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Emma H&N > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

why do we need sleep?

A
  • memory consolidation
  • healing
  • growth
  • immune response
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2
Q

sleep-wake cycle: competition/balance between ________ and ________

A

sleep-wake cycle: competition/balance between SLEEP LOAD and CIRCADIAN ALTERING SIGNAL

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3
Q

deepest level of sleep?

A

NREM III
(non-REM III)

-get most rest/relaxation

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4
Q

what occurs during REM sleep?

A
  • dreams
  • mental/physical relaxation
  • memory consolidation
  • emotional processing
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5
Q

physiologic occurances in REM sleep

A
  • rapid eye movement
  • increased brain activity
  • complete paralysis
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6
Q

as the night progresses, does REM get progressively shorter or longer?

A

REM gets progressively longer

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7
Q

primary sleep disorders

A

Dyssomnias

  • idiopathic hypersomnia
  • narcolepsy
  • sleep apnea
  • periodic leg movements
  • restless leg syndrome
  • insomnia

Parasomnias

  • sleep terror
  • sleep walking
  • sleep talking
  • nightmare disorder
  • REM behavior disorder
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8
Q

secondary sleep disorders

A

due to external issues

  • mental disorders (anxiety, depression, PTSD)
  • medical disorders (arthritis, fibromyalgia)
  • substance use (drugs, alc, meds)
  • sleep deprivation due to schedule etc

MORE COMMON THAN PRIMARY DISORDERS

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9
Q

circadian rhythm disorders

A
  • delayed sleep phase disorder
  • advanced sleep phase disorders
  • free running type
  • jet lag disorder
  • shift work disorder
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10
Q

most adults need ____ hours of sleep per night

A

7-9 hours

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11
Q

in laboratory rats, complete sleep deprivation leads to

A
  • failure to thrive
  • excessive food intake with decreased weight
  • loss of hair
  • skin abnormalities
  • hyperactivity
  • death at day 22
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12
Q

effects of caffeine on sleep architecture

A
  • caffeine blocks adenosine receptors

- sleep structure completely abnormal

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13
Q

ways to test for excessive daytime sleepiness

A
  • history
  • Epworth sleep scale
  • polysomnography
  • multiple sleep latency test (MSLT)
  • maintenance of wakefulness test (MWT)
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14
Q

management of a sleep disorder

A

-treat any underlying sleep pathology

Patient education

  • adequate total sleep time
  • proper sleep hygeine
  • limited role for medications
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15
Q

state boundary disorders

A

the 3 distinct states (awake, non-REM, REM) are somewhat overlapping
ex: narcolepsy, parasomnias

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16
Q

narcolepsy

A

intrusion of REM sleep features into the waking state

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17
Q

parasomnias

A

inappropriate release of awake behaviors during sleep

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18
Q

classic tetrad of daytime sleepiness (narcolepsy)

A
  • cataplexy
  • hypnogogic hallucinations
  • sleep paralysis
19
Q

neuronal level explanation of narcolepsy

A
  • inconsistent inhibition of REM-on neurons
  • go into REM sleep during the day
  • REM-on neurons of pons tell medullary inhibitory region to inhibit motor neurons
  • –paralysis causes cataplexy
  • might start to dream
20
Q

cataplexy

A
  • sudden bilateral loss of muscle tone
  • preserved consciousness
  • triggered by strong emotions
  • localized or generalized
  • seconds to minutes

10-50% of narcoleptics do NOT have cataplexy

21
Q

hyponogogic/hypnopompic hallucinations

A
  • upon falling asleep or awakening
  • realistic awareness of presence of someone/something in the room
  • possible visual, tactile, kinetic, auditory phenomena
  • often associated with SLEEP PARALYSIS

40-80% of narcoleptics have this

22
Q

sleep paralysis

A
  • inability to move/speak during onset of sleep or upon awakening
  • muscular control regained within several minutes
  • may occur in gen pop with sleep deprivation

