Sleep Disorders Flashcards

1
Q

What is sleep? How is it different from coma?

A

rapidly reversible state of reduced responsiveness, motor activity & metabolism
different from coma b/c patients in a coma cannot be aroused

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2
Q

Identify the amount of sleep required for each of the following age groups: newborns, infants, toddlers, preschoolers, school-aged children, teenagers, young adults, older adults

A
  • newborns - 14-17 hrs
  • infants - 12-15 hrs
  • toddlers - 11-14 hrs
  • preschoolers - 10-13 hrs
  • school-aged children - 9-11 hrs
  • teenagers - 8-10 hrs
  • young adults - 7-9 hrs
  • older adults - 7-9 hrs
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3
Q

Why is sleep important?

A
  • restoration & cognitive function
  • improves immunity
  • maintains hormone homeostasis (cortisol levels)
  • memory storage
  • protein synthesis & repair
  • mental health stability
  • decrease risk of chronic health problems
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4
Q

NREM is what percent of sleep?

A

75-90%

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5
Q

REM is what percentage of all sleep?

A

10-25%

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6
Q

What are the EEG positions in a sleep study?

A
  • mastoid
  • occipital
  • central
  • frontal
  • eye
  • chin
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7
Q

Identify the name of the EEG characteristics indicated on the provided picture:

A
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8
Q

What are the characteristics of stage N1 of sleep?

Percentage of NREM sleep?

EEG characteristics?

Eye movements?

Muscle tone?

A
  • transition wakefulness to sleep
    • lightest stage - may not know asleep
  • 5-10% NREM
  • EEG
    • lo amplitude mixed frequencies theta range (4-7 Hz) at least 50%
  • Eye movements: slow & rolling
  • Muscle tone: present & breathing is regular
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9
Q

What are the characteristics of stage N2 of sleep?

Percentage of NREM sleep?

EEG characteristics?

A
  • largest percentage total sleep time
    • 45-55% NREM
  • EEG:
    • theta (4-7 Hz)
    • sleep spindles - short duration 11-16 Hz in central lead
    • K-complexes - well-delineated, negative sharp waves followed by positive component duration >0.5 s in frontal lead
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10
Q

Benzodiazepines have what effect on sleep stages?

A

increase N2 stage & increase spindle activity

decrease REM sleep

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11
Q

What are the characteristics of stage N3 of sleep?

Percentage of NREM sleep?

EEG characteristics?

Eye movements?

Muscle tone?

A
  • “deep sleep” or “slow wave sleep”
    • occur more in first half of night
    • more difficult to arouse sleepers
    • decreases with age
  • 10-20% NREM
  • EEG
    • low frequency (0.5-2 Hz)
    • high amplitude delta waves (20%)
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12
Q

What area parasominas & in what stage are they most likely to occur?

A

things that happen in sleep- ie. sleep walking & night terrors

N3

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13
Q

What are the characteristics of stage R of sleep?

EEG characteristics?

Eye movements?

Muscle tone / breathing?

Breathing?

A
  • associated with dreaming
  • EEG
    • low voltage, mixed pattern w/ 2-6 Hz sharp wave patterns in sharp bursts (sawtooth)
  • Rapid eye movements w/ conjugate, irregular sharply peaked eye movements on EOG
  • EMG: atonia, inactivity of all voluntary muscles
    • direct inhibition of alpha motor neurons
  • breathing more erratic & irregular; HR increased
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14
Q

What are the 2 stages of R sleep?

A
  • Phasic
    • bursts of rapid eye movement, respiratory variability & brief EMG activity (muscle twitches)
  • Tonic
    • fewer eye movements & more limited motor activity (atonia more common)
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15
Q

What is the most important thing in evaluating a patient or a sleep disorder?

A

sleep history

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16
Q

When taking a sleep history, what types of symptoms should you ask about?

A
  • presenting symptoms
  • nocturnal symptoms
  • daytime symptoms
  • sleep routine
  • sleep area
  • substances
  • other medical problems
17
Q

When seeing a patient for a sleep disorder, what should you include in the physical examination?

A

neck circumference

mallampati score

retrognathia

septal deviation

obesity abnormal monofilament test

18
Q

Describe the difference classes of Mallampati Score:

A
  1. Class I:
    1. complete visualization of soft palate
  2. Class II:
    1. complete visualization of uvula
  3. Class III
    1. visualization of only the base of the uvula
  4. Class IV:
    1. soft palate is not visible at all
19
Q

What diagnostic testing can you perform on a person to work up for a sleep disorder?

A
  • overnight pulse-oximetry
  • home sleep study
  • polysomnogram
  • sleep latency testing
20
Q

What type of disorder is characterized by the inability to fall asleep & stay asleep?

21
Q

What type of disorder is characterized by excessive sleepiness?

A

hypersominas

22
Q

What type of disorder is characterized difficulty breathing during sleep?

A

sleep related breathing disordrs

23
Q

What type of disorder is characterized by sleeping at non-normal intervals?

A

circadian rhythm sleep wake disorders

24
Q

What type of disorder is characterized by the abnormal or unwanted events that occur while falling asleep, sleeping or waking up?

A

parasomnias

25
What type of disorder is characterized by movement prior or during sleep that affect sleep quality?
sleep movement disorders
26
What is the most common sleep complaint in primary care?
Insomnia
27
What are the types of insomnia?
onset insomnia: difficulty falling asleep maintenance insomnia: difficulty staying asleep acute insomnia precipitated by life event - usually \< 3 mo.
28
Insomnia is most commonly seen in what demographics?
women, elderly, substance abuse
29
What is the strategy to manage insomnia?
* manage underlying conditions * sleep hygiene * polysomnography (if other sleep disorder is suspected) * **cognitive behavioral therapy is first line** * Pharmacological therapies * short acting benzodiazepines & antipsychotics are NOT recommended