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behavioral medicine > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What percent of patients in a primary care setting will complain of difficulty sleeping?

A

50%

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2
Q

What does REM stand for?

A

Rapid Eye Movement

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3
Q

How many stages of NREM/REM cycles occur nightly?

A

3-6 Cycles

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4
Q

How long does the first REM cycle last?

A

5-10 minutes

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5
Q

What stage of sleep is considered wakefulness with eyes closed

A

Stage 0

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6
Q

Wakefulness is characterized by more desynchronous activity beta waves predominate which are ____ (High/Low) in amplitude and (High/Low) in frequency

A

Low Amplitude

High Frequency

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7
Q

At what stage of sleep would delta waves appear on EEG?

A

Stage 3

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8
Q

At what stage of sleep would theta waves dominate the EEG?

A

Stage 2

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9
Q

During REM sleep, waves on the EEG are __________ (synchronized/desynchronized)

A

Desynchronized

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10
Q

What percent of total sleep time is spent in each stage?

A

Stage 1: 5%

Stage 2: 45-55%

Stage 3: 15-20%

REM: 20-25%

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11
Q

REM Sleep length ________ (increases/decreases) throughout the night

A

Increases

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12
Q

The __________ _______ _______ of the hypothalamus is one area of the brain that is particularly involved in the switch between wakefulness and sleep

A

Ventrolateral Preoptic Nucleus (VLPO or VLPN)

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13
Q

What are examples of the neurotransmitters involved in sleep?

A 
Acetylcholine
Histamine
Dopamine
Norepinephrine
Serotonin
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14
Q

T/F: A MSE is useful in assessing sleep

A

True

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15
Q

What is a polysomnography?

What are components of this?

A

A sleep study…..

EEG, EOG, EMG, Vitals

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16
Q

What ‘test’ is used to work up excessive sleepiness or excessive daytime sleepiness?

A

Multiple sleep latency test (MSLT)

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17
Q

What three things are required for a formal diagnosis of insomnia disorder?

How long must these symptoms be present?

A

1) Difficulty initiating sleep
2) Difficulty maintaining sleep
3. Early awakening, can’t fall back to sleep

3 nights a week for at least 3 months

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18
Q

What is the non-pharmacological managements of insomnia disorder?

What are examples of this?

A

Sleep Hygiene…..

Set wake/sleep times
Avoid daytime naps
Avoid alcohol
Avoid caffeine

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19
Q

When should sedatives/hypnotics be considered for insomnia?

A

Transient Insmnia

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20
Q

How does the sedative ativan work/

A

Increases GABA, depresses CNS (limbic)

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21
Q

Ramelton (Rozerem) is a _________ (Melatonin/Dopamine) receptor agonist

A

Melatonin (MT1 & MT2)

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22
Q

What is hypersomnolence disorder?

How long must symptoms be present to have the diagnosis?

A

Excessive daytime sleepiness/somnolence even with prolonged nocturnal sleep often with 1-2 one hour naps

3x week for 3 months

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23
Q

T/F: Hypersomnolence disorder is a diagnosis of exclusion

A

True

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24
Q

Is there an effective cure for hypersomnolence?

A

No

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25
Q

How is hypersomnolence managed?

A

Sleep Hygiene

Sleep Therapy

26
Q

What are two stimulants used in treating hypersomnolence?

A

Dextroamphetamine

Methylphenidate

27
Q

What is Modafinil used for?

A

Nacrolepsy

28
Q

The following are all characteristics of what sleep disorder……

Recurrent Episodes of irrepressible sleep
Sleep attacks (seconds to minutes)
A

Nacrolepsy

29
Q

What are the four things that may be present with sleep attacks in narcolepsy?

A

Cataplexy
CSF Hypocretin Deficiency
Nocturnal Polysomnography with REM latency for less than 15 minutes
MSLT sleep latency for less than 8 minutes

30
Q

Patients with nacrolepsy need safe guards in place for what types of activities?

A

Travel

Driving

31
Q

Sodium oxybate is used in nacrolepsy when patients have what?

A

Cataplexy

32
Q

_____ is defined as a pause in breathing

A

Apnea

33
Q

_____ is defined as a decrease in airflow during breathing

A

Hypoapnea

34
Q

What is the most common breathing related disorder?

A

Obstructive Sleep Apnea Hypoapnea Disorder

35
Q

In what patient ‘population’ is Obstructive Sleep Apnea Hypoapnea Disorder most common in?

A

Obesity

Middle-Aged

36
Q

How is Obstructive Sleep Apnea Hypoapnea Disorder managed?

A 
Sleep Study
Weight Loss
Avoid sedatives
Sleep positioning 
CPAP

+/- Surgery (Tracheostomy if severe end of the spectrum)

37
Q

How does OSA vary from central sleep apnea disorder?

A

In central sleep apnea…..

There is no airway obstruction, the pathophysiology lies within the CNS

38
Q

Is snoring more common in OSA or central sleep apnea?

A

OSA

39
Q

Is cheyne-stokes breathing more common with OSA or central sleep apnea?

What conditions is this associated with?

A

Central Sleep Apnea

CHF, CVA, Renal Failure

40
Q

What is the one difference in management between OSA and central sleep apnea/

A

Adaptive servo ventilation (ASV)- provides positive expiratory airway pressure (EPAP) and inspiratory pressure support (IPAP), which is servocontrolled based on the detection of central sleep apnea

41
Q

The following are defining characteristics of what sleep disorder……

Decreased response to high levels of CO2
Frequent episodes of shallow breathing

A

Sleep-related hypoventilation disorder

42
Q

Sleep-related hypoventilation disorder is typically associated with what kind of disorders?

A

Lung Disease
Neuromuscular Disease
Chest Wall Disorders

43
Q

What is a typical complaint in patients with sleep-related hypoventialtion?

A

Headaches upon wakening

44
Q

Long-term uncontrolled sleep-related hypoventialtion can result in what conditions?

A

Pulmonary HTN
Polycythemia
Right HF

45
Q

What class of medication is useful in treating sleep-related hypoventilation in patients with underlying lung disease?

A

Bronchodilators

46
Q

What gland secretes melatonin in response to increasing darkness?

A

Pineal Gland

47
Q

What is Circadian Rhythm Sleep-Wake disorder?

A

Interference with a patient’s sleep-wake schedule

Ex: Working a night shift and trying to fall asleep in the light

48
Q

What is the “delayed sleep phase” treatment for circadian rhythm sleep-wake disorders?

A

Delay sleep on successive nights for 30 minutes to 3 hours until there a full 24 hour period of wakefulness then sleep at a “normal” time

49
Q

What is the name of the medication that is FDA approved for patients working the night shift?

A

Armodafinil (Nuvigil)

50
Q

The following are characteristics of what sleep disorder…..

Sleep walking
Sleep Terrors

A

NREM Sleep Arousal Disorder

51
Q

What ‘portion’ of the sleep cycle does NREM Sleep Arousal Disorder occur?

A

First 1/3rd

52
Q

Do patients with NREM Sleep Arousal Disorder usually have memory of the events?

A

No

53
Q

What is the most crucial portion of NREM Sleep Arousal Disorder treatment?

A

Keeping the patient safe

54
Q

_________ disorder is characterized by vivid terrifying dreams usually involving imminent threats and are well-remember

A

Nightmare disorder

55
Q

Are vocalizations and movements common in nightmares?

A

No

56
Q

How does REM Sleep Behavior Disorder vary from Nightmare Disorder?

A

REM Sleep Behavior Disorder is associated with vocalizations and complex motor movements and occurs after 90 minutes of sleep

57
Q

T/F: 50% of those presenting to sleep clinics with REM behavior complaints will develop a neurodegenerative disorder (ex: Parkinson’s, Lewy Body)

A

True

58
Q

What is the ‘drug of choice’ in managing REM sleep behavior disorder?

A

Clonazepam

***Symptoms will typically return if the medications are stopped

59
Q

Desire to move legs associated with unpleasant sensations, tingling, “creeping, crawling” best describes what disorder?

A

Restless Leg Syndrome

60
Q

What medications are the mainstay of restless leg syndrome management?

A

Dopamine Agonists….

Ropinirole
Pramipexole

behavioral medicine (16 decks)

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