Sleep Disorders Flashcards
What percent of patients in a primary care setting will complain of difficulty sleeping?
50%
What does REM stand for?
Rapid Eye Movement
How many stages of NREM/REM cycles occur nightly?
3-6 Cycles
How long does the first REM cycle last?
5-10 minutes
What stage of sleep is considered wakefulness with eyes closed
Stage 0
Wakefulness is characterized by more desynchronous activity beta waves predominate which are ____ (High/Low) in amplitude and (High/Low) in frequency
Low Amplitude
High Frequency
At what stage of sleep would delta waves appear on EEG?
Stage 3
At what stage of sleep would theta waves dominate the EEG?
Stage 2
During REM sleep, waves on the EEG are __________ (synchronized/desynchronized)
Desynchronized
What percent of total sleep time is spent in each stage?
Stage 1: 5%
Stage 2: 45-55%
Stage 3: 15-20%
REM: 20-25%
REM Sleep length ________ (increases/decreases) throughout the night
Increases
The __________ _______ _______ of the hypothalamus is one area of the brain that is particularly involved in the switch between wakefulness and sleep
Ventrolateral Preoptic Nucleus (VLPO or VLPN)
What are examples of the neurotransmitters involved in sleep?
Acetylcholine Histamine Dopamine Norepinephrine Serotonin
T/F: A MSE is useful in assessing sleep
True
What is a polysomnography?
What are components of this?
A sleep study…..
EEG, EOG, EMG, Vitals
What ‘test’ is used to work up excessive sleepiness or excessive daytime sleepiness?
Multiple sleep latency test (MSLT)
What three things are required for a formal diagnosis of insomnia disorder?
How long must these symptoms be present?
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
What is the non-pharmacological managements of insomnia disorder?
What are examples of this?
Sleep Hygiene…..
Set wake/sleep times
Avoid daytime naps
Avoid alcohol
Avoid caffeine
When should sedatives/hypnotics be considered for insomnia?
Transient Insmnia
How does the sedative ativan work/
Increases GABA, depresses CNS (limbic)
Ramelton (Rozerem) is a _________ (Melatonin/Dopamine) receptor agonist
Melatonin (MT1 & MT2)
What is hypersomnolence disorder?
How long must symptoms be present to have the diagnosis?
Excessive daytime sleepiness/somnolence even with prolonged nocturnal sleep often with 1-2 one hour naps
3x week for 3 months
T/F: Hypersomnolence disorder is a diagnosis of exclusion
True
Is there an effective cure for hypersomnolence?
No
How is hypersomnolence managed?
Sleep Hygiene
Sleep Therapy
What are two stimulants used in treating hypersomnolence?
Dextroamphetamine
Methylphenidate
What is Modafinil used for?
Nacrolepsy
The following are all characteristics of what sleep disorder……
Recurrent Episodes of irrepressible sleep Sleep attacks (seconds to minutes)
Nacrolepsy
What are the four things that may be present with sleep attacks in narcolepsy?
Cataplexy
CSF Hypocretin Deficiency
Nocturnal Polysomnography with REM latency for less than 15 minutes
MSLT sleep latency for less than 8 minutes
Patients with nacrolepsy need safe guards in place for what types of activities?
Travel
Driving
Sodium oxybate is used in nacrolepsy when patients have what?
Cataplexy
_____ is defined as a pause in breathing
Apnea
_____ is defined as a decrease in airflow during breathing
Hypoapnea
What is the most common breathing related disorder?
Obstructive Sleep Apnea Hypoapnea Disorder
In what patient ‘population’ is Obstructive Sleep Apnea Hypoapnea Disorder most common in?
Obesity
Middle-Aged
How is Obstructive Sleep Apnea Hypoapnea Disorder managed?
Sleep Study Weight Loss Avoid sedatives Sleep positioning CPAP
+/- Surgery (Tracheostomy if severe end of the spectrum)
How does OSA vary from central sleep apnea disorder?
In central sleep apnea…..
There is no airway obstruction, the pathophysiology lies within the CNS
Is snoring more common in OSA or central sleep apnea?
OSA
Is cheyne-stokes breathing more common with OSA or central sleep apnea?
What conditions is this associated with?
Central Sleep Apnea
CHF, CVA, Renal Failure
What is the one difference in management between OSA and central sleep apnea/
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
The following are defining characteristics of what sleep disorder……
Decreased response to high levels of CO2
Frequent episodes of shallow breathing
Sleep-related hypoventilation disorder
Sleep-related hypoventilation disorder is typically associated with what kind of disorders?
Lung Disease
Neuromuscular Disease
Chest Wall Disorders
What is a typical complaint in patients with sleep-related hypoventialtion?
Headaches upon wakening
Long-term uncontrolled sleep-related hypoventialtion can result in what conditions?
Pulmonary HTN
Polycythemia
Right HF
What class of medication is useful in treating sleep-related hypoventilation in patients with underlying lung disease?
Bronchodilators
What gland secretes melatonin in response to increasing darkness?
Pineal Gland
What is Circadian Rhythm Sleep-Wake disorder?
Interference with a patient’s sleep-wake schedule
Ex: Working a night shift and trying to fall asleep in the light
What is the “delayed sleep phase” treatment for circadian rhythm sleep-wake disorders?
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
What is the name of the medication that is FDA approved for patients working the night shift?
Armodafinil (Nuvigil)
The following are characteristics of what sleep disorder…..
Sleep walking
Sleep Terrors
NREM Sleep Arousal Disorder
What ‘portion’ of the sleep cycle does NREM Sleep Arousal Disorder occur?
First 1/3rd
Do patients with NREM Sleep Arousal Disorder usually have memory of the events?
No
What is the most crucial portion of NREM Sleep Arousal Disorder treatment?
Keeping the patient safe
_________ disorder is characterized by vivid terrifying dreams usually involving imminent threats and are well-remember
Nightmare disorder
Are vocalizations and movements common in nightmares?
No
How does REM Sleep Behavior Disorder vary from Nightmare Disorder?
REM Sleep Behavior Disorder is associated with vocalizations and complex motor movements and occurs after 90 minutes of sleep
T/F: 50% of those presenting to sleep clinics with REM behavior complaints will develop a neurodegenerative disorder (ex: Parkinson’s, Lewy Body)
True
What is the ‘drug of choice’ in managing REM sleep behavior disorder?
Clonazepam
***Symptoms will typically return if the medications are stopped
Desire to move legs associated with unpleasant sensations, tingling, “creeping, crawling” best describes what disorder?
Restless Leg Syndrome
What medications are the mainstay of restless leg syndrome management?
Dopamine Agonists….
Ropinirole
Pramipexole
