Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behave med test 2 > sleep disorders > Flashcards

sleep disorders Flashcards

1
Q

breathing related sleep disorders

A

Obstructive sleep apnea hypopnea
Central sleep apnea
Sleep related hypoventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

parasomnias

A

Non-rapid eye movement sleep arousal disorders

Nightmare disorder

Rapid eye movement sleep behavior disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Subjective estimates of sleep duration and pattern tend to (overestimate, underestimate) degree of disturbance

A

overestimate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

t/f Transient insomnia very common (few nights) so the duration of the insomnia is very important to elucidate

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 types of insomnia that need to be differentiated

A

For a formal diagnosis

  1. ) Difficulty initiating or
  2. ) maintaining sleep or
  3. ) early awakening and can’t fall back asleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how often must insomnia occur to be dx

who is it most common in

A

At least 3 nights a week for 3 months

More common in elderly, women, chronic medical problems, lower income, less education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

tx for insomnia disorder

A

Start with sleep hygiene measures

Sleep medications/hypnotics

combo works best

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why are benzo’s not first line for insomnia

A

tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name some non benzo’s that are commonly used

A

eszopiclone
ramelteon
zaleplon
zolpidem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Targeted insomnia meds, have less day time sleepiness, less tolerance and less potential for abuse

A

zolpidem, eszopiclone, belsomra (suvorexant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Excessive daytime sleepiness/somnolence

Usually involves prolonged nocturnal sleep and continual daytime drowsiness

Often 1-2 long naps (1 hour) during the day

At least 3 nights a week for 3 months

A

Hypersomnolence Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A diagnosis of exclusion

Patients have diminished delta sleep (stage 3) and short latency to REM sleep (MSLT)

A

Hypersomnolence Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hypersomnolence Disorder tx

A

No effective cure

Treatment is symptomatic
Sleep hygiene
Sleep therapy
Stimulants
Dextroamphetamine- short half-life

Methylphenidate- short half-life (3.6 hrs)

Take in multiple, divided doses throughout the day

Modafinil- usually used for narcolepsy, single dose in AM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how can you estimate how long a drug will remain active

A

rules of 5

drug eliminated by 5x the half life

at 3 times the half life drug no longer having therapeutic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recurrent episodes of an irrepressible need to sleep

Sleep attacks (seconds to 30 minutes or longer) occur with one or more of the following: 
Cataplexy (long-standing versus new onset criteria)

CSF hypocretin (Orexin) deficiency

Nocturnal polysomnography with REM latency <15 min or a MSLT sleep latency less than 8 minutes

A

Narcolepsy Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

does Narcolepsy Disorder have a known etiology

who is affected

A

Affects 1 in 2000, men and women equally represented, runs in families

One of the only diagnoses with known etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

narcolepsy tx

A

Stimulants
Dextroamphetamine- short half-life
Methylphenidate- short half-life

Take in multiple, divided doses throughout the day

Modafinil- single dose 200-400 mg in AM

Sodium oxybate is prescribed for cataplexy, can reduce frequency of episodes
Considerable social, occupational and mental support
Safeguards in place for travel/driving
May require naps during day at work to reduce symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the two definitions of cataplexy

A

1) long standing disease, brief sec to min episodes of b/l muscle tone loss. brought on by emotions
2) within 6 mo of onset, spontaneous grimaces or jaw opening episodes with tongue thrusting or global hypotonia w/o emotional triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common breathing-related disorder

A

obstructive sleep apnea hypoapnea disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is Apnea

A

pause in breathing/breathing stops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is Hypoapnea

A

decrease in airflow during breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

t/f Patient usually unaware of these events on waking

A

t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

who is obstructive sleep apnea hypoapnea disorder most common in

A

Most common in overweight, middle-aged and older adults

24
Q

Obstructive Sleep Apnea Hypoapnea Disorder tx

A

Obtain a sleep study

Weight loss

Sleep position training

CPAP (continuous positive airway pressure) device

Surgery to remove excess oropharyngeal tissue

Tracheostomy at extreme end of the spectrum

25
Q

what do you aviod using with Obstructive Sleep Apnea Hypoapnea Disorder

A

Avoid sedative/hypnotic meds

26
Q

There is no upper airway obstruction

The pathophysiology in CNS control

Brain fails to up-regulate breathing during periods of relative hypoxia

Snoring is not uncommon

Cheyne-Stokes and Opioid variants - Associated with heart failure, stroke, renal failure and chronic opioid use, respectively

A

Central Sleep Apnea Disorder

27
Q

Central Sleep Apnea Disorder tx

A

Obtain a sleep study

Treat underlying medical conditions

CPAP

Supplemental oxygen

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

28
Q

what do you avoid with Central Sleep Apnea Disorder

A

Avoid sedative/hypnotic meds

29
Q

Decreased response to high levels of CO2

Frequent episodes of shallow breathing, >10 secs

A

Sleep-related Hypoventilation Disorder

30
Q

t/f OSA and CSA may occur along with SHD

A

true

31
Q

with sleep related hypoventilation Persistent hypoventilation may result in what????!!!

