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INS > Sleep disorders > Flashcards

Sleep disorders Flashcards

1
Q

Alpha rhythm is associated with ____

A

awake with eyes closed

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2
Q

vertex waves are associated with ______

A

NREM N1

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3
Q

K complex is associated with

A

NREM N2

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4
Q

Sleep spindles are associated with

A

NREM N2

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5
Q

Slow wave sleep is associated with

A

NREM N3

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6
Q

Saw tooth waves are associated with

A

REM

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7
Q

In _____ sleep, there is an increase in parasympathetic activity

A

NREM

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8
Q

In ___ sleep, there is an increase in sympathetic activity, dreaming, paralysis of skeletal muscle

A

REM

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9
Q

Differentiate between NREM parasomnias and REM parasomnias

A

NREM: overlap between wake and NREM sleep, behaviors are not under conscious control and not remembered upon awakening, most common in children who often “grow out of them”

REM: loss of paralysis, acting out dreams, eyes are closed, rapid alertness and recall on awakening, common in elderly men

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10
Q

List the differential diagnosis for a child with sleep terrors

A

NREM parasomnia

nocturnal panic attacks, nocturnal frontal lobe seizure, delerium, REM sleep behavior disorder

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11
Q

Describe the three step model for treatment of NREM parasomnias

A
  1. modify predisposing factors (avoid sleep deprivation, stress)
  2. improve safety of sleep environment
  3. pharmacotherapy (BZDs)
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12
Q

REM sleep behavior disorder is associated with ______ in young people

A

nacrolepsy

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13
Q

Among older men with REM sleep behavior disorder, there is an increased risk for developing ________

A

Parkinson’s

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14
Q

Describe management of REM sleep behavior disorder

A
  1. verify diagnosis with sleep study (elevated muscle tone)
  2. treat co-morbid sleep disorders
  3. remove iatorgenic causes (ex antidepressants)
  4. pharmacology: BZDs, melatonin, pramipexole
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15
Q

List major symptoms of narcolepsy

A
  • excessive daytime sleepiness
  • sleep paralysis
  • hypnagogic imagery
  • cataplexy
  • automatic behaviors
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16
Q

Define cataplexy

A

Loss of muscle tone in response to emotional stimuli

17
Q

Describe the cause of narcolepsy with cataplexy

A

Loss of hypocretin/orexin containing neurons in the lateral hypothalamus
Likely autoimmune

18
Q

Describe treatment for narcolepsy

A
  • avoid sleep deprivation
  • scheduled naps
  • stimulants to reduce daytime sleepiness
  • antidepressants for cataplexy
  • sodium oxybate for sleepiness and cataplexy
19
Q

Restless leg syndrome is more common in (women/men), (young/elderly), and people of ________ descent

A

elderly women

Northern European descent

20
Q

List major criteria of restless leg syndrome

A

URGE
U: urge to move legs, usually with other uncomfortable sensations
R: rest-induced
G: get better with movement
E: evening and night are worse; clear circadian rhythm to symptoms

21
Q

What is the primary cause of restless leg syndrome?

A

Dysfunction of CNS iron metabolism

22
Q

Describe non-pharmacologic therapy of restless leg syndrome

A

mental alerting activities
abstinence from nicotine, alcohol, caffeine
Iron replacement
remove medications that contribute

23
Q

Describe pharmacologic therapy of restless leg syndrome

A

Dopamine agonist: pramipexole, ropinirole, rotigitine

calcium channel ligand: gabapentin, pregabalin

24
Q

Shift work sleep disorder is considered an _____ circadian rhythm disorder

A

exogenous

25
Q

Describe treatment for shift work sleep disorder

A
  1. increase sleep duration: sleep hygiene, hypnotic medications
  2. increase alertness: prophylactic naps, caffeine, wake-promoting drugs
  3. re-align circadian rhythm: adjust light exposure, melatonin
26
Q

Delayed sleep phase syndrome is more common in ____ and advanced sleep phase syndrome is more common in ____

A

delayed in adolescents

advanced in elderly

27
Q

90% of cases of chronic insomnia are caused by _____

A

comorbid conditions, not primary insomnia

28
Q

List some risk factors for insomnia

A 
older age
female gender
divorce/ widowhood
psychiatric illness
medical conditions
cigarette smoking
alcohol or caffeine consumption 
prescription drugs
29
Q

List some psychological factors that contribute to insomnia

A

More reactive to stressors
Worries and intrusive thoughts prior to sleep
Over time may develop negative associations with bedtime/environment
Maladaptive responses may perpetuate insomnia

30
Q

List common medical comorbidities seen with chronic insomnia

A

Cardiac, pulmonary, rheumatologic, neurologic, endocrine, gastrointestinal, renal, pain syndromes

31
Q

Insomnia itself is a risk factor for incident ____

A

MDD

32
Q

List medications linked to insomnia

A 
Antidepressants
Stimulants
Steroids
Decongestants 
Antihypertensives
Caffeine 
Alcohol
33
Q

List the 3 Ps used in the behavioral model of chronic insomnia

A
  • predisposing
  • precipitating
  • perpetuating
34
Q

Describe components of sleep hygiene

A 
Avoid watching clock, stimulants, heavy meals before bedtime
Keep the room dark, cool, quiet
Increase daytime light exposure
Practice relaxing routine
Reduce time in bed
35
Q

List pharmacologic approaches to insomnia

A
  • BZDs
  • melatonin agonists
  • orexin antagonists (suvorexant)
  • doxepin- TCA re-marketed for sleep, strong H1 affinity
36
Q

List antidepressants used off label to treat insomnia and their advantages/ disadvantages

A

Mirtazapine, Trazodone, Nefazodone, Amitriptyline, Trimipramine

little abuse liability

some daytime sedation, weight gain, anticholinergic side effects

37
Q

List anticonvulsants used off label to treat insomnia and their advantages/ disadvantages

A

gabapentin, pregabalin

little use liability and help with co-morbid RLS

Less effective than BZDs, cognitive impairment, daytime sedation, weight gain, edema

38
Q

List antipsychotics used off label to treat insomnia and their advantages/ disadvantages

A

Olanzapine, Quetiapine, Risperidone, Ziprasidone

anxiolytic and help stabilize co-morbid bipolar disorder

less effective than BZDs, side effect profile, should not be used unless patient has underling psychotic disorder

INS (21 decks)

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