Sleep Disorders Flashcards
What are teh two sleep states and NTs involved
- REM: acetylcholine (Ach)
- NREM: serotonin
What does normal sleep architecture look like?
What EEG pattersns are seen during sleep cycle
How long is the human circadian cycle?
What do we see in awake EEG?
What is difference bwtn sleep latency and sleep efficiency?
Human Circadian Cycle = 25 hours
Awake EEG - beta and alpha waves
Sleep Latency = time it takes to fall asleep (less than 10 minutes)
Sleep Efficiency = time sleeping/time spent trying to sleep (100%)
What are the sleep requirments for
Newborn –
Adolescent –
Adult –
Older Adult –
Newborn – 16-18
Adolescent – 9-10
Adult – 8
Older Adult – 7-8
- 25% of all sleep
- Every 90 minutes
- Each episode – 10-40 minutes
- Longer episodes – second half of night
REM sleep
During REM:
• Blood pressure, pulse rate, and respirations____
- Penile and clitoral ____
- Skeletal mm_____
– increase
erection
paralysis
Why do we dream?
wish fulfilment, random neural impulses, what we learn during wake cycle or purging
threat simulaiton or process pain or problem solving
Non-REM Sleep
Non-REM = Stage 1, 2, 3, and 4
- Stage 1 = ___% sleep
- Stage 2 = __% sleep
- Stage 3 and 4 = ___% sleep : most deep sleep occurring during the first half of the night
5
45
25
Stage 1 NREM
- Lasts about___ minutes
- Breathing - ____
- Heart rate – ___
- Blood pressure -____
Stage 1 NREM
- Lasts about 10 minutes
- Breathing - slow and even
- Heart rate – regular
- Blood pressure - decrease
- Temperature - decrease
- Blood flow to brain – decrease
- EEG – brain waves smaller, slower, irregular •
Sleeper easily awoken
Stage 1 NREM
- Lasts about 20 minutes
- Bodily functions continue to slow
- Even if eyes are opened, sleeper cannot see
- EEG – larger brain waves, occasional quick bursts of activity
• Sleeper can be awakened by sounds
Stage 2 NREM
- Begins about 30-45 minutes after sleep is initiated
- EEG – brain waves are slow and large (up to 5x as large as in Stage 2)
- Sleeper is much less easy to awake, requiring loud noise or active attempts to wake
Stage 3 NREM
- Bodily functions decline to the deepest state of rest
- EEG – brain wakes are large, slow and make a jagged pattern
• Sleeper experiences oblivion - if awakened, very disoriented
Stage 4 NREM
What happens to
REM
Stage 3 and 4
as we get older?
Decreased REM
Decreased Stage 3 and 4 sleep
Increased night-time awakenings - decreased sleep efficiency
What happens to REM in depressed pts? what about stage 3/4 sleep?
Decreased REM latenly: first REM within 45 mins!
Increased total REM
Decreased total 3/4
*wake alot, especially in morning
____– Abnormal timing, quality, and amount of sleep
_____– Abnormal behaviors associated with sleep
Dyssomnias
Parasomnias
What dyssomnias are associated with:
Timing
Quality
Amount
Timing : Narcolepsy and Circadian rhythm sleep disorder
Quality: Restless legs or Sleep apnea
Amount: Insomnia or Hypersomnia
Bruxism (tooth grinding)
Night terror
Sleepwalking
REM sleep behavior disorder
all are examples of:
Parasomnias
- Sleep attacks
- Hypnogogic/hypnopompic hallucinations
- Cataplexy
- Sleep paralysis
Narcolepsy (dyssomnias)
Changes seen in Narcolepsy:
Abnormalities in sleep architecture
- _____ sleep latency
- ____ REM latency: less than 10 minutes
-___ REM overall
Decreased
Decreased
Less
What neuro factor is different in narcolepsy
hypocretin (orexin) deficiency
Epidemiologic factors
- Usually diagnosed in adolescence - Significant genetic component
Tx options for narcolepsy
- Scheduled daytime naps
- Psychostimulants: methylphenidate (Ritalin) modafinil (Provigil)
What is circadian ryhthm sleep disorder
Features
- Inability to sleep at appropriate or desired times -
Two types: Delayed or Advanced -
Causes: Intrinsic or Extrinsic (e.g. shift work, jet lag)
What are the tx recommendations for circadian sleep rythm disorder:
both delayed and advanced
( Shift work: Modafinil 100-200 mg or caffeine for alertness; Melatonin or other hypnotic at bedtime)
- Uncomfortable sensation in the legs
- Repetitive limb jerking
- Frequent night-time awakenings
Restless Legs Syndrome: dyssomnias
Who gets RLS and what’s the treatement?
Epidemiologic factors: Usually occurs in older adults
Treatment: Antiparkinsonian agents, levodopa, carbidopa/levodopa (Sinemet) ropinirole (Requip)
- Cessation of breathing
- Carbon dioxide increases
- Frequent awakenings
- Increase rate of sudden death
Sleep Apnea (dyssomnia)
what in the hypothalamus transmits information to pineal gland to increase produciton of melaotnin which aids in sleep
Suprachiasmiatic nucleus
Pt comes in saying she has recurrent headaches and feels very drowsy during the day. Her husband has moved to the other room to sleep because of her snoring. She is overweight. What is a possible dx? What would you expect to see on her labs?
Sleep apnea (likley obstructive from weight)
lab would show respiratory acidosis
Cauased by decreased respiratory effort; usually in older adults. A type of dyssomnia
Central Sleep apnea
Seen in pts with NORMAL respiratory effort and obstructed airway; seen in middle aged adults, more common in men and associated with obesity
Obstructive sleep apnea
What are some tx options for Sleep Apnea
- Weight loss (if obesity present)
- Continuous positive airway pressure (CPAP)
- Medroxyprogesterone acetate
- Uvulopalatoplasty /Tracheostomy
Pt comes in stating he’s been having issues fallling asleep. It has been going on for the past two weeks about 3-4 days a week. He feels tired and groggy all the time. Whats going on?
May be developing Insomnia, need to wait a MONTH to make dx,but needs 3/4 s a week
seen in 30% poputlation
Pt was recently dx with insomnia, what may be some possible etiologies
seen in pts with cognitive impairement and in accidents
Recommended tx for insomnia
- Avoid caffeine, especially in evenings
- AM exercise
- Develop sleep routine
- Relaxation techniques
- Hypnotic medication: May, however, decreased REM and delta sleep.
When does Bruxism occur and what is a tx option?
Stage 2 sleep; wear appliance
Child comes in with mother. Mom states he’s been screaming at about 2-3 in the morning the past several weeks on and off. He is difficult to rouse and has no memory of the dream when he wakes. What stage of sleep is thi slikley during?
Night Terrors: likely stage 3-4
What stage does sleepwalking occur
Occurs in Stage 3 and 4 sleep (usually the first half of the night)
no memory, create safe envirnoment
- Motor activity while dreaming
- Eyes closed
- Awakens fully alert and able to recount their dream
REM Sleep Bhavior Disorder (occurs during REM in second half of night)
What pts are prone to REM Sleep Behavior disorder and what can we tx pts with?
Associated with Parkinson disease and Lewy Body Dementia Treatment:
- Environmental manipulation: Safety
- Melatonin or low-dose benzodiazepines