A

pulmonary hypertension, polycythemia, right heart failure

32
Q

what is Sleep-related Hypoventilation Disorder associated with

A

Frequently associated with lung disease, neuromuscular disorders, chest wall disorders
Patients often have headaches upon waking, insomnia, daytime sleepiness, etc.

33
Q

Sleep-related Hypoventilation Disorder tx

A

Obtain a sleep study

Treat underlying disorder

For example, bronchodilators for patients with obstructive lung disease

Supplemental oxygen
But as underlying disorder progresses, may require more extreme support and ultimately mechanical ventilation/tracheostomy

34
Q

what do you avoid in Sleep-related Hypoventilation Disorder

A

Avoid sedative/hypnotic meds

35
Q

Circadian Rhythms Influenced/integrated by:

A

Light exposure

Sleep wake/centers of the brain

Genetics

36
Q

Sleep disturbances from altered sleep-wake cycle

May be delayed (night-owls) or advanced phase ”morning people”

Or their schedule, job, other factors may interfere (shift-work), morning light exposure constantly “resets” their clock

A

Circadian Rhythm Sleep-Wake Disorders

37
Q

t/f with Circadian Rhythm Sleep-Wake Disorders Sleep itself is of normal quality and patients can usually sleep enough if allowed to

A

t

38
Q

Circadian Rhythm Sleep-Wake Disorders tx

A

Delayed sleep phase - Delay sleep on successive nights for 30 min to 3 hours unit full 24 hr period of wakefulness achieved. Then sleep at “normal” time.

Shift work - stop working the night shift or there is an FDA approved stimulant drug, Nuvigil (armodafinil)

Jet lag (not DSM-5) - Zolpidem or melatonin short term; keep normal sleep schedule if possible

39
Q

Sleep walking and sleep terrors, usually during first 1/3 of major sleep episode

Complex motor behavior without conscious awareness during NREM sleep, little to no memory

A

NREM Sleep Arousal Disorders

40
Q

Sleep walking

A

very hard to arouse patient, blank stare, amnesia upon awakening. STAGE 3 NREM

41
Q

Sleep terrors

A

partial arousal from delta sleep, usually with screaming in terror, motor activity, may not fully awaken and will not remember episode

42
Q

Both are familial, most common in children, usually outgrown by adolescence

A

sleep walking, sleep terrors

43
Q

NREM Sleep Arousal Disorders

A

Keep them safe!!!

Identify triggers, stressors
Avoid caffeine/alcohol

Benzodiazepines promote stage 3 sleep

TCAs, SSRIs and melatonin have been used but no controlled studies proving effectiveness

Sleep hygiene

44
Q

Vivid, terrifying dreams, usually focused on imminent threat to one’s survival

Well-remembered, immediately alert after waking

In children, they may not be able to distinguish between reality and the dream

A

Nightmare Disorder

45
Q

what do you need to rule out with Nightmare Disorder

A

Rule out substance abuse, withdrawal, other mental illness

46
Q

when does Nightmare Disorder occur

A

Usually occurs during 2nd half of a sleep period

Usually occur during REM sleep

47
Q

t/f Body movements and vocalizations are typical

A

f they are not typical

48
Q

Nightmare Disorder tx

A

Treat underlying cause if clear -
- EtOH withdrawal, benzodiazepine withdrawal

Treat underlying mental illness -
depression, trauma counseling

Judicious use of hypnotics/sedatives

49
Q

Arousal during sleep associated with vocalizations and/or complex motor movements

Often dream of being attacked or escaping

Can usually recall dream content

Complex motor activity has the ability to cause injury to the patient or others, and often does

A

REM Sleep Behavior Disorder

50
Q

when does REM Sleep Behavior Disorder occur

A

During REM sleep

Usually later in sleep cycle (> 90 minutes)

51
Q

what is REM Sleep Behavior Disorder associated with

A

Association with PD, Lewy Body Dementia, and multiple system atrophy

50% of those presenting to sleep clinics will develop a neurodegenerative disorder

52
Q

REM Sleep Behavior Disorder tx

A

Keep them safe!!!

May have to have partners sleep in different rooms

Identify triggers, stressors if possible

TCAs, SSRIs and beta-blockers have been associated with this disorder, minimize/stop if possible

Clonazepam is the drug of choice, but symptoms will often return if meds are stopped

53
Q

drug of choice to treat REM Sleep Behavior Disorder

A

clonazepam

54
Q

Desire to move legs associated with unpleasant sensations, tingling, “creeping, crawling”

Symptoms at least 3x a week for 3 months

Sensations and movements delay sleep or wake patients from sleep

Movement of their legs relieves the unpleasant sensations

A

Restless Legs Syndrome

55
Q

Restless Legs Syndrome tx

A

Dopamine agonists are mainstay:
Ropinirole 0.25 mg -4.0 mg/day
Pramipexole 0.125 mg -0.5 mg/day

56
Q

what do you need to rule out for Restless Legs Syndrome

A 
Rule out medical conditions such as:
Leg cramps
Positional ischemia/PAD
Arthritis
Myalgias
Peripheral neuropathy

Behave med test 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions