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MP422 > SLEEP DISORDERS > Flashcards

SLEEP DISORDERS Flashcards

1
Q

stage 1 of sleep

A

~5-10min
transition from awake to asleep (loss of muscle tone, easily aroused)

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2
Q

stage 2 of sleep

A

~20min
light sleep, movement stops, HR and body temp. decrease

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3
Q

stages 3 & 4 of sleep

A

~30min each
deep or slow wave sleep (restorative), essential for cognitive function and nervous system

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4
Q

stage 5 of sleep

A

REM (rapid eye movement)
increased brain activity, processing and consolidation of information and emotions

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5
Q

sleep architecture

A

stages 1-5 make up the sleep cycle lasting about 90min

cycle is repeated 5-6x a night

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6
Q

neurotransmitters in sleep

A

high neuronal activity in histaminergic, noradrenergic and serotonergic pathways during wakefulness - decreased during non-REM and almost stops during REM

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7
Q

GABA in sleep

A

inhibitory transmitter
induces relaxation and sleep

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8
Q

melatonin in sleep

A

released from pineal gland
regulates circadian rhythm

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9
Q

orexins in sleep

A

from hypothalamus regulate sleep-wake cycle

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10
Q

sleep disorders

A

characterised by disturbances of usual sleep patterns or behaviours that cause distress and impair daytime functioning

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11
Q

insomnia

A
  • inability to get to sleep
  • inability to stay asleep
  • waking early
  • unsatisfying sleep (e.g. still tired)
  • sleep disturbance alongside significant daytime dysfunction
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12
Q

parasomnia

A

disturbance of arousal-sleep maintenance mechanisms (polysomnography PSG often required)

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13
Q

sleep apnoea

A

restriction of airflow
interrupts breathing (poor sleep quality)

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14
Q

narcolepsy

A

neurological disorder when the brain is unable to regulate the sleep-wake cycle

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15
Q

management of sleep disorders and insomnia

A
  • treat underlying condition
  • sleep hygiene
  • psychological therapies (CBT)
  • complementary therapies (herbal)
  • medication to increase pain inhibition via GABA/BZ receptor OR decrease excitation by blocking 5-HT or histamine receptors
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16
Q

sleep hygiene

A
  • maintain an environment conductive to sleep (decreased noise etc.)
  • avoid caffeine/alcohol
  • relaxation (avoid exercise later in day)
  • bed time routines
  • body awareness i.e. rest-activity cycle
17
Q

how does medication help sleep disorders

A

medication (hypnotics e.g. BZP or Z drugs, melatonin, chlormethiazole) decrease time to sleep onset and episodes of walking, BUT get an increase in total sleep time - short term use only i.e. 6 weeks

18
Q

what medication is best for when you can’t get to sleep

A

Z drugs:
zopiclone
zolpidem

19
Q

what medication is best for maintaining sleep

A

benzos:
diazepam

20
Q

Benzodiazepines and Z hypnotics moa

A
  • bind to GABA A receptor and enhance inhibitory effect of GABA - activation of the GABA receptor leads to influx of Cl- ions into the neuron reduces its excitability - thereby reducing activity in the brain - sedation, induces sleep
21
Q

what part of the sleep cycle do benzodiazepines act on

A

BZs suppress stage 4 (deep sleep) and decrease REM

22
Q

what part of the sleep cycle do Z drugs act on

A

Z drugs decrease stage 1 but increase stage 2, little effect on 3,4 and REM

23
Q

BZs kinetics

A
  • rapidly absorbed from GI tract and extensively metabolised by oxidation in the liver - some active metabolites e.g. oxazepam
  • long, medium and short-acting BZs based upon plasma half-life and duration of action
  • substrates for several CYP enzymes - caution when co-prescribed with inhibitors or inducers
  • additive or synergic effects with other psychotropic drugs - increase impairment of motor/intellectual function or worsen respiratory depression
24
Q

various formulations for BZ kinetics

A

oral, IM, and IV for acute/rapid sedation (agitation/pre-operatively) and for emergency treatment of seizures

low water solubility so administered with solvents or as emulsion

25
Q

BZs as hypnotics

A
  • induces sleep within 30 min (stages 1-3)
  • residual effect likely, esp. with nitrazepam - caution in elderly
  • driving offence - all BZs can impair driving ability but esp. clonazepam, diazepam and lorazepam
26
Q

mild side effects of BZs

A

irritability
tremor
headache
nausea

27
Q

moderate side effects of BZs

A

flu-like symptoms
decreased appetite
abnormal sensation of movement
affect driving performance

28
Q

severe side effects of BZs

A

seizures
psychosis
amnesia
blurred vision
respiratory depression (IV route)

29
Q

prescribing for withdrawal/cessation

A
  • short-acting benzos tend to be more problematic
  • to withdraw or stop - best to convert to diazepam and then gradually reduce by 1/8th or 1/6th of total daily dose every fortnight/week - over 6-12 months depending on symptoms
30
Q

Z drugs - zopiclone, zolpidem, zaleplon

A
  • alternative to BZs - lower risk of dependence/tolerance and abuse
  • agonist at a1 subunit of GABA receptor (increased GABA mediated Cl- influx into the cell = inhibits neurotransmission)
  • rapid onset and relatively short duration - decreased hangover effect, cognition function etc.
31
Q

side effects of Z drugs

A

metallic taste (mainly zopiclone)
GI disturbance
dizziness
headache

32
Q

OTC management of sleep

A

sedative antihistamines (diphenhydramine, promethazine)
OR
herbal products (lavender, CBD/cannabidiols)
for short term use only

33
Q

antihistamines for sleep management

A
  • only those that can cross the BBB - i.e. antagonists at the H1 receptor thereby causing sedation
  • primarily used in children
  • promethazine (5-10mg at night) however has a long half-life but low abuse potential
  • diphenhydramine (25-50mg at night) increased potential for abuse - affects cognitive function
34
Q

melatonin for sleep management

A
  • natural hormone produced by the pineal gland regulating circadian rhythm of sleep i.e. stimulated by nightfall
  • promotes sleep initiation - resets the ciradian clock
  • agonist at M1,M2 and M3 receptors
  • efficacy for primary insomnia is poor, better for jet lag
  • relatively short duration of action, rapidly excreted (half-life is 30-60min)

MP422 (17 decks)

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