Sleep Disorders Flashcards
how many stages of sleep
4 measurable ones
REM stage
rapid eye movements
how many stages of REM/NREM per night?
3-4
the first REM period is about __min and then each successive cycle increases in ___
first one about 5-10 min
then increases in frequency and length
density of REM sleep increases over the night
stage 0
wakefulness with eye closed just before sleep onset
stage 1
presleep drowsiness, NREM
small wave 4-7 hz on EEG
stage 2
asleep, NREM
EEG has theta waves but hz increase leading to E burst on EEG = sleep spindle
what percentage of sleep is spent in each stage?
1: 5%
2: 45-55%
3: 15-20%
stage 3
delta waves, 1-4 hz, less sleep spindles, NREM sleep
REM sleep
aka paradoxical sleep
fast desynchronized EEG
body paralyzed - dreaming
20-25% of sleep
after reaching REM what happens?
go back to stage 2, then go back to REM and repeat ever 90 min 4-5 x/night
when relazed and sleepy brain activity is more__
synchronized
wakefulness
desynchronous beta waves predominate
low in amplitude but high in frequency
closing eyes triggers
alpha waves to dominate
slower frequency an higher amplitude
what 4 areas of brain regulates sleep
brainstem, thalamus, hypothalamus, basal forebrain
what is multiple sleep latency test for
excessive sleepiness that occurs during normal period of wakefulness
q2 hrs pt is placed in dark room to sleep for 20 min
what result of MSLT signifies dx excessive daytime sleepiness
an average sleep latency less than 5 min
insomnia dx
must be difficulty with sleep initiation, maintaining, or early awakening
at least 3 days/ wk for 3 mo
what populations is insomnia more common in?
elderly women chornic medical problems lower income less education
hypnotics should be used for ___insomnia
transient/ short term
are bzd and antihistamines good for insomnia?
can tx but tolerance can form
ramelteon
insomnia tx option
melatonin receptor agonist for MT1 and MT2
zolpidem
esozopiclone
and belsomra
are…
targeted insomnia meds
with less daytime sleepiness
less tolerance and less potential for abuse
hypersomnolence disorder
excessive daytime sleepiness
prolonged nocturnal sleep and continual daytime drowsy
1-2 long naps (1hr) 3 times per wk for 3 mo
what will hypersomnolence disorder show on EEG
diminished delta sleep (stage 3)
and short latency to REM sleep (MSLT)
tx for hypersomnolence disorder
tx is symptomatic: sleep hygiene and therapy
what stimulants can be used for hypersomnolence disorder?
dextroamphetamine
methylphenidate
multiple doses per day
modafinil is for
narcolepsy single dose in morning
unknown MOA
stimulant
can be used for hypersomnolence disorder
narcolepsy
recurrent episodes of irrepressible need to sleep
sleep attacks
narcolepsy sleep attacks occur with 1+ of these factors
- cataplexy
- CSF hypocretin deficiency (under 1/3 of normal)
- nocturnal polysomnography with REM latency under 15min or MSLT sleep latency under 8min
Tx for narcolepsy
- stim: dextramphetamine or methylphenidate
- modafinil
- Na oxybate for cataplexy
- supportive tx
what is cataplexy
when strong emotion / laughter causes individual to collapse
what are 3 breathing sleep disorders
- obstructive sleep apnea hypopnea
- central sleep apnea
- sleep related hypoventilation
central sleep apnea disorder cause
problem with CNS control
ex: Cheyne Stokes, Opioid Variants
TX central sleep apnea disorder
CPAP: continuous positive airway pressure
ASV: adaptive servo ventilation
sleep related hypoventilation disorder
decreased response to high Co2
pts with lung dz, neuromuscular disorder, chest wall disorder
sx of sleep related hypoventilation
wake up with headaches, insomnia, daytime sleepiness
persistant sleep related hypoventilation complications
pulmonary HTN, polycythemia, Right HF
tx sleep related hypoventilation
supplemental oxygen
mechanical ventilation if severe
__ regulates our light and dark information
suprachaismatic nucleus
– gland secretes melatonin in response to increasing darkness
pineal gland
circadian rhythm sleep wake disorder
sleep disturbance from altered sleep wake cycle
work: night shift etc
TX circadian disorder
quit that shift
or take Nuvigil (armodafinil)
3 parasomnia disorders
- NREM sleep arousal disorder
- Nightmare disorder
- REM sleep behavior disorder
NREM sleep arousal disorders
sleep walking, sleep terrors
complex motor behavior w/o consciousness
TX NREM sleep arousal disorder
BZD will promote stage 3 sleep
keep them safe
avoid caffeine / alcohol
nightmare disorder
vivid terrifying dreams
well remembered after waking
during REM sleep
TX nightmare disorder
treat underlying mental illness if there is one
judicious use sedatives / hypnotics
REM sleep behavior disorder
arousal during sleep associated with vocalizations +/- complex motor mvmt
REM sleep behavior disorder dreams associated with
dream of being attacked or escaping
can recall dream
associated with PD, lewy body dementia, and multiple system atrophy 50% will dev these
DOC for REM sleep behavior disorder
clonazepam
what meds could cause REM sleep behavior disorder
TCA, SSRI, BB
TX restless leg syndrome
dopamine agonist
Ropinirole
Pramipexole
