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Foundations II (Cholley) > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

Describe REM sleep

A
  • Low amplitude, mixed frequency EEG
  • Bursts of REM similar to wakefulness
  • EMG activity absent = characteristic of REM sleep
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2
Q

What are the 3 stages of NREM sleep?

A

N1, N2, N3

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3
Q

Describe NREM sleep

A

Increased arousal threshold & slowing of cortical EEG as you move through the 3 stages

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4
Q

Describe stage N1

A

Btwn wakefulness & deeper sleep

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5
Q

If someone is awoken, when does vivid recall of dream imagery occur?

A

If awoken from REM sleep

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6
Q

What degrades cognitive performance?

A

Sleep deprivation

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7
Q

Sleep deficiency can cause what?

A

Glucose intolerance –> DM, obesity, metabolic syndrome, impaired immunity, accelerated atherosclerosis, stroke

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8
Q

How many hours of sleep does the average adult need?

A
  1. 5-8 hrs

* Teens need 9+ hrs

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9
Q

What is the impact of insufficient sleep?

A
  • Inattentive, irritable, unmotivated, depressed

- Difficulty w/ school, work, driving

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10
Q

What should be included in PE when evaluating a pt for a sleep disorder?

A
  • Airway
  • Tonsils
  • Neurologic
  • MSK
  • CV
  • Pulm
  • Abd
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11
Q

How do you dx a sleep d/o?

A

Polysomnography

  • EEG
  • EOG: measures eye movement
  • EMG: measured on chin, neck, legs
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12
Q

What does polysomnography measure?

A
  • Sleep stages
  • Respiratory effort & airflow
  • O2 sat
  • Limb movements
  • Heart rhythm
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13
Q

What are other dx tests for sleep d/o?

A
  • Home sleep test
  • Multiple sleep latency test (MSLT)
  • Maintenance of wakefulness test
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14
Q

What scale is used for dx of sleep d/o?

A

Epworth sleepiness scale (ESS)

- Over 10 = excessive sleepiness

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15
Q

How are sleep disorders classified?

A
  • Insomnia
  • Sleep-related breathing
  • Central d/o of hypersomnolence
  • Circadian rhythm sleep-wake
  • Parasomnias
  • Sleep-related movement disorders

*There are 60 diagnoses

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16
Q

What are the RFs of insomnia?

A
  • W > M
  • Older
  • Unemployed
  • Lower SES
  • Divorced, widowed, separated
  • Medical, psychiatric, substance abuse
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17
Q

What is the dx criteria for insomnia?

A
  • Sx at least 3 x per wk
  • Sleep initiation or maintenance problem
  • Adequate opportunity to sleep
  • Daytime consequences
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18
Q

What is considered short-term insomnia?

A
  • < 3mos
  • can be a stressor, but to dx there should be an independent focus on the insomnia
  • resolves when stressor does
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19
Q

How do you dx insomnia?

A

Clinically!

- But look for conditions, meds, substance abuse

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20
Q

How do you tx insomnia?

A
  • Sleep hygiene & stimulus control counseling
  • Behavioral therapy
  • Pharmacologic therapy
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21
Q

What med tx can you use for insomnia?

A
  • Benzodiazepines
  • Nonbenzodiazepine sedatives
  • Melatonin agonists
  • Doxepin
  • Suvorexant
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22
Q

What are 4 sleep-related breathing disorders?

A
  1. Central sleep apnea
  2. Obstructive sleep apnea
  3. Sleep-related hypoventilation
  4. Sleep-related hypoxemia
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23
Q

What is the impact of insomnia?

A
  • Decreased QOL & performance
  • Increased CV risk, DM
  • Associated w/ depression, anxiety
24
Q

What causes OSA?

A

Repetitive collapse of upper airway during sleep

25
Q

Describe OSA

A

15+ obstructive respiratory events per hr

26
Q

What is the dx criteria for OSA?

A

Can dx w/ 5+ events if:

  • s/s of excessive sleepiness, fatigue, &/or insomnia
  • waking up w/ breath holding, gasping, choking
  • snoring, breathing interruptions, or both noted by bed partner or observer
  • HTN, mood d/o, cognitive dysfunction, CAD, stroke, HF, AF, DM
27
Q

What are the RFs of OSA?

A
  • Obesity
  • Male
  • Advanced age
  • Craniofacial morphology or upper airways abnormalities
28
Q

What is the clinical presentation of OSA?

A

Excessive daytime sleepiness, snoring, choking, or gasping during sleep

29
Q

In OSA, what is seen on PE?

A
  • Obesity
  • Crowded/narrow OP airway
  • Elevated BP
  • Signs of pulm HTN or cor pulmonale
30
Q

How do you dx OSA?

