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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
Q

What are secondary insomnias?

A

transient
Nonmedical: alcohol or drug abuse, psychological issue
Medical: arthritic pain, GERD/PUD, prostatism, nocturia

26
Q

What are the diagnostic tools we use to determine sleep disorders?

A

sleep diary
validated symptom assessment systems
polysomnography: EEG plus some

27
Q

What are the symptom assessment systems?

A

epworth sleepiness score

stanford sleepiness score

28
Q

What are 2 tests that are polysomnography?

A

multiple sleep latency test

maintenance of wakefulness test

29
Q

What are the treatments for insomnia?

A

secondary: treat underlying disorder
primary: very difficult, don’t want to prescribe meds that can be abused

30
Q

What can you do for people with chronic primary insomnia?

A

sleep hygiene
cognitive & behavioral therapy
medications

31
Q

What is involved in sleep hygiene?

A

Re set sleep cycle: no naps, exercise
Re set circadian rhythm: lights out
Avoid caffeine, alcohol, tobacco
bedroom: quiet, dark, rituals, no clock

32
Q

What are the breathing disorders of sleep? Which diagnostic tool is essential for this?

A 
obstructive sleep apnea
central sleep apnea
mixed sleep apnea
complex sleep apnea
upper airway resistance syndrome
**use polysomnography
33
Q

Is central sleep apnea common? What is its primary & secondary causes?

A

uncommon
primary: ondine’s curse
secondary: lower brain stem abnormalities (like the medulla), like strokes & syringobulbia
PICA occlusion

34
Q

What happens in the more common obstructive sleep apnea?

A

posterior pharyngeal muscles collapse & narrow the airway
noisy cyclic snoring
apnea of 10-30 seconds
occurs in REM & nonREM

35
Q

What is the usual presentation of obstructive sleep apnea? What is the clinical phenotype?

A

usual presentation: excessive daytime somnolence

clinical phenotype: overweight, middle-aged men

36
Q

What is STOP-BANG?

A

a validated screening tool
asks about BMI, snoring etc.
fairly sensitive

37
Q

What does polysomnography include?

A 
EMG
Airflow
EEG
Oxygen Saturation
Cardiac Rhythm
Leg Movements
38
Q

What are other findings in obstructive sleep apnea, physical findings?

A 
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
Q

How do you treat central sleep apnea?

A

treat underlying cause. Ex: CHF
give low flow oxygen
meds usu not helpful

40
Q

What is the treatment for obstructive sleep apnea?

A

CPAP & BIPAP
surgical: uvulectomy
mandibular advancement
dental appliances

41
Q

What are behavioral measures for obstructive sleep apnea?

A 
weight loss
avoidance of alcohol
avoidance of sedatives
avoidance of smoking
non-supine sleep
42
Q

What is restless leg syndrome?

A

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
Q

What makes restless leg syndrome better or worse?

A

provoked by rest & fatigue, warm weather

better w/ moving limbs

44
Q

T/F Sleep disorders can be worsened by natural REM associated atonia.

A

True.

45
Q

What causes RLS?

A

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
Q

What are the treatments of RLS?

A 
iron supplementation
dopamine agonists
long acting carbidopa, L-dopa
gabapentin
clonazepam
47
Q

What is the narcoleptic tetrad?

A
  • *recurrent attacks of irresistible sleep (“narcolepsy”)
  • *cataplexy (~70%)
  • *sleep paralysis (hypnagogic)
  • *hallucinations (hypnagogic)
48
Q

What is the age of onset for narcolepsy?

A

15-35

usu by age 25

49
Q

How do people with narcolepsy sleep?

A

less than 15 minutes at a time

2-6 times/day

50
Q

What are the genetics of narcolepsy?

