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Foundations-Neuro > Sleep disorders > Flashcards

Sleep disorders Flashcards

1
Q

How much time do we spend in Rapid Eye Movement (REM)

A

20-25%

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2
Q

How much time do we spend in Non-Rapid Eye Movement (NREM)

A

50-60%

N1 and N2

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3
Q

What is characteristic of REM sleep?

A

Brainstem mediated muscle atonia=ABSENT EMG activity in nearly all skeletal muscle=Body paralysis

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4
Q

List the 3 stages of NREM. Which one is the most difficult to arouse you from?

A
  1. N1
  2. N2
  3. N3-Most difficult to arouse
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5
Q

What sleep stage do you observe decreased BP, HR and RR

A

NREM-Especially N3

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6
Q

What hormone do men secrete during sleep?

A

GH

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7
Q

What hormone do women secrete during sleep?

A

Prolactin

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8
Q

What hormones are inhibited during sleep?

A
  1. TSH

2. ACTH-Cortisol axis

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9
Q

What is considered the “regenerative” stage of sleep

A

N3

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10
Q

How much sleep does the average adult need?

A

7.5-8 hrs

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11
Q

How much sleep do teenagers need?

A

9+ hrs

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12
Q

What does Multiple Sleep Latency Test (MSLT) measure?

A

Propensity to sleep during the day

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13
Q

What does Maintenance of Wakefulness Test measure?

A

Ability to sustain wakefulness during daytime

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14
Q

Diagnostic criteria for insomnia

A
  1. Symptoms at least 3 x/wk
  2. Sleep initiation OR maintenance problem
  3. Opportunity to sleep
  4. Daytime consequences
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15
Q

Short term insomnia

A

<3 months

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16
Q

Chronic insomnia

A

> 3 months

17
Q

What medication would you prescribe for a patient who has a short, acute episode of insomnia due to stress from a death in the family

A

Benzodiazepines

18
Q

What is nonbenzodiazepine sedative that you could consider in insomnia?

A

Zolpidem (Ambien)

19
Q

What is actually considered first line tx for insomnia, but patients have a low tolerance for?

A

Melatonin Agonist

20
Q

What causes obstructive sleep apnea?

A

Repetitive collapse of upper airway during sleep

21
Q

When can you diagnose sleep apnea with just 5+ events (compared to 15)

A
  1. Excessive sleepiness, fatigue, and/or insomnia
  2. Waking with gasping/choking
  3. Habitual snoring or breathing interrruptions
  4. HTN, CAD, stroke, A-fib, HF, DM
  5. Mood disorder, cognitive dysfunction
22
Q

Highest prevalence of sleep apnea

A
  1. Men

2. African Americans

23
Q

Sleep apnea risk factors

A
  1. Obesity
  2. Male
  3. Advanced age
  4. Craniofacial morphology or upper airway soft tissue abnormality (tonsillar/adenoid hypertrophy)
24
Q

Sleep apnea PEx findings

A
  1. Obesity
  2. Elevated BP
  3. Pulmonary HTN
  4. Crowded/narrow orophargneal
25
Q

How do you diagnose sleep apnea?

A

Polysomnography

26
Q

Sleep apnea Treatment

A
  1. Positive airway pressure (CPAP)= initial therapy

2. Behavioral: Wt. loss/exercise, sleep position, avoid alcohol

27
Q

What is the estimated percentage of sleep apnea patients who DO NOT use their CPAP device?

A

20-40%

28
Q

What is the average nightly use of CPAP?

A

4 hrs

29
Q

Narcolepsy etiology

A
  • Loss of hypothalamic neurons that produce orexin neuropeptides
  • Orexins promote long episodes of wakefulness and suppress REM sleep
30
Q

List the two types of narcolepsy

A
  1. Type 1- With Cataplexy

2. Type 2- WithOUT Cataplexy

31
Q

Define cataplexy

A
  • Sudden muscle weakness without LOC

- Usually triggered by strain emotions (laughing, crying)

32
Q

Define Hypnagogic hallucinations

A

Dream-like hallucinations at sleep onset or upon awakening (hypnopompic)

33
Q

What is a typical Epworth sleepiness scale score in narcolepsy?

A

> 15

34
Q

Polysomnogram findings in narcolepsy

A

REM sleep within 15 minutes of sleep onset at night

35
Q

Multiple sleep latency (MSLT) findings in narcolepsy

A

sleep latency < 8 minutes & REM episodes in at least 2 of the naps

36
Q

What is first line pharmacologic treatment for narcolepsy?

A

Modafinil: Wake-promoting

37
Q

What can you prescribe to treat cataplexy?

A

Antidepressants that increase noradrenergic or serotonergic tone=suppress REM sleep and cataplexy

38
Q

List the NREM related parasomnias

A

Disorders of arousal:

  1. Confusional arousal
  2. Sleepwalking
  3. Sleep Terrors: Autonomic activation (tachypnea, tachycardia, mydriasis)
  4. Sleep-Related eating disorders
39
Q

List the REM related parasomnias

A

Intrusion of features of REM sleep into wakefulness:

  1. Sleep paralysis
  2. Nightmare disorder

Foundations-Neuro (5 decks)

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