Sleep Disorders Flashcards
Area of brain that regulates sleep
- suprachiasmatic nucleus
- pineal gland
blue light to retina, projects to SCN, projects to pineal gland and inhibits melatonin production
List 7 general causes of insomnia
- poor sleep hygiene
- Psychiatric conditions
- medical conditions
- acute stressors
- circadian rhythm disorders
- medications
- primary sleep disorder
Examples of poor sleep hygiene that can cause insomnia
alcohol
caffeine
nicotine
sleep schedule
examples of psychiatric conditions that can cause insomnia
anxiety
depression
Examples of medical conditions that can cause insomnia
lung disease
heart failure
neuro disorders
pain disorders
Examples of acute stressors that can cause insomnia
bereavement
relocation
marriage/divorce
Examples of circadian rhythm disorders that can cause insomnia
- advanced or delayed sleep phase
- irregular sleep/wake
Examples of medications that can cause insomnia
- BB
- bronchodilators
- CNS stimulants
- corticosteroids
- decongestants
Examples of primary sleep disorders that can cause insomnia
sleep apnea
primary therapy for insomnia
cognitive behavioral therapy
Online program that is as effective as face-to-face CBT for insomnia
www. cbtforinsomnia.com
- 5 weeks, 5 sessions, all online CBT
Drug categories that have been evaluated for insomnia management
- BZDs
- Orexin receptor antagonists
- Melatonin (Ramelteon)
- off label (Trazodone MC, TCAs like amitriptyline, mirtazapine, quetiapine, hydroxyzine
Define narcolepsy
Sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, possible cataplexy
Define cataplexy
Partial or total loss of muscle control, often triggered by strong emotion like laughter
State role of orexin/hypocretin receptors in sleep
- 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
What is the role of orexin/hypocretin receptors in therapy of narcoplepsy
Thought is if can antagonize orexin (which is low in people with narcolepsy), can put person to sleep
What wavelength of light stimulates the retina and ultimately affects melatonin levels?
blue light
Define mixed apnea
combo of OSA and CSA
Define treatment induced CSA
can be caused by inappropriately titrated CPAP settings
What is GS dx test for sleep apnea
polysomnogram
aka “sleep testing”
What is PSG, how is it used in testing/management of apnea
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
What is PAP titration, how is it used in testing/management of apnea
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”)
What is split night, how is it used in testing/management of apnea
half the night’s testing is to figure out the dx, the second half of the night is to figure out a tx plan
What is MSLT, how is it used in testing/management of apnea
- 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