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Neuro II > Sleep Disorders > Flashcards

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?

A

insomnia

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
Q

What type of disorder is characterized by movement prior or during sleep that affect sleep quality?

A

sleep movement disorders

26
Q

What is the most common sleep complaint in primary care?

A

Insomnia

27
Q

What are the types of insomnia?

A

onset insomnia: difficulty falling asleep

maintenance insomnia: difficulty staying asleep

acute insomnia precipitated by life event - usually < 3 mo.

28
Q

Insomnia is most commonly seen in what demographics?

A

women, elderly, substance abuse

29
Q

What is the strategy to manage insomnia?

A
  • 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

Neuro II (30 decks)

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