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Geriatrics > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What is sleep onset latency?

A

Time it takes to transition from wakefulness to sleep

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2
Q

What is sleep maintenance?

A

The ability to stay asleep

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3
Q

What is sleep efficiency?

A

Amount of sleep in relation to the amount of time in bed

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4
Q

What is sleep architecture?

A

Structure and pattern of sleep (including sleep cycle, duration spent asleep during 24 hour period etc)

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5
Q

Where does the circadian rhythm originate from?

A

Superchiasmatic nucleus in the hypothalamus

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6
Q

What does the circadian rhythm control?

A

Physiologic functions, hormone secretions, body temperature, and sleep wake cycle

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7
Q

Why do we care about sleep in the elderly?

A

50% of community-dwelling older adults complain of some form of sleep difficulty

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8
Q

How is sleep affected in older adults?

A

Takes longer to fall asleep
Wake more often
Lower sleep efficacy

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9
Q

What are the etiologies of sleep disorders?

A

Primary sleep disorders
Endogenous changes in circadian clock
Medical and psychiatric illnesses
Medications

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10
Q

What psychiatric illnesses can lead to sleep disorders?

A

Depression
Dementia
Anxiety

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11
Q

What happens to the superchiastmatic nucleus with age?

A

Degenerates

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12
Q

What hormone secretion is decreased at night with age?

A

Endogenous melatonin

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13
Q

With age, do we become more or less sensitive to exposure to external signals?

A

Less sensitive

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14
Q

How does the sleep-wake cycle shift in the elderly?

A

Earlier shift

Older people may get sleepy earlier in the evening and wake earlier in the morning

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15
Q

Are there required treatments for changes in sleep with aging?

A

No, nonpharmacologic treatment is preferred if patient wants to change habits

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16
Q

What are nonpharmacologic treatments for adjusting sleep habits?

A

Sleep-wake cycle retraining

Bright light therapy

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17
Q

What are the types of sleep disorders?

A

Circadian rhythm sleep disorder
Periodic limb movement in sleep(PLMS) /restless leg syndrome (RLS)
REM behavior disorder
Insomnia

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18
Q

What is PLMS?

A

Jerking movement of extremities every 20-40 seconds during the night

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19
Q

What is RLS?

A

Dysesthesia of the legs (“creeping, crawling sensation” or “pins and needles”)

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20
Q

What is the hypothesis for the cause of PLMS/RLS?

A

Dysfunction of DA system - treat with DA agonists

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21
Q

How do PLMS/RLS affect sleep?

A

Arouses patient out of sleep, or prevents them from falling asleep

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22
Q

What is a primary presenting sign of PLMS/RLS?

A

Insomnia

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23
Q

What is REM behavior disorder?

A

Complex motor behaviors while in a sleeping state

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24
Q

What actions occur in REM behavior disorder?

A

Walking, talking, eating, etc

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25
Q

What part of sleep does REM behavior disorder occur?

A

During a lack of skeletal muscle tone during REM stage sleep

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26
Q

What is the usual treatment of REM behavior disorder?

A

Clonazepam which decreases motor movements partially or completely

27
Q

Is it more common for RLS to have PLMS or PLMS to have RLS?

A

90% of patients with RLS have PLMS

20% of patients with PLMS have RLS

28
Q

What is insomnia?

A

Low quantity and/or poor quality of sleep resulting in nonrestorative sleep

29
Q

What may insomnia result from?

A

Problems with sleep onset, sleep maintenance, or early morning awakening with inability to return to sleep

30
Q

What are sedating agents?

A

Hypnotics
Antihistamines
Antipsychotis
Antidepressants

31
Q

What are activating agents?

A 
Nicotine
CNS stimulants
Thyroid hormones
Bronchodilators
Corticosteroids
32
Q

What are non-pharm approaches for sleeping?

A

Avoid caffeine, alcohol, and cigarettes after lunch
Limit liquids in the evening
Keep a regular bedtime-waketime schedule
Avoid naps (no longer than 20 minutes)
Spend times outdoows, particularly in later afternoon or early evening
Exercise, but avoid in the evening

33
Q

What can many sedating medications cause?

A

Falls, fractures, and cognitive slowing

34
Q

What % of community dwelling older adults complain of some form of sleep difficulty?

A

50%

35
Q

If a patient has difficulty falling asleep, what type of agent should be used?

A

Shorter half-lives

36
Q

If a patient has difficulty maintaining sleep, what type of agent should be used?

A

Intermediate half-lives

37
Q

What is the MOA of benzo receptor agonists?

A

Enhances activity of GABA (inhibitory neurotransmitter) at various receptor sites leading to sedative and hypnotic effects resulting from decreased neuronal excitability

38
Q

What are benzo receptor agonists?

A

Non-benzo/non-barbiturate
Ambien
Lunesta
Zaleplon

39
Q

How do benzo receptor agonists compare to benzos?

A

Lower tolerance effects
Rebound insomnia
Residual daytime sleepiness

40
Q

What is Ambien effective for?

A

Sleep onset (ER can help with sleep maintenance as well)

41
Q

Where does ambien work?

A

Benzodiazepine-1 receptor

42
Q

What is Lunesta effective for?

A

Sleep onset and maintenance

43
Q

Where does Lunesta work?

A

GABA-receptor complex domain

44
Q

What is zaleplon effective for?

A

Sleep onset

45
Q

Where does zaleplon work?

A

Omega-1 receptor GABA-A

46
Q

What are common SEs for benzodiazepine receptor agonists?

A

HA
Dizziness
Somnolence

47
Q

Which benzo receptor agonist leaves a found taste in the mouth?

A

Lunesta

48
Q

What is melatonin’s MOA?

A

Binds to melatonin receptor at the suprachiasmatic nucleus of the hypothalamus, which plays a key role in circadian rhythms and synchronization of sleep-wake cycle. MT1 receptor responsible for inducing sleepiness, MT2 receptor responsible for circadian rhythms

49
Q

Which type of patients is melatonin most beneficial for?

A

Melatonin deficient

50
Q

What are common SEs of melatonin agonists?

A 
Similar to placebo
HA
Dizziness
Nausea
Drowsiness
51
Q

What are the melatonin agonists?

A

Melatonin

Ramelteon (Rozerem)

52
Q

What is ramelteon effective for?

A

Sleep onset

53
Q

What is Ramelteon more selective for?

A

MT1 > MT2

54
Q

Does melatonin or ramelteon have a higher affinity for MT1?

A

Ramelteon

55
Q

What is ramelteon more effective for?

A

Primary insomnia (w/o melatonin deficiency)

56
Q

What are the antidepressants that can be used for insomnia?

A

Trazodone
Mirtazapine
Doxepin

57
Q

Which patients receive Trazodone?

A

With concomitant depression

58
Q

What are SE of trazodone?

A 
Nausea
Dry mouth
Dizziness
HA
Somnolence
Blurred vision
Nervousness
Fatigue
Priapism
59
Q

Who receives mirtazapine?

A

With concomitant depression and/or decreased appetite/weight

60
Q

What type of mirtazapine doses are sedating?

A

Lower

61
Q

What are the SE for Mirtazapine?

A 
Increased appetite
Increased TG
Constipation
Dry mouth
Somnolence
62
Q

What does the insomnia dose of doxepin do?

A

Selectively antagonizes H1 receptors

63
Q

What other medications may be used for depression but are on the Beers list?

A

Antihistamines
Antipsychotics
Benzos

Geriatrics (15 decks)

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