Sleep Disorders Flashcards
What are the three normal physiologic levels of consciousness?
- Awake
- NREM
- REM
What two independent forces impact sleep?
- Circadian rhythm
- Sleep debt
Sleep is normally entered via which stage of sleep?
What are three characteristics of this stage? (3)
NREM sleep:
- Decrease muscle tone
- Slow eye movements (+/- asynchronous)
- Lose alpha rhythm; low voltage, mixed Hz
What does REM sleep look like on EEG?
What are two features of this stage of sleep?
- EEG mimics Stage 1 NREM/ relaxed awake
- Muscle Atonia w/ intermittent twitching
- Rapid eye movement
How long is the typical sleep cycle?
How many stages are there?
What is the distribution of the stages?
- Typical sleep cycle = 90 min
- There are 4 stages + REM
- NREM (slow wave sleep) predominates first 2/3 of the night; REM predominates last 1/3 of the night
Most of the night is spent in what stage of sleep?
Stage 2; may enter directly here if sleep deprived
With age, how does the distribution of sleep stages change?
Less delta (slow wave) sleep, especially in men; waves have decreased amplitude
K complexes and sleep spindles are more frequent in…
Children; adults have these but not as frequently
What are the three types of sleep apnea?
Describe each one.
- Obstructive (effort to breathe, no air mvmt)
- Central (no effort to breathe or air mvmt)
- Mixed (initially NO effort to breathe; later effort without air mvmt)
How does the definition of obstructive sleep apnea differ between children and adults?
How is it the same?
BOTH: Greater than 90% DECREASE in airflow compared to baseline; associated with respiratory effort throughout entire period of decreased flow
Adults: Obstruction lasts 10 seconds or more
Kids: Obstruction lasts length of 2 breaths during baseline breathing
What are two common comorbidities associated with obstructive sleep apnea?
- Nocturea (4-7 nightly trips to the bathroom)
- Nocturnal GERD
Describe the sleep of a patient with obstructive sleep apnea; what are some characteristic features (4)
- Snoring loudly and disruptively
- Periods of silence w gasps/ snorts between
- Observed apneas in 75% of bed partners
- Restless sleep in 50% patients
What are the daytime clinical sings and sx of obstructive sleep apnea? (5)
- Daytime sleepiness/ fatigue
- Slow reaction time
- Personality changes (mood disorders)
- Decreased sexual fxn
- MORNING HA’s
How might obstructive sleep apnea present in a kid during the day?
Mimics ADHD; poor attention, impulse control, distractibility, irritability, daytime sleepiness
What are three behavioral treatments for obstructive sleep apnea?
- Weight loss
- Smoking cessation
- Body positioning (use snore ball)
What are some devices used to treat obstructive sleep apnea? (3)
- CPAP/BIPAP (continuous vs. bilevel air pressure)
- Snore balls
- Oral and nasal appliances
One common complaint with the CPAP/BIPAP
Patients complain that at higher levels of pressure, they feel smothered because they can’t exhale
List three types of meds that might be helpful in treating obstructive sleep apnea:
- Nasal steroids (allergic patients)
- Antidepressants
- Stimulants to relieve daytime sleepiness (avoid this as long as possible)
List 4 surgical treatments for obstructive sleep apnea:
- Tonsillectomy/ Adenoidectomy (kids)
- Uvuolopalatalpharyngioplasty
- Mandibular advancement
- Trachiostomy
What type of prescription drugs can cause hypersomnolence?
Antiepileptics and Antipsychotics (DA inhibitors)
Define Narcolepsy Type I (3)
Daily periods of irrepressible need to sleep/ daytime lapses for @ least THREE MONTHS
- *PLUS one or both or the following:
1. Cataplexy, mean sleep latency of under 8 min, 2+ SOREMPs (REM in 15 min)
2. CSF hypocretin-1 LESS THAN 110 pg/mL
Define cataplexy
Multiple episodes of brief BL, symmetrical loss of muscle tone w/ retained consciousness; typically associated with excitement, laughter, strong positive emotions
Define Narcolepsy Type II (4)
Narcolepsy sans cataplexy:
- Daily periods of irrepressible need to sleep/ daytime lapses for @ least THREE MONTHS
- Mean sleep latency of under 8 min, 2+ SOREMPs (REM in 15 min)
- Unmeasured hypocretin 1 or MORE than 110pg/mL
- No other explanation for hypersomnolence etc.
What are hypocretin/ orexin 1 and 2?
What is the function of hypocretin 1?
What two factors influence its production?
Homologous neuropeptides produced by cells in perifornical area of posterior hypothalamus
Hypocretin 1 stimulates wakefulness and suppresses REM sleep; levels fluctuate over 24 hour period in response to circadian rhythm and increased sleep debt
What is the narcoleptic tetrad?
- Sleep attacks
- Sleep paralysis
- Hypnagogic/hypnopompic hallucinations
- Cataplexy
(Last 3 are REM associated pathology)
List 3 other associated features with narcolepsy:
- Disrupted sleep
- Obesity
- Anxiety/ panic attacks
How do we evaluate for narcolepsy dx?
Overnight polysomogram w/ MSLT and SOREMPs
**Will document adequate sleep or sleep latency
What are some behavioral modifications to treat narcolepsy (3)?
- Adequate nighttime sleep
- Daily naps (decrease need for meds)
- Physical activity
Which meds treat daytime sleepiness associated with narcolepsy?
Cataplexy?
Sleepiness: stimulants; modafanil, amphetamines, atomoxetine
Cataplexy: sodium oxybate and SSRIs
REM sleep behavior disorder is more common in what age group?
Describe the difference between acute and chronic.
More common in elderly; patients act out their dreams
Acute: Toxic/ metabolic (i.e. ETOH or BDZ withdrawal)
Chronic: Idiopathic or associated with neurological disease (EPS, narcolepsy, NPH, mitochondrial disorder)
During which stages of sleep are the non-rem parasomnias most common?
Which age group gets them?
Is there a familial component?
What are some triggers (4)?
- Occur during slow wave (stages 3, 4) sleep; more common during first 1/3 of night
- Kids get them more than adults; strong family hx
Triggers: ^ tiredness, arousals, unfamiliar places, ETOH
Majority of normal sleep is spent in stage…
2
Most common complaint of obstructive sleep apnea patients is…
Daytime sleepiness
