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Block 8; Week 1 > SLEEP: From Deep to Disordered-Rothrock > Flashcards

SLEEP: From Deep to Disordered-Rothrock Flashcards

1
Q

What is the autonomic regulator & the probable regulator of normal sleep?

A

hypothalamus

suprachiasmatic nuclei

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2
Q

How much do you sleep when you are a newborn? Adolescent? Late adult life?

A

Newborn: 10-12 hrs
Adolescent: 7-7.5 hrs
Late Adult Life: >6.5 hrs

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3
Q

Which hormones drop w/ sleep onset?

A

Cortisol & TSH

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4
Q

Which hormones increase w/ sleep onset?

A

growth hormone

prolactin

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5
Q

Where does melatonin come from? What is its relationship w/ sunlight?

A

pineal gland gives melatonin

secreted w/ sunlight

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6
Q

There are 5 stages. What is stage 1?

A

1: NonREM. drowsy, slow, roving horizontal eye movements

low EEG voltage

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7
Q

What is stage 2?

A

2: NONREM. EEG shows sleep spindles-burst of high frequency waves in the parietal lobe bilaterally.

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8
Q

What are stages 3 & 4?

A

3 & 4: nonREm. EEG has high amplitude w/ slow waves. Delta waves.

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9
Q

What is the deal with the EEG in Non Rem 1-3?

A

Non REm 1-3 EEG is symmetrical & synchronized.

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10
Q

What is stage 5?

A

5: REM. EEG nonsynchornized. fast waves. bursts of REMs.

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11
Q

What do you look at with the EEG & sleep?

A

voltage: high or low
frequency: fast or slow, alpha, beta, delta waves

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12
Q

Which of the frequencies gives slow waves?

A

slow waves are delta waves

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13
Q

Benzos give what types of wave frequencies?

A

fast wave frequencies

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14
Q

Aging decreases which stage?

A

NonREM 3

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15
Q

How many NREM-REM cycles do people usu experience per night?

A

4-6 per night

2 during latter portion of the night.

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16
Q

How long does each cycle take?

A

60-90 minutes

but first cycle is 70-100 minutes

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17
Q

When does dreaming occur?

A

REM sleep

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18
Q

When are you easily awakened?

A

Rem sleep

not NREM 3

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19
Q

Aside from dreaming, what else happens during REM?

A

minimal tonic muscle activity

erection

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20
Q

What happens if you are deprived of sleep for over 60 hours?

A

increasing sleepiness, fatigue, irritability

difficulty concentrating

impaired skilled motor function (esp if require speed, perseverance)

inattention

impaired judgement

nystagmus, loss of accomodation, bilat hand tremor, ptosis, expressionless face, thick speech, mispronunciations, word substit.

if persists: visual/tactile hallucinations, psychosis, seizure activity

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21
Q

What is loss of accommodation?

A

eyes can’t come together to focus

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22
Q

What are other more systemic & frightening results from chronic lack of sleep?

A 
HTN
Stroke
MI
Pulmonary HTN
Early Death
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23
Q

What are some sleep disorders?

A 
Insomnias
Narcolepsy & Cataplexy
Sleep Apnea: central & obstructive
Restless Leg Syndrome & Periodic Leg Movements of Sleep
REM sleep behavioral disorder
excessive daytime somnolence
24
Q

What is primary insomnia?

A

sleep disturbance w/o psychiatric or medical disorder
“sleep hypochondriacs”
exaggerate their lack of sleep, but do have disordered sleep