40-80% of narcoleptics experience this

23
Q

prevalence of narcolepsy in US

A

1 in 2,000

  • equal in men and women
  • presents between ages of 15-30
24
Q

diagnosis of narcolepsy

A
  • symptoms (cataplexy is diagnostic)
  • overnight polysomnography
  • –sleep fragmentation
  • –short REM latency
  • mean sleep latency test (MSLT)
25
Q

neurochemical basis of disease

A

90% of patients with narcolepsy with cataplexy have low HYPOCRETIN (orexin) levels in CSF

26
Q

genetic basis for narcolepsy

A

90% of narcoleptics with cataplexy have HLA DQB1 allele

—also in 25% of gen pop without narcolepsy

27
Q

treatment for narcolepsy

A
  • planned short naps, avoid sleep deprivation
  • avoid sedentary jobs

wake promoting drugs

  • methylphenidate, dextrophetamine, methamphetamine
  • modafinil, armodafinil, sodium oxybate

treatment of cataplexy

  • SSRIs
  • SNRIs (Serotonin-NE)
  • sodium oxybate
28
Q

non-REM parasomnias

A
  • night terrors
  • sleep talking/walking
  • sleep related eating disorder
  • confusional arousal
  • sleep enuresis

inappropriate release of instinctual behaviors

29
Q

REM parasomnias

A
  • nightmare disorder

- REM behavior disorder

30
Q

timing of REM vs non-REM parasomias

A

REM: last few cycles (second half of the night)

non-REM: first few cycles (last half of the night)

31
Q

sleep terror

A
  • sudden cry or piercing scream
  • intense fear
  • eyes may be open, but cannot see parent
  • forget it happened the next day
32
Q

sleep walking

A
  • sitting up or bolting from bed
  • eyes open with glassy stare
  • hard to arouse
  • routine/inappropriate behavior
  • amnesia of episode next day
33
Q

sleep related eating disorder

A
  • involuntary eating and drinking during main sleep period
  • consumption of peculiar food
  • potential injury
  • morning amnesia
34
Q

neuronal level of explanation for REM parasomnias

A
  • REM on neurons NOT active
  • —do not inhibit pons
  • pons does not inhibit muscles (no sleep paralysis)
  • enact dreams
35
Q

REM behavior disorders have a strong association with _________

A

REM behavior disorders have a strong association with PARKINSONS

36
Q

insomnia

A
  • difficulty initiating sleep or maintaining sleep
  • waking up too early
  • non restorative sleep
  • despite adequate sleep opportunity
  • associated with daytime impairment
37
Q

insomnia could be an early marker for _________

A

insomnia could be an early marker for DEPRESSION (or other psychiatric disease)

-also high risk for alcohol abuse

38
Q

acute insomnia

A
  • adjustment, transient, stress related

- temporally associated with identifiable stressor

39
Q

chronic insomnia

A
  • psychophysiologic
  • idiopathic
  • paradoxical

comorbid insomnia

  • due to mental disorder
  • due to drug/substance
  • due to medical condition
40
Q

psychophysiologic insomnia – predisposing, precipitating, perpetrating factors

A

Predisposing factors

  • habitual light sleepers
  • episodic poor sleepers

Precipitating factors

  • stress
  • environmental
  • life change

Perpetuating factors
-anxious concern over health and well being

41
Q

proper sleep hygeine

A

Proper sleep hygeine

  • standardized sleep/wake times
  • limit time awake in bed
  • remove bedroom clock
  • limit bright light exposure at night
  • avoid late evening exercise
  • limit naps
  • reduce/eliminate alcohol, caffeine, tobacco
42
Q

behavioral therapies (for insomnia)

A
  • relaxation techniques
  • sleep restriction
  • paradoxical intension
  • biofeedback
  • circadian rhythm entrainment
  • CBT
43
Q

OTC meds for insomnia

A
  • melatonin
  • antihistamines
  • analgesis
  • valerian root
44
Q

prescription meds for insomnia

A
  • benzodiazepines
  • benzodiazepine receptor agonists
  • melatonin receptor agonists
  • sedating antidepressants
  • anticonvulsants
  • atypical antipsychotics

Emma H&N (49 decks)

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