Sleep Disorders Flashcards
What is sleep? How is it different from coma?
rapidly reversible state of reduced responsiveness, motor activity & metabolism
different from coma b/c patients in a coma cannot be aroused
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
- 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
Why is sleep important?
- restoration & cognitive function
- improves immunity
- maintains hormone homeostasis (cortisol levels)
- memory storage
- protein synthesis & repair
- mental health stability
- decrease risk of chronic health problems
NREM is what percent of sleep?
75-90%
REM is what percentage of all sleep?
10-25%
What are the EEG positions in a sleep study?
- mastoid
- occipital
- central
- frontal
- eye
- chin
Identify the name of the EEG characteristics indicated on the provided picture:
What are the characteristics of stage N1 of sleep?
Percentage of NREM sleep?
EEG characteristics?
Eye movements?
Muscle tone?
- 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
What are the characteristics of stage N2 of sleep?
Percentage of NREM sleep?
EEG characteristics?
- 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
Benzodiazepines have what effect on sleep stages?
increase N2 stage & increase spindle activity
decrease REM sleep
What are the characteristics of stage N3 of sleep?
Percentage of NREM sleep?
EEG characteristics?
Eye movements?
Muscle tone?
- “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%)
What area parasominas & in what stage are they most likely to occur?
things that happen in sleep- ie. sleep walking & night terrors
N3
What are the characteristics of stage R of sleep?
EEG characteristics?
Eye movements?
Muscle tone / breathing?
Breathing?
- 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
What are the 2 stages of R sleep?
- Phasic
- bursts of rapid eye movement, respiratory variability & brief EMG activity (muscle twitches)
- Tonic
- fewer eye movements & more limited motor activity (atonia more common)
What is the most important thing in evaluating a patient or a sleep disorder?
sleep history
When taking a sleep history, what types of symptoms should you ask about?
- presenting symptoms
- nocturnal symptoms
- daytime symptoms
- sleep routine
- sleep area
- substances
- other medical problems
When seeing a patient for a sleep disorder, what should you include in the physical examination?
neck circumference
mallampati score
retrognathia
septal deviation
obesity abnormal monofilament test
Describe the difference classes of Mallampati Score:
- Class I:
- complete visualization of soft palate
- Class II:
- complete visualization of uvula
- Class III
- visualization of only the base of the uvula
- Class IV:
- soft palate is not visible at all
What diagnostic testing can you perform on a person to work up for a sleep disorder?
- overnight pulse-oximetry
- home sleep study
- polysomnogram
- sleep latency testing
What type of disorder is characterized by the inability to fall asleep & stay asleep?
insomnia
What type of disorder is characterized by excessive sleepiness?
hypersominas
What type of disorder is characterized difficulty breathing during sleep?
sleep related breathing disordrs
What type of disorder is characterized by sleeping at non-normal intervals?
circadian rhythm sleep wake disorders
What type of disorder is characterized by the abnormal or unwanted events that occur while falling asleep, sleeping or waking up?
parasomnias
What type of disorder is characterized by movement prior or during sleep that affect sleep quality?
sleep movement disorders
What is the most common sleep complaint in primary care?
Insomnia
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.
Insomnia is most commonly seen in what demographics?
women, elderly, substance abuse
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
