Sleep Disorders Flashcards
Sleep is composed of 2 distinct states
NREM (stag 1-3) and REM
In the sleep cycle, what do older adults have less of?
NREM- stage 3
(Less slow wave sleep SWS)
Because adults have less of NREM SWS how does this affect the REM sleep
Lighter more fragmented sleep
Generalized slowing of the electroencephalographic activity characterizes the transition to what?
Transition from drowsiness to light sleep (stage 1 NREM)
Emergence of sleep spindles and k-complex waveforms accompany what stage of sleep?
Stage 2 (onset of deeper sleep)
Desynchronization of slow delta waves characterizes what stage of sleep?
NREM stage 3 (slow wave sleep)
How many cycles of NREM and REM do people experience on average?
5 cycles
Each cycle of REM and NREM sleep lasts approximately how long?
70-90mins
Periods of NREM sleep constitute what percentage of. Total sleep time?
80%
What two opposing processes interact to strengthen sleep?
- Homeostatic drive for sleep
- Circadian system
What are the benefits of sleeping in time with your circadian rhythm?
- Quicker onset of sleep
- Fewer awakenings
Where is the ‘physiological pacemaker’ located?
Suprachiasmatic nucleus of the hypothalamus
Melatonin is secreted from the ________
Pineal gland
Onset of secretion for melatonin is early evening and peak levels occur when?
Middle of the night
Central melatonin receptors are concentrated where?
Primarily in the suprachiasmatic nucleus in hypothalamus
Classification of sleep disorders consists of what categories?
Primary and secondary sleep disorders
Define insomnia
Difficulty initiating sleep and staying asleep
And dissatisfaction with sleep quality
Additional criteria that may help to categorize insomnia include:
- Daytime tiredness
- Poor functioning
- Fatigue or malaise
- Naps during the day
- Disturbances in concentration
- Memory and mood
- Tension headaches
- GI symptoms
Lost the criteria for chronic insomnia
Sleep disturbance for at least 3 nights/wk
Persists for more than 3 months
List examples of primary sleep disorders under the Dyssomnia sleep category
Primary insomnia
Hypersomnia
Narcolepsy
Sleep apnea
Circadian rhythm sleep disorders
Secondary sleep disorders are due to what?
Medical or psychiatric conditions
Opioids are associated with sleep disordered breathing
Both central and obstructive sleep apnea have been associated with chronic opioid treatment
Central sleep apnea is the absence of airflow for more than 10 seconds with an absence of ventilator effort
Obstructive sleep apnea is associated with continued ventilator effort
What two cancers have the highest rate of sleep disturbance?
Breast
Lung
Insomnia is more likely to be reported in young or old cancer patients?
Young
I’m chronically ill patients what two demographics are associated with insomnia?
Increased prevalence in older
Adults and women.
Self report questionnaires have been developed
List three:
The Pittsburgh sleep quality index (PSQI)
global sleep quality index (GSQI)
Insomnia severity index
What is an example of a non benzo benzodiazepine receptor agonist
Zopiclone
Name 3 benzodiazepines that could be used to treat sleep disturbances
Alprazolam
Diazepam
Clonazepam
What is a non benzodiazepine hypnotic drug that is a benzo receptor agonist
Zopiclone
What are the side effects of zopiclone?
Palpitations
Agitation
Anterograde amnesia
Asthenia
GI symptoms
What two anticonvulsants May you use to manage sleep disturbances?
Gabapentin
Pregabalin
What are some side effects of Gabapentin
Drowsiness
Dizziness
Ataxia
Tremor
Diplopia
Nystagmus
Myalgia
Peripheral edema
Name two atypical antipsychotics you may use to manage sleep disturbance.
Olanzapine
Quetiapine
What are side effects of quetiapine and olanzapine that you need to monitor for
Drowsiness
Dizziness
Ataxia tremor
EPS
New onset diabetes
What is the first line recommendation for insomnia
CBT
Proven for treatment and prevention of insomnia relapse
Patients undergoing CBT for insomnia are likely to use what technique in presleep periods?
Relaxation training
