Sleep and sleep disorders Flashcards
What types of waves are present in awake people? What are the waves present in the four stages of non-REM sleep?
awake = alpha waves
stage 1 = decreasing alpha waves and emerging theta waves
stage 2 = mostly theta waves + sleep spindles and K complexes
stage 3 = emerging delta waves
stage 4 = mostly delta waves
What is the sleep cycle? How often does this pattern repeat? How does the time in each stage of sleep change as the night progresses?
1->2->3->4->3->2->REM->2->3->4->3->2…
Repeats ever 90-120min
Stages 3 and 4 are occur mostly in the first half of the night
REM sleep becomes longer as the night progresses
What muscle movements (or lack thereof) are associated with each stage of sleep?
stage 1 - twitches, jerks/myoclonus, lose some muscle tone
stage 2 - lose more muscle tone
stage 3 and 4 - lose even more muscle tone. night terrors, sleepwalking, sleeptalking, involuntary urination while asleep (nocturnal enuresis)
REM - absent muscle activity, rapid eye movements, shallow breathing, tachycardia, dreaming
How does the nature of sleep change with age?
Decreased: amount of time spent in stage 3-4 sleep amount of time spent in REM sleep sleep efficiency Increased: Number of awakenings Amount of time spend in stage 1 sleep sleep latency
What are the questions you should ask in a sleep history?
snoring? problems initiating sleep? problems maintaining sleep? sleep environment? body pain? limb movements? enuresis (urinating while asleep)? nocturia (waking up to urinate)? sleep paralysis? irregular breathing? leg cramps/restless legs? Bruxism (teeth grinding or clenching of jaw?
What are the symptoms of obstructive sleep apnea?
excessive daytime sleepiness, snoring, choking /gasping/snorting during sleep, pauses in breathing while asleep
memory/cognitive/concentration loss, morning headaches, loss of sexual interest,
What are the sequelae of obstructive sleep apnea?
right heart failure, stroke, MVA accidents, occupational accidents, increased insulin resistance
What is the classic tetrad of clinical features of narcolepsy?
excessive daytime sleepiness, cataplexy (sleep attacks - a sudden and transient intrusion of REM sleep in periods of wakefulness, typically triggered by emotions such as laughing, crying, terror), sleep paralysis, hypnagogic hallucinations (vivid hallucinations during transition between sleep and wakefulness)
When patients first fall asleep, they go right into REM sleep instead of stage 1->2->3->4
But patients get normal amounts of sleep during the night
What are the clinical features of Kleine-Levin syndrome? What is the etiology? What type of patient population does it usually affect?
excessive daytime sleepiness, hyperphagia, hypersexuality, aggressiveness, long periods that are asymptomatic followed by symptoms for 1day-1week
Unknown etiology
Classically affects teenage males
What are the clinical features of Onidine’s curse?
when patients fall asleep, they “forget” to breathe due to total loss of automatic breathing during sleep
What are the possible etiologies of restless leg syndrome?
idiopathic (genetic component) iron deficiency ESRD DM MS Parkinsons's
What are the non-REM sleep disorders? During which stage of sleep do they occur? During what part of the night do these disorders occur? Do patients remember the episodes? What is the classic patient profile?
Sleepwalking and sleep terrors Occur in stage 3/4 sleep Occur within the first two hours of falling asleep Patients do not remember Sleep terrors usually affect children
What are the REM sleep disorders? During which stage of sleep do they occur? During what part of the night do these disorders occur? Do patients remember the episodes? What is the classic patient profile?
Nightmare disorders, REM behavior disorder (loss of muscle paralysis during REM sleep allows patients to act out their dreams) Occur in REM sleep Occur anytime of the night Patients vividly remember Classically affects older males
What sleep disorder is characterized by both insomnia AND excessive sleepiness?
circadian rhythm sleep disorders like shift work sleep disorder
What neurotransmitter induces REM sleep?
acetylcholine