25
What are secondary insomnias?
transient Nonmedical: alcohol or drug abuse, psychological issue Medical: arthritic pain, GERD/PUD, prostatism, nocturia
26
What are the diagnostic tools we use to determine sleep disorders?
sleep diary validated symptom assessment systems polysomnography: EEG plus some
27
What are the symptom assessment systems?
epworth sleepiness score | stanford sleepiness score
28
What are 2 tests that are polysomnography?
multiple sleep latency test | maintenance of wakefulness test
29
What are the treatments for insomnia?
secondary: treat underlying disorder primary: very difficult, don't want to prescribe meds that can be abused
30
What can you do for people with chronic primary insomnia?
sleep hygiene cognitive & behavioral therapy medications
31
What is involved in sleep hygiene?
Re set sleep cycle: no naps, exercise Re set circadian rhythm: lights out Avoid caffeine, alcohol, tobacco bedroom: quiet, dark, rituals, no clock
32
What are the breathing disorders of sleep? Which diagnostic tool is essential for this?
``` obstructive sleep apnea central sleep apnea mixed sleep apnea complex sleep apnea upper airway resistance syndrome **use polysomnography ```
33
Is central sleep apnea common? What is its primary & secondary causes?
uncommon primary: ondine's curse secondary: lower brain stem abnormalities (like the medulla), like strokes & syringobulbia PICA occlusion
34
What happens in the more common obstructive sleep apnea?
posterior pharyngeal muscles collapse & narrow the airway noisy cyclic snoring apnea of 10-30 seconds occurs in REM & nonREM
35
What is the usual presentation of obstructive sleep apnea? What is the clinical phenotype?
usual presentation: excessive daytime somnolence | clinical phenotype: overweight, middle-aged men
36
What is STOP-BANG?
a validated screening tool asks about BMI, snoring etc. fairly sensitive
37
What does polysomnography include?
``` EMG Airflow EEG Oxygen Saturation Cardiac Rhythm Leg Movements ```
38
What are other findings in obstructive sleep apnea, physical findings?
``` Nasal obstruction Long, thick soft palate Retrodisplaced mandible Narrowed oropharynx Redundant pharyngeal tissues Large lingual tonsil Large tongue Large or floppy epiglottis Retro-displaced hyoid complex ```
39
How do you treat central sleep apnea?
treat underlying cause. Ex: CHF give low flow oxygen meds usu not helpful
40
What is the treatment for obstructive sleep apnea?
CPAP & BIPAP surgical: uvulectomy mandibular advancement dental appliances
41
What are behavioral measures for obstructive sleep apnea?
``` weight loss avoidance of alcohol avoidance of sedatives avoidance of smoking non-supine sleep ```
42
What is restless leg syndrome?
unpleasant sensation in legs with irresistible urge to move the affected limb delays sleep onset occurs in early stages of sleep can persist into daytime
43
What makes restless leg syndrome better or worse?
provoked by rest & fatigue, warm weather | better w/ moving limbs
44
T/F Sleep disorders can be worsened by natural REM associated atonia.
True.
45
What causes RLS?
we don't know associated with iron deficiency anemia associated with dysthyroidism, pregnancy, some drugs, like antihistamines & tricyclic antidepressants releated to decreased dopamine production
46
What are the treatments of RLS?
``` iron supplementation dopamine agonists long acting carbidopa, L-dopa gabapentin clonazepam ```
47
What is the narcoleptic tetrad?
* *recurrent attacks of irresistible sleep (“narcolepsy”) * *cataplexy (~70%) * *sleep paralysis (hypnagogic) * *hallucinations (hypnagogic)
48
What is the age of onset for narcolepsy?
15-35 | usu by age 25
49
How do people with narcolepsy sleep?
less than 15 minutes at a time | 2-6 times/day
50
What are the genetics of narcolepsy?
familial, not Mendelian | genetic predisposition w/ superimposed autoimmune disorder affecting hypocretin neurons
51
What's awesome about carbidopa?
doesn't cross BBB | doesn't have side effects of dopamine
52
What is the pathophysiology of narcolepsy?
involves hypothalamic neuropeptide--hypocretin. | projects to sleep structures--locus ceruleus, ventral tegmentum
53
T/F Narcolepsy involves reversal of REM & non-REM sleep.
True. ANd latency to sleep reduced. Sudden sleep b/c REM comes first.
54
What is cataplexy?
sudden loss of muscle tone provoked by emotions
55
How do you diagnose narcolepsy?
overnight polysomnography multiple sleep latency test measured CSF levels of hypocretin
56
What is the treatment for narcolepsy?
short naps stimulant drugs tricyclic antidepressants immune globulin infusions
57
GIve more specifics of the narcolepsy drugs.
``` modafinil provigil dextroamphetamine methylphenidate protriptyline imipramine ```

Block 8; Week 1 (13 decks)

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