A

Polysomnography

31
Q

How do you tx OSA?

A
  • Behavioral

- + airway pressure (CPAP) = initial therapy

32
Q

What is the avg nightly use of CPAP?

A

4 hours

33
Q

What is the impact of OSA?

A
  • Decreased QOL, daily function
  • Increased risk MCV & poor neurocognitive performance
  • Increased all-cause & cardiovascular mortality
34
Q

What are central disorders of hypersomnolence?

A

Narcolepsy types 1 & 2

35
Q

Describe narcolepsy

A
  • Loss of hypothalamic neurons that produce orexin neuropeptides
  • May have autoimmune component
  • Difficulty sustaining wakefullness, poor regulation of REM, disturbed nocturnal sleep
36
Q

What is the difference btwn Type 1 & 2 narcolepsy?

A

Type 1 = w/ cataplexy

Type 2 = w/out cataplexy

37
Q

What is cataplexy?

A

Sudden muscle weakness w/out loss of consciousness, triggered by emotions

38
Q

Besides cataplexy, what are other presentations of narcolepsy?

A
  • Hypnagogic hallucinations: dream-like, at sleep onset or upon awakening
  • Sleep paralysis: muscle paralysis upon awakening or just before falling asleep
39
Q

What is the clinical presentation of narcolepsy?

A
  • Excessive daytime sleepiness
  • Fragmented sleep
  • Other sleep disorders
  • Psychiatric comorbidities
40
Q

How do you dx narcolepsy?

A
  • H&P
  • Polysomnogram
  • MSLT: sleep latency < 8 mins & REM episodes in at least 2 of the naps
41
Q

How do you tx narcolepsy?

A
  • Nonpharmacologic

- Pharmacologic: Modafinil = 1st line, methyphenidate, amphetamines

42
Q

How do you tx cataplexy?

A

Antidepressants

43
Q

What is the clinical presentation of shift work d/o?

A
  • Fragmented sleep
  • Difficulty falling/staying asleep
  • Poor sleep quality
  • Reduced sleep duration
44
Q

How do you manage shift work d/o?

A
  • Change work schedule
  • Improve daytime sleep
  • Regular sleep schedule
  • Sleep hygiene
  • CBT
  • Therapeutics: short-acting hypnotics, melatonin, caffeine
45
Q

What are parasomnias?

A

Undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep

46
Q

What population is most commonly affected by parasomnias?

A

Children!

47
Q

Parasomnias: What are NREM-related components?

A

Disorders of arousal

  • Confusional
  • Sleepwalking
  • Sleep terrors
  • Sleep-related eating d/o
48
Q

Parasomnias: What are REM-related components?

A

Intrusion of features of REM sleep into wakefulness

  • Sleep paralysis
  • Exaggerated features of REM sleep
  • Aberrations of REM sleep
49
Q

What is the criteria for parasomnia dx?

A
  • Recurrent episodes of incomplete awakening
  • Absent or inappropriate responsiveness
  • Limited or no cognition or dream report
  • Partial or complete amnesia for the event
50
Q

How do you dx parasomnia?

A
  • History

- PSG (if suspect comorbid sleep d/o)

51
Q

What are precipitating factors of parasomnias?

A
  • Sleep deprivation, emotional stress
  • Fever, malaise, environmental or internal stimuli
  • Comorbid sleep disorders
  • Meds, substances
52
Q

What are sleep terrors?

A

Sudden arousal from sleep associated w/ sitting up in bed, intense fear, a piercing scream, & intense autonomic activation including tachycardia, tachypnea, diaphoresis, facial flushing, & mydriasis

53
Q

How do people w/ sleep terrors present?

A
  • Frightened, confused, inconsolable, difficult to arouse
  • No recollection
  • Lasts several mins
  • Quietly return to sleep
54
Q

How do sleep walkers present?

A
  • Slow, quiet ambulation w/ eyes open
  • Might prepare food, eat, clean, rearrange furniture, drive
  • Terminate spontaneously
  • Appear confused, agitated or aggressive when aroused
  • Self-injury
55
Q

What is sleep related eating d/o?

A
  • Variant of sleepwalking

- Involuntary eating associated w/ diminished LOC during an arousal from sleep

56
Q

How do you tx parasomnias?

A
  • Avoid sleep deprivation, ETOH, certain meds
  • Maintain consistent, regular sleep-wake cycles
  • Safety interventions
  • Bystanders should allow pt to move freely but ensure safety. Gently coax back to bed.
  • Anticipatory awakening

Foundations II (Cholley) (25 decks)

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