _______ during sleeping causes narrowing of the airway, or closure–> brain wakes pt up
muscle relaxation
Tx for Obstructive sleep apnea hypopnea d/o?
CPAP, weight loss, sleep position training, surgery to remove oropharyngeal tissue, and or tracheostomy if extreme
Central sleep apnea d/o comprises ___% of breathing related sleep d/o
<5%
In Central sleep apnea d/o, there (is no/is) upper airway obstruction
is NO
Is snoring common/uncommon in Central sleep apnea d/o?
common
Describe the pathophysiology of Central sleep apnea d/o
CNS control, brain regions involved in regulating muscles of respiration fail to up regulate breathing
Central sleep apnea d/o may be experience ______ with subsequent __, __, __, and may be due to ______
Cheyne stokes breathing (w/ HF, CVA, renal failure)
Opioid use
tx for Central sleep apnea d/o?
Sleep study Avoid sedative/hypnotic meds CPAP device Tx underlying medical conditions Supplemental oxygen Adaptive servo ventilation (ASV)- provides positive expiratory airway pressure (EPAP) & inspiratory pressure support (IPAP); servo controlled based on detection of central sleep apnea
Sleep related hypoventilation d/o is characterized by a _____ response to _____ CO2 levels
decreased response to higher CO2 levels
Patients with Sleep related hypoventilation d/o will have frequent episodes of ____, which last ____
shallow breathing, >10 seconds
Sleep related hypoventilation d/o is frequently associated with ____ and _____ (such as ____)
lung dz and neuromuscular/chest wall d/o (pectus excavatum)
Pts with Sleep related hypoventilation d/o often have ___ upon waking, ____, and _____
HA, insomnia, ad daytime sleepiness
____ and ____ may occur along with Sleep related hypoventilation d/o
OSA and CSA
Sleep related hypoventilation d/o may result in ___, ___, and ____. (medical conditions)
polycythemia, pulmonary HTN, and right sided HF
Tx for Sleep related hypoventilation d/o?
Sleep study
Avoid sedative/hypnotic meds
Tx underlying d/o→ bronchodilators if obstructive lung dz
Supplemental O2
As underlying d/o progresses, may require more extreme support and ultimately mechanical ventilation/tracheostomy
