Sleep disorders Flashcards
How much time do we spend in Rapid Eye Movement (REM)
20-25%
How much time do we spend in Non-Rapid Eye Movement (NREM)
50-60%
N1 and N2
What is characteristic of REM sleep?
Brainstem mediated muscle atonia=ABSENT EMG activity in nearly all skeletal muscle=Body paralysis
List the 3 stages of NREM. Which one is the most difficult to arouse you from?
- N1
- N2
- N3-Most difficult to arouse
What sleep stage do you observe decreased BP, HR and RR
NREM-Especially N3
What hormone do men secrete during sleep?
GH
What hormone do women secrete during sleep?
Prolactin
What hormones are inhibited during sleep?
- TSH
2. ACTH-Cortisol axis
What is considered the “regenerative” stage of sleep
N3
How much sleep does the average adult need?
7.5-8 hrs
How much sleep do teenagers need?
9+ hrs
What does Multiple Sleep Latency Test (MSLT) measure?
Propensity to sleep during the day
What does Maintenance of Wakefulness Test measure?
Ability to sustain wakefulness during daytime
Diagnostic criteria for insomnia
- Symptoms at least 3 x/wk
- Sleep initiation OR maintenance problem
- Opportunity to sleep
- Daytime consequences
Short term insomnia
<3 months
Chronic insomnia
> 3 months
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
Benzodiazepines
What is nonbenzodiazepine sedative that you could consider in insomnia?
Zolpidem (Ambien)
What is actually considered first line tx for insomnia, but patients have a low tolerance for?
Melatonin Agonist
What causes obstructive sleep apnea?
Repetitive collapse of upper airway during sleep
When can you diagnose sleep apnea with just 5+ events (compared to 15)
- Excessive sleepiness, fatigue, and/or insomnia
- Waking with gasping/choking
- Habitual snoring or breathing interrruptions
- HTN, CAD, stroke, A-fib, HF, DM
- Mood disorder, cognitive dysfunction
Highest prevalence of sleep apnea
- Men
2. African Americans
Sleep apnea risk factors
- Obesity
- Male
- Advanced age
- Craniofacial morphology or upper airway soft tissue abnormality (tonsillar/adenoid hypertrophy)
Sleep apnea PEx findings
- Obesity
- Elevated BP
- Pulmonary HTN
- Crowded/narrow orophargneal
How do you diagnose sleep apnea?
Polysomnography
Sleep apnea Treatment
- Positive airway pressure (CPAP)= initial therapy
2. Behavioral: Wt. loss/exercise, sleep position, avoid alcohol
What is the estimated percentage of sleep apnea patients who DO NOT use their CPAP device?
20-40%
What is the average nightly use of CPAP?
4 hrs
Narcolepsy etiology
- Loss of hypothalamic neurons that produce orexin neuropeptides
- Orexins promote long episodes of wakefulness and suppress REM sleep
List the two types of narcolepsy
- Type 1- With Cataplexy
2. Type 2- WithOUT Cataplexy
Define cataplexy
- Sudden muscle weakness without LOC
- Usually triggered by strain emotions (laughing, crying)
Define Hypnagogic hallucinations
Dream-like hallucinations at sleep onset or upon awakening (hypnopompic)
What is a typical Epworth sleepiness scale score in narcolepsy?
> 15
Polysomnogram findings in narcolepsy
REM sleep within 15 minutes of sleep onset at night
Multiple sleep latency (MSLT) findings in narcolepsy
sleep latency < 8 minutes & REM episodes in at least 2 of the naps
What is first line pharmacologic treatment for narcolepsy?
Modafinil: Wake-promoting
What can you prescribe to treat cataplexy?
Antidepressants that increase noradrenergic or serotonergic tone=suppress REM sleep and cataplexy
List the NREM related parasomnias
Disorders of arousal:
- Confusional arousal
- Sleepwalking
- Sleep Terrors: Autonomic activation (tachypnea, tachycardia, mydriasis)
- Sleep-Related eating disorders
List the REM related parasomnias
Intrusion of features of REM sleep into wakefulness:
- Sleep paralysis
- Nightmare disorder
