Sleep Disorders TBL Flashcards
Sleep is divided into 2 phases: ____ and _____
Rapid Eye Movement asleep (REM) and Non-Rapid Eye Movement sleep (NREM)
Normal sleep includes ____ cycles of REM AND NREM lasting 70-120 minutes each.
4-6
The normal sleep-wake cycle is ___ hours.
25
Stages ___ of sleep are deep sleep, most restorative, called delta sleep because of the delta waves seen on EEG.
3 and 4
____ phase of sleep is associated with heightened brain activity, loss of muscle tone, associated with dreaming.
REM
True or false: Sleep efficiency and total sleep time decreases with age. Older adults have lighter sleep.
True
This neurotransmitter is sleep promoting.
GABA
These neurotransmitters are wakefulness promoting.
NE, dopamine, and orexin
List the important brain structures for sleep.
Basal forebrain, lower brainstem, and hypothalamus.
True or false: insomnia is more common in men.
False: insomnia is 1.5 times more common in women.
True or False: Most people pass through stages 1 and 2 quickly to deep sleep, then cycle back up to stage 2.
True
True or false: Insomnia is usually a symptom of something else or related to environmental factors.
True
The main feature of _____ is excessive daytime sleepiness, like sleep attacks. Patient will also typically have nighttime awakenings, delayed sleep latency, and nightmares.
Narcolepsy
Cataplexy is characterized by loss of muscle tone caused by intense emotion, such as laughing, crying, anger, startle, and is a sign of this sleep disorder.
Narcolepsy
This condition has multiple nocturnal apneic episodes → loss of blood oxygen → arousal from sleep to restart breathing (snoring, gasping). This results in daytime fatigue.
Obstructive Sleep Apnea (OSA)
True or False: Obstructive Sleep Apnea (OSA) should be treated like insomnia is.
False. OSA is generally exacerbated by sedating meds, so treating it like insomnia is the wrong approach
______ is due to loss of the breathing drive in the brain.
Central sleep apnea (CSA)
________ is described as paresthesias, often painful, deep in the calf muscles, but may be in upper limbs. Patients describe the urge to move as irresistible and distressing, which impairs ability to sleep
Restless Legs Syndrome (RLS)
can be referred to as Periodic Limb Movements (PLMS)
True or False: Restless Legs Syndrome (RLS) is more common in older adults and can be due to iron deficiency.
True
Restless Legs Syndrome (RLS) can be attributed to a deficiency in ____.
Iron (Fe)
________ describes sleepwalking and sleeptalking where there is sleep paralysis, hypnogogic hallucinations.
Parasomnias
Jet lag and shift work sleep disruption are under the category of ________.
Circadian rhythm disorders
The brand name for Estazolam is _____.
Prosom
The brand name for Flurazepam is _________.
Dalmane
The brand name for Quazepam is _______.
Doral
The brand name for Temazepam is _______.
Restoril
The brand name for Triazolam is _______.
Halcion
The brand name for Eszopiclone is _______.
Lunesta
The brand name for Zolpidem is _______.
Ambien
The brand name for Zolpidem sublingual is _______.
Intermezzo
Long duration of action often means daytime hangover, which is especially of concern in older patients. Which benzodiazepine receptor agonists have higher risk of daytime hangover and residual effects?
Flurazepam (Dalmane) and Quazepam (Doral)
Which benzodiazepine receptor agonists require no dosage change in hepatic impairment?
Flurazepam (Dalmane) and Temazepam (Restoril)
What is a reason to use the benzodiazepine receptor agonist drugs for as short a duration as possible while the cause of insomnia is addressed?
Due to risk of rebound insomnia
________ is a benzodiazepine receptor agonist that can be used for up to 6 months.
Eszopiclone (Lunesta)
With Eszopiclone (Lunesta), what should the patient be counseled on?
Avoid a high-fat late night snack to prevent dose-dumping.
True or False: The Z drugs (eszopiclone, zaleplon, and zolpidem) are thought to be less risky for tolerance, rebound insomnia and withdrawal, but they certainly can happen.
True
For parasomnias, what is the drug therapy of choice?
Drug therapy is usually not recommended.
The mainstay of therapy for obstructive sleep apnea is ____________.
Nasal continuous positive airway pressure (CPAP)
True or False: Melatonin products are unregulated in the US, so there is uncertainty about the formulation
True
True or False: Physiologically, melatonin is known to regulate circadian rhythm and sleep onset.
True
What are the 2 main melatonin receptor types?
MT1 and MT2
What are the 2 MT agonists that are FDA approved?
Ramelteon (Rozerem) and Tasimelteon (Hetlioz)
Which MT agonist is available in limited distribution due to its increased risk of hepatic toxicity?
Tasimelteon
Tasimelteon works on which melatonin receptor type?
MT2
Ramelteon works on which melatonin receptor type?
MT1
True or False: Ramelteon should be taken with food.
FALSE! Take on an empty stomach.
Both MT agonists that are FDA approved have (quick OR slow) onset and short duration, so they don’t cause as much daytime residual effects as BZ agonists.
Quick onset
True or False: MT agonists may be especially useful for circadian rhythm disorders such as jet lag and shift-work sleep disturbance.
True
An advantage of ____ is that it’s not a controlled substance, so it may be safer than a BZ or Z drug in patients with a history of substance abuse
Ramelteon
______ is a NT system that is important in promoting wakefulness. It acts in a variety of functions with other NT systems (DA, 5-HT, NE, glutamate) and brain structures to stimulate arousal. These type of neurons cease firing during sleep.
Orexin
Orexin has 2 receptor types: OX1 and OX2. Which is believed to play a more important role in sleep-wake homeostasis?
OX2
OX1 receptor is:
A. Selective for orexin A
B. Selective for orexin B
C. Non-selective
A. Selective for orexin A
OX2 receptor is:
A. Selective for orexin A
B. Selective for orexin B
C. Non-selective
C. Non-selective
Orexin antagonist drugs are classified as ____ and ____.
- Selective orexin receptor antagonists (SORAs)
- Dual orexin receptor antagonists (DORAs)
There is only 1 orexin antagonist currently approved by the FDA: ________.
Suvorexant (Belsomra)
Suvorexant (Belsomra) is a:
A. Selective orexin receptor antagonist (SORA)
B. Dual orexin receptor antagonist (DORA)
B. Dual orexin receptor antagonist (DORA)
Side effects of suvorexant include daytime drowsiness and hypnogogic hallucinations, but not associated with rebound insomnia when stopped after up to _______ of nightly use
4 weeks
______ is a widely used and FDA approved OTC medication; efficacy demonstrated for reducing sleep onset latency and increasing sleep time. However, its anticholinergic effects are prominent and especially problematic in elderly patients.
Diphenhydramine
