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Neurology > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

Why do we need sleep?

A
  • Improve concentration and memory
  • Maintain appropriate function of body systems
  • Brain/neuron restoration
  • Maintain optimal emotional and social functioning
  • Conservation of energy
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2
Q

What is stage 1 of sleep?

A
  • NREM
  • Transition between wake to sleep
  • Described as awake, drowsy, or asleep
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3
Q

Stage 2 of sleep

A
  • NREM
  • Light sleep
  • Heartbeat, breathing, and brain activity begins to slow
  • Most sleep time is spent in this stage
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4
Q

Stage 3/4 of Sleep

A
  • NREM
  • Delta sleep or deep sleep
  • Needed to feel refreshed
  • Metabolic and brain activity slows dramatically
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5
Q

REM sleep

A
  • Stage 5 of sleep
  • Eye movements
  • Dreaming occurs
  • Generally occurs ~90 minutes after falling asleep
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6
Q

Which neurotransmitter promote wakefulness?

A
  • Norepinephrine
  • Orexin (Hypocretin)
  • Dopamine
  • Histamine
  • Substance P
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7
Q

Which neurotransmitter promote sleepiness?

A
  • GABA
  • Adenosine
  • Melatonin
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8
Q

Sleep-onset insomnia

A
  • Difficulty falling asleep at the beginning of the night or whenever a person attempts to initiate sleep
  • Sleep latency: 20-30 minutes–> length of time to fall asleep
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9
Q

Sleep maintenance insomnia

A
  • Inability to stay asleep through the night
  • Struggling to get back to sleep for 20-30 minutes
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10
Q

Polysomnography (PSG)

A
  • Primary method used to assess and record variables that characterizes sleep and aid in diagnosis of sleep disorders
  • Measured/observed in sleep laboratories
  • Indicated when:
    • Reasonable clinical suspicion of breathing or movement disorder
    • Initial diagnosis is uncertain
      -Treatment failure
      • Dangerous awakenings/violent or injurious behavior
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11
Q

Actinography

A

Method to characterize circadian rhythm patterns or sleep disturbances in individuals with insomnia

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12
Q

Benzodiazepines

A
  • Traditional benzodiazepines have sedative, anxiolytic, muscle relaxant properties
  • Reducing sleep latency and increasing total sleep time by INCREASING stage 2 sleep while DECREASING delta sleep
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13
Q

Which benzodiazepines is long lasting?

A

Quazepam (Doral) and flurazepam (Dalmane)

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14
Q

Which benzodiazepams are preferred for older adults with changes in hepatic metabolism?

A
  • Lorazepam
  • Oxazepam
  • Temazepam
    Are metabolized by Phase II
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15
Q

Rebound insomnia

A
  • More likely to occur with shorter acting agents
  • May be more severe symptoms than patients had before starting BZDs
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16
Q

Benzodiazepine-Receptor Agonist

A
  • Z drugs
  • Possesses ONLY sedative properties with less withdrawal, tolerance, and rebound insomnia
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17
Q

Zolpidem IR

A
  • Sleep onset or maintenance insomnia–short-term use
  • Duration of effect: 6-8 hours
  • 10mg for male
  • 5 mg for females, older patients, and those with hepatic renal impairments
  • CYP3A4 drug interactions
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18
Q

What are the adverse effects of Zolpidem IR?

A
  • Drowsiness
  • Amnesia
  • Dizziness
  • Headache
  • Gastrointestinal complains
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19
Q

Zolpidem ER

A
  • Sleep onset or maintenance insomnia
  • Duration of effect: 6-8 hours
  • 12.5 mg for men
  • 6.25 mg for women, elderly, and those with hepatic renal impairment
  • CYP3A4 drug interactions
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20
Q

What are the adverse effects of Zolpidem ER?

A
  • Drowsiness
  • Amnesia
  • Dizziness
  • Headache
  • GI upset
  • Weight gain
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21
Q

Eszopiclone (Lunesta)

A
  • Sleep maintenance and sleep onset
  • Long term use up to 6 months
  • Duration: 6 hours
  • Dose: 2-3 mg
  • Take immediately before bed and avoid taking with a high-fat meal
  • CYP3A4 drug interactions
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22
Q

What are the adverse effects of Eszopiclone?

A
  • Somnolence
  • Unpleasant taste
  • Headache
  • Dry mouth
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23
Q

Zaleplon (Sonata)

A
  • Sleep onset insomnia
  • Shown effective for up to 35 nights
  • Can be used for middle of the night awakenings
  • Duration: 6 hours
  • 10 mg for adults
  • 5 mg for older adults and liver disease
  • CYP3A4: Rifampin (plasma level decreases) and Cimetidine (plasma level increases)
24
Q

Melatonin-Receptor Agonists (Ramelteon, Rozerem)

A
  • Sleep onset insomnia
  • Onset: 30 min
  • Dosing: 8 mg once daily
    • Taken within 30 min before going to bed
    • Avoid taking with or soon after a high-fat meal
  • Contraindicated in combination with fluvoxamine
  • CYP1A2, CYP2C, and CYP3A4 interactions
25
Q

What are the adverse effects of melatonin-receptor agonists?

A
  • Somnolence
  • Dizziness
  • Fatigue
  • Nausea
  • Exacerbation of insomnia
26
Q

Suvorexant (Belsomra)

A
  • Orexin Receptor Antagonist
  • Contraindication: Narcolepsy
  • Dose: 10-20 mg
  • Administer 30 minutes before bedtime and only if 7 hours or more until planned awakening
  • Strong/moderate CYP3A4 inhibitors-AVOID
27
Q

What is the MOA of Suvorexant?

