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behavioral med Q2 > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

how many stages of sleep

A

4 measurable ones

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2
Q

REM stage

A

rapid eye movements

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3
Q

how many stages of REM/NREM per night?

A

3-4

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4
Q

the first REM period is about __min and then each successive cycle increases in ___

A

first one about 5-10 min
then increases in frequency and length

density of REM sleep increases over the night

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5
Q

stage 0

A

wakefulness with eye closed just before sleep onset

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6
Q

stage 1

A

presleep drowsiness, NREM

small wave 4-7 hz on EEG

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7
Q

stage 2

A

asleep, NREM

EEG has theta waves but hz increase leading to E burst on EEG = sleep spindle

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8
Q

what percentage of sleep is spent in each stage?

A

1: 5%
2: 45-55%
3: 15-20%

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9
Q

stage 3

A

delta waves, 1-4 hz, less sleep spindles, NREM sleep

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10
Q

REM sleep

A

aka paradoxical sleep
fast desynchronized EEG
body paralyzed - dreaming
20-25% of sleep

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11
Q

after reaching REM what happens?

A

go back to stage 2, then go back to REM and repeat ever 90 min 4-5 x/night

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12
Q

when relazed and sleepy brain activity is more__

A

synchronized

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13
Q

wakefulness

A

desynchronous beta waves predominate

low in amplitude but high in frequency

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14
Q

closing eyes triggers

A

alpha waves to dominate

slower frequency an higher amplitude

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15
Q

what 4 areas of brain regulates sleep

A

brainstem, thalamus, hypothalamus, basal forebrain

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16
Q

what is multiple sleep latency test for

A

excessive sleepiness that occurs during normal period of wakefulness

q2 hrs pt is placed in dark room to sleep for 20 min

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17
Q

what result of MSLT signifies dx excessive daytime sleepiness

A

an average sleep latency less than 5 min

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18
Q

insomnia dx

A

must be difficulty with sleep initiation, maintaining, or early awakening

at least 3 days/ wk for 3 mo

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19
Q

what populations is insomnia more common in?

A 
elderly 
women 
chornic medical problems 
lower income 
less education
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20
Q

hypnotics should be used for ___insomnia

A

transient/ short term

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21
Q

are bzd and antihistamines good for insomnia?

A

can tx but tolerance can form

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22
Q

ramelteon

A

insomnia tx option

melatonin receptor agonist for MT1 and MT2

23
Q

zolpidem
esozopiclone
and belsomra
are…

A

targeted insomnia meds
with less daytime sleepiness
less tolerance and less potential for abuse

24
Q

hypersomnolence disorder

A

excessive daytime sleepiness
prolonged nocturnal sleep and continual daytime drowsy

1-2 long naps (1hr) 3 times per wk for 3 mo

25
Q

what will hypersomnolence disorder show on EEG

A

diminished delta sleep (stage 3)

and short latency to REM sleep (MSLT)

26
Q

tx for hypersomnolence disorder

A

tx is symptomatic: sleep hygiene and therapy

27
Q

what stimulants can be used for hypersomnolence disorder?

A

dextroamphetamine
methylphenidate

multiple doses per day

28
Q

modafinil is for

A

narcolepsy single dose in morning
unknown MOA
stimulant

can be used for hypersomnolence disorder

29
Q

narcolepsy

A

recurrent episodes of irrepressible need to sleep

sleep attacks

30
Q

narcolepsy sleep attacks occur with 1+ of these factors

A
  1. cataplexy
  2. CSF hypocretin deficiency (under 1/3 of normal)
  3. nocturnal polysomnography with REM latency under 15min or MSLT sleep latency under 8min
31
Q

Tx for narcolepsy

A
  1. stim: dextramphetamine or methylphenidate
  2. modafinil
  3. Na oxybate for cataplexy
  4. supportive tx
32
Q

what is cataplexy

A

when strong emotion / laughter causes individual to collapse

33
Q

what are 3 breathing sleep disorders

A
  1. obstructive sleep apnea hypopnea
  2. central sleep apnea
  3. sleep related hypoventilation
34
Q

central sleep apnea disorder cause

A

problem with CNS control

ex: Cheyne Stokes, Opioid Variants

35
Q

TX central sleep apnea disorder

A

CPAP: continuous positive airway pressure
ASV: adaptive servo ventilation

36
Q

sleep related hypoventilation disorder

A

decreased response to high Co2

pts with lung dz, neuromuscular disorder, chest wall disorder

37
Q

sx of sleep related hypoventilation

A

wake up with headaches, insomnia, daytime sleepiness

38
Q

persistant sleep related hypoventilation complications

A

pulmonary HTN, polycythemia, Right HF

39
Q

tx sleep related hypoventilation

A

supplemental oxygen

mechanical ventilation if severe

40
Q

__ regulates our light and dark information

A

suprachaismatic nucleus

41
Q

– gland secretes melatonin in response to increasing darkness

A

pineal gland

42
Q

circadian rhythm sleep wake disorder

A

sleep disturbance from altered sleep wake cycle

work: night shift etc

43
Q

TX circadian disorder

A

quit that shift

or take Nuvigil (armodafinil)

44
Q

3 parasomnia disorders

A
  1. NREM sleep arousal disorder
  2. Nightmare disorder
  3. REM sleep behavior disorder
45
Q

NREM sleep arousal disorders

A

sleep walking, sleep terrors

complex motor behavior w/o consciousness

46
Q

TX NREM sleep arousal disorder

A

BZD will promote stage 3 sleep
keep them safe
avoid caffeine / alcohol

47
Q

nightmare disorder

A

vivid terrifying dreams
well remembered after waking
during REM sleep

48
Q

TX nightmare disorder

A

treat underlying mental illness if there is one

judicious use sedatives / hypnotics

49
Q

REM sleep behavior disorder

A

arousal during sleep associated with vocalizations +/- complex motor mvmt

50
Q

REM sleep behavior disorder dreams associated with

A

dream of being attacked or escaping
can recall dream

associated with PD, lewy body dementia, and multiple system atrophy 50% will dev these

51
Q

DOC for REM sleep behavior disorder

A

clonazepam

52
Q

what meds could cause REM sleep behavior disorder

A

TCA, SSRI, BB

53
Q

TX restless leg syndrome

A

dopamine agonist
Ropinirole
Pramipexole

behavioral med Q2 (5 decks)

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