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Behavioral Health 2 > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

Area of brain that regulates sleep

A
  • suprachiasmatic nucleus
  • pineal gland

blue light to retina, projects to SCN, projects to pineal gland and inhibits melatonin production

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2
Q

List 7 general causes of insomnia

A
  1. poor sleep hygiene
  2. Psychiatric conditions
  3. medical conditions
  4. acute stressors
  5. circadian rhythm disorders
  6. medications
  7. primary sleep disorder
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3
Q

Examples of poor sleep hygiene that can cause insomnia

A

alcohol
caffeine
nicotine
sleep schedule

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4
Q

examples of psychiatric conditions that can cause insomnia

A

anxiety

depression

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5
Q

Examples of medical conditions that can cause insomnia

A

lung disease
heart failure
neuro disorders
pain disorders

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6
Q

Examples of acute stressors that can cause insomnia

A

bereavement
relocation
marriage/divorce

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7
Q

Examples of circadian rhythm disorders that can cause insomnia

A
  • advanced or delayed sleep phase

- irregular sleep/wake

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8
Q

Examples of medications that can cause insomnia

A
  • BB
  • bronchodilators
  • CNS stimulants
  • corticosteroids
  • decongestants
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9
Q

Examples of primary sleep disorders that can cause insomnia

A

sleep apnea

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10
Q

primary therapy for insomnia

A

cognitive behavioral therapy

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11
Q

Online program that is as effective as face-to-face CBT for insomnia

A

www. cbtforinsomnia.com

- 5 weeks, 5 sessions, all online CBT

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12
Q

Drug categories that have been evaluated for insomnia management

A
  • BZDs
  • Orexin receptor antagonists
  • Melatonin (Ramelteon)
  • off label (Trazodone MC, TCAs like amitriptyline, mirtazapine, quetiapine, hydroxyzine
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13
Q

Define narcolepsy

A

Sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, possible cataplexy

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14
Q

Define cataplexy

A

Partial or total loss of muscle control, often triggered by strong emotion like laughter

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15
Q

State role of orexin/hypocretin receptors in sleep

A
  • Interact with all wake-promoting areas of the brain and spinal cord
  • Pts with narcolepsy (esp with cataplexy) are deficient in orexin
  • Thought is if can antagonize orexin, can put person to sleep
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16
Q

What is the role of orexin/hypocretin receptors in therapy of narcoplepsy

A

Thought is if can antagonize orexin (which is low in people with narcolepsy), can put person to sleep

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17
Q

What wavelength of light stimulates the retina and ultimately affects melatonin levels?

A

blue light

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18
Q

Define mixed apnea

A

combo of OSA and CSA

19
Q

Define treatment induced CSA

A

can be caused by inappropriately titrated CPAP settings

20
Q

What is GS dx test for sleep apnea

A

polysomnogram

aka “sleep testing”

21
Q

What is PSG, how is it used in testing/management of apnea

A

polysomnogram

  • Record of sleep activity.
  • Includes EEG to determine stages of sleep, EKG to look for arrhythmias (bradycardia and afib most common)
  • Determines how many episodes of apnea happen in the session
22
Q

What is PAP titration, how is it used in testing/management of apnea

A

positive air pressure titration

  • Everyone’s pressure requirement is different
  • Procedure to change the pressure of the CPAP until enough pressure to tx sleep apnea but not too high (can confuse RAS and cause “induced central apnea”)
23
Q

What is split night, how is it used in testing/management of apnea

A

half the night’s testing is to figure out the dx, the second half of the night is to figure out a tx plan

24
Q

What is MSLT, how is it used in testing/management of apnea

A
  • multiple sleep latency testing
  • For excessive sleepiness syndromes (like narcolepsy)
  • Go to lab during day, have 5 scheduled 20 minute nap sessions
  • Look for sleep latency and how quickly pt entered REM sleep
  • Considered abnl if pt enters REM in 2 or more of the naps
25
Q

What is MWT, how is it used in testing/management of apnea

A
  • maintenance of wakefulness
  • Put pt in a boring room, tell pt not to sleep
  • Used for truck drivers and pilots to prove pt is appropriately treated and will stay awake when necessary
26
Q

GS tx for sleep apnea

A

PAP therapy

27
Q

What is the utility of mandibular advance devices in managing sleep apnea

A

not good, don’t use

28
Q

Restless limb syndrome

  • MC secondary cause
  • best way to dx
  • recommended therapy
A
  • iron deficient anemia
  • test for ferritin levels
  • iron supplement to tx OR anti-da drugs bc is a muscular movement disorder
29
Q

Define periodic limb movement disorder. how is it usually IDed?

A
  • Kick all night but not aware

- often IDed by spouse who is sick of being kicked

30
Q

What is the site of endogenous circadian cycle control?

A

Suprachiasmatic nucleus

31
Q

What is the primary determinant of circadian phase

A

nadir (lowest part) of core body temp

32
Q

what is definition of entrainment

A

Process by which light synchronizes the SCN to a 24 hour cycle

33
Q

What happens to phase response curve when there is light exposure before the nadir of core body temp

A

leads to phase delay (light later in the day)

- example is to treat advanced sleep phase

34
Q

What happens to phase response curve when there is light exposure after the nadir of core body temp

A

leads to phase advance (light in the morning)

- example is to treat delayed sleep phase

35
Q

Delayed sleep phase

A
  • Delay in the phase of sleep period in relation to desired sleep time
  • Chronic or recurrent complaint of inability to fall asleep at a desired time and inability to awaken at a desired/socially acceptable time
  • Classic teenage sleep pattern
36
Q

Advanced sleep phase

A
  • Converse of delayed sleep phase
  • Go to bed early and wake up early
  • Middle aged and elderly
37
Q

Jet lag

A
  • Insomnia and excessive daytime sleepiness associated with jet travel
  • Impairment of daytime function, general malaise, GI disturbance
  • Occur bc endogenous circadian rhythm is misaligned to external clock
38
Q

Shift work sleep disorder

A
  • Constant state of circadian misalignment

- Work and sleep at the wrong circadian phase

39
Q

Therapy for delayed sleep phase

A
  • Blue light 30 minutes following rise time, advance 30 minutes earlier every few weeks until desired wake time is achieved
  • Melatonin: given 12 hours prior to light exposure
40
Q

Therapy for advanced sleep phase

A
  • Blue light 30-60 min prior to patient’s bed time
  • Melatonin not effective
  • Possibly pharm options and caffeine
41
Q

Therapy for jet lag

A
  • Blue light (using process for delayed and advanced sleep phases)
  • Avoidance of light
  • Melatonin 12 hours prior to light therapy like for delayed sleep phase
42
Q

Therapy for shift work sleep disorder

A
  • Light therapy
  • Melatonin
  • Hypnotics to improve sleep quality
  • To improve alertness: caffeine, modafinil/armodafinil, scheduled naps
43
Q

What is the dual mechanism interaction of sleep

A

Homeostatic

  • accumulates as a function of wakefulness
  • important factor in sleep quality

Endogenous

  • core temp and melatonin
  • important for sleep quantity

Behavioral Health 2 (11 decks)

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