A

Dual orexin A and orexin B receptor antagonist (DORA) which turns off wake signaling

28
Q

What are the adverse effects of Suvorexant?

A
  • Somnolence
  • Rare: Sleep paralysis, cataplexy, and other narcolepsy-like symptoms
29
Q

Leborexant (Davigo)

A
  • Orexin Receptor Antagonist
  • Sleep onset and maintenance
  • Contraindication: Narcolepsy
  • Dose: 5-10 mg
  • Administer immediately before bedtime and only if 7 hours or more left until planned awakening
  • Strong/moderate CYP3A4 inhibitors - AVOID
30
Q

What are the adverse effects of Lemborexant?

A
  • Somnolence
  • Rare: Sleep paralysis, cataplexy, and other narcolepsy-like symptoms
31
Q

Daridorexant (Quivivq)

A
  • Orexin Receptor Antagonist
  • Sleep onset and maintenance
  • Contraindication: Narcolepsy
  • Dose: 25-50 mg
  • Administer immediately before bedtime and only if 7 hours or more left until planned awakening
  • Strong CYP3A4 inhibitors: AVOID
  • Strong/moderate CYP3A4 inducers: AVOID
32
Q

What are some adverse effects of Daridorexant (Quivivq)?

A
  • Somnolence
  • Rare: Sleep paralysis, cataplexy, and other narcolepsy-like symptoms
33
Q

What is the MOA of Doxepin (Silenor)?

A

Tricyclic antidepressants medication that is unique in this class in having antihistaminic activity
* Histamine H1 receptor antagonist = sedating effects

34
Q

Doxepin (Silenor)

A
  • Sleep maintenance
  • Onset: 30 min
  • Dose: 3-6 mg
  • Doxepin <= 6 mg is NOT on the Beers Criteria
  • CYP2D6 and CYP2C19 interactions
35
Q

Which antidepressants are used off-label for insomnia?

A
  • Trazodone
  • Mirtazapine
  • Tricyclic Antidepressants
36
Q

What are the side effects of Trazodone?

A
  • Carryover sedation
  • Alpha-adrenergic blockade
  • Orthostasis
37
Q

What are the side effects of Mirtazapine?

A
  • Daytime sedation
  • Weight gain
  • Anticholinergic effects
38
Q

Which atypical antipsychotics are used off-label for insomnia?

A
  • Quetiapine
  • Risperidone
  • Olanzapine
39
Q

What over the counter medications are used for insomnia?

A
  • Diphenhydramine
  • Doxylamine
40
Q

Sleep apnea

A

Repetitive episodes of cessation of breathing during sleep followed by blood oxygen desaturation and brief arousal from sleep to restart breathing

41
Q

Obstructive Sleep Apnea

A

Collapse or obstruction of upper airway

42
Q

What are the risk factors of obstructive sleep apnea?

A
  • Male sex
  • Obesity
  • CHF, atrial fibrillation, refractory hypertension
  • T2DM
  • Stroke
  • Pulmonary Hypertension
43
Q

What are the some symptoms of obstructive sleep apnea?

A
  • Loud, disruptive snoring
  • Witnessed apneas during sleep
  • Excessive daytime sleepiness
44
Q

How do you assess for obstructive sleep apnea?

A
  • Polysomnography (PSG)
  • STOP-BANG questionnaire
45
Q

CPAP

A
  • Standard treatment for OSA
  • Positive pressure column in the upper airway using room air to maintain patency by using a flexible tube that connects the PAP machine to a mask that covers the nose or mouth
46
Q

Central Sleep Apnea (CSA)

A
  • Impairment of respiratory drive
47
Q

What are the risk factors of Restless Legs Syndrome?

A
  • Family history/genetics
48
Q

What are the four cardinal signs/symptoms of Restless Legs Syndrome?

A
  • An urge to move the limbs that usually associated with paresthesia or dysesthesia
  • Symptoms that start or become worse with rest
  • At least partial relief of symptoms with physical activity
  • Worsening of symptoms in the evening or at night
49
Q

What can secondary RLS be due to?

A
  • Iron deficiency
  • Kidney failure
  • Peripheral neuropathy
  • Caffeine
  • Alcohol
  • Stress
  • Fatigue
50
Q

What are the some pharmacological treatments for RLS?

A
  • Dopamine agonists
  • Gabapentin enacarbil
51
Q

Ropinerole/Requip

A
  • Dopamine agonist
  • 0.25 mg PO 1-3 hours before bedtime (max: 4 mg/day)
52
Q

Pramipexole/Mirapex

A
  • Dopamine agonists
  • 0.125. mg PO 2-3 hours before bedtime (max: 0.5 mg/day)
53
Q

Rotigotine/Neupro

A
  • Dopamine agonist
  • 1 patch (1mg/24 hours) transdermally daily (max: 3 mg/24 hours)
54
Q

What are some adverse effects of dopamine agonist?

A
  • Impulse control disorders
  • Nausea
  • Somnolence
  • Headache
  • Dizziness
  • Vomiting
55
Q

Gabapentin enacarbil (Horizant)

A
  • Gabapentin pro-drug
  • Dose: 600 mg once dailiy at 5 pm w/ food
56
Q

Periodic Limb Movements of Sleep (PLMS)

A
  • Repetitive limb movements during sleep
  • Can caus arousal from sleep

Neurology (21 decks)

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