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Behavioral Med II > Sleep and Sleep D/o > Flashcards

Sleep and Sleep D/o Flashcards

1
Q

What % of life is spent sleeping?

A

33%

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2
Q

What would getting no sleep lead to physiologically? (x3)

A

neurocognitive impairment, lower immune fxn, and physiological dysfxn

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3
Q

(Young/old) people need more sleep than (young/old) people.

A

young, old

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4
Q

What are the 4 stages of sleep and what are they characterized by?

A

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

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5
Q

How long do sleep stages usually last for? How many NREM/REM cycles occur nightly?

A

70-120 minutes

3-6 cycles

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6
Q

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

A

~5-10

increases, increases

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7
Q

What is Stage 0 of the sleep cycle?

A

Considered wakefulness with eyes closed, occurs just before sleep onset

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8
Q

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)

A

desynchronous
beta
low
high

synchronous
alpha
high
slower/lower

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9
Q

In what parts of the brain is wakefulness regulated? (x4)

A

Brainstem, thalamus, hypothalamus, basal forebrain

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10
Q

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 _____)

A

Ventrolateral preoptic nucleus (VLPN/VLPO)

brainstem

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11
Q

What are some neurotransmitters that are involved in wakefulness?

A

ACh, histamine, DA, NorEpi, and serotonin

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12
Q

Located in the _______, the Perifornical Area contains neurons that secrete _________, which stimulate VLPO and promote ________, “unique” to the phenomenon of wakefulness

A

lateral hypothalamus
hypocretin/orexin
wakefulness

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13
Q

What is included as part of a polysomnography sleep study? (x4)

A

EEG (electroencephalography)
EOG (electrooculography)
EMG (electromyography)
Vitals (SpO2, HR, RR, EKG)

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14
Q

What is the multiple sleep latency test used for?

How is it performed?

A

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

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15
Q

If a pt’s average sleep latency _____ (time), they are dx with excessive daytime sleepiness

A

<5 min

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16
Q

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

A 
elderly
women
medication
low
low
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17
Q

Insomnia is defined as inability to sleep at least ____ nights/week for at least ___ months

A

3, 3

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18
Q

For a formal dx of insomnia, a pt must have difficulty with _____, _____, or have _____

A

initiating sleep, maintaining sleep, early awakening and cannot fall back asleep

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19
Q

What is the tx for insomnia? What should be started with?

A 
Start with sleep hygiene
Sleep Rx (avoid BZDs) --> use Zolpidem, Eszopiclone, Doxepin, Ramelteon
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20
Q

_____ medications can be habit forming, but will not form dependence or tolerance to in the tx of insominia

A

hypnotic

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21
Q

____ have sleep promoting effects, but tolerance can develop over time, same with ____ medications (tx of insomnia)

A

BZD

antihistamines

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22
Q

Hyper-somnolence d/o occurs in ___% of the population

A

5%

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23
Q

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

A

3, 3

24
Q

Hyper-somnolence d/o is characterized by prolonged ____ and continual _____

A

nocturnal sleep, daytime drowsiness

25
Q

Often , pts with Hyper-somnolence d/o will take ____ naps per day, lasting ____

A

1-2

1 hour

26
Q

T/F: Hyper-somnolence d/o is a dx of exclusion

A

True

27
Q

pts with Hyper-somnolence d/o have a diminished ____ sleep stage and short latency to ____

A

delta stage 3

REM

28
Q

How to tx Hyper-somnolence d/o?

A

No effective cure, sx tx
sleep hygiene and sleep therapy
Stimulant medications i.e. Dextroamphetamine and Methylphenidate (multiple divided doses throughout the day)

29
Q

Is Narcolepsy more common in males or females?

A

Equal

30
Q

Does narcolepsy run in families?

A

Yes

31
Q

What is the definition of narcolepsy?

A

recurrent episodes of an irrepressible need to sleep

32
Q

T/F: Narcolepsy is one of the only dx with a known etiology

A

true

33
Q

In pts w/ narcolepsy, they experience sleep attacks that can last from ___ to ____, and occur with one of the following:

  1. _______, most severe
  2. ____ deficiency
  3. Nocturnal polysomnography with ____ latency ___ min or a ____ sleep latency of ____ min
A 
seconds to 30 min
Cataplexy
CSF hypocretin (Orexin)
REM <15 min
MSLT <8 min
34
Q

How to tx narcolepsy?

Tx Cataplexy?

A

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

35
Q

What are the three breathing related sleep d/o?

A

Obstructive sleep apnea hypopnea d/o
Central Sleep Apnea d/o
Sleep related hypoventilation d/o

36
Q

What is the most common breathing related sleep d/o?

A

Obstructive sleep apnea hypopnea d/o

37
Q

Obstructive sleep apnea hypopnea d/o is most common in pts who are ____ and ____

A

overweight, middle aged/older adults

38
Q

In Obstructive sleep apnea hypopnea d/o, breathing reportedly does what?

A

Stops and starts during sleep

39
Q

What is apnea?

A

pause in breathing, breathing stops

40
Q

What is hypopnea?

A

decrease in airflow during breathing

41
Q

In Obstructive sleep apnea hypopnea d/o, patients are (aware/unaware) that they stop breathing?

A

unaware

42
Q

In Obstructive sleep apnea hypopnea d/o, _______ during sleeping causes narrowing of the airway, or closure–> brain wakes pt up

A

muscle relaxation

43
Q

Tx for Obstructive sleep apnea hypopnea d/o?

A

CPAP, weight loss, sleep position training, surgery to remove oropharyngeal tissue, and or tracheostomy if extreme

44
Q

Central sleep apnea d/o comprises ___% of breathing related sleep d/o

A

<5%

45
Q

In Central sleep apnea d/o, there (is no/is) upper airway obstruction

A

is NO

46
Q

Is snoring common/uncommon in Central sleep apnea d/o?

A

common

47
Q

Describe the pathophysiology of Central sleep apnea d/o

A

CNS control, brain regions involved in regulating muscles of respiration fail to up regulate breathing

48
Q

Central sleep apnea d/o may be experience ______ with subsequent __, __, __, and may be due to ______

A

Cheyne stokes breathing (w/ HF, CVA, renal failure)

Opioid use

49
Q

tx for Central sleep apnea d/o?

A 
Sleep study
Avoid sedative/hypnotic meds
CPAP device
Tx underlying medical conditions
Supplemental oxygen
Adaptive servo ventilation (ASV)- provides positive expiratory airway pressure (EPAP) &amp; inspiratory pressure support (IPAP); servo controlled based on detection of central sleep apnea
50
Q

Sleep related hypoventilation d/o is characterized by a _____ response to _____ CO2 levels

A

decreased response to higher CO2 levels

51
Q

Patients with Sleep related hypoventilation d/o will have frequent episodes of ____, which last ____

A

shallow breathing, >10 seconds

52
Q

Sleep related hypoventilation d/o is frequently associated with ____ and _____ (such as ____)

A

lung dz and neuromuscular/chest wall d/o (pectus excavatum)

53
Q

Pts with Sleep related hypoventilation d/o often have ___ upon waking, ____, and _____

A

HA, insomnia, ad daytime sleepiness

54
Q

____ and ____ may occur along with Sleep related hypoventilation d/o

A

OSA and CSA

55
Q

Sleep related hypoventilation d/o may result in ___, ___, and ____. (medical conditions)

A

polycythemia, pulmonary HTN, and right sided HF

56
Q

Tx for Sleep related hypoventilation d/o?

A

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

Behavioral Med II (7 decks)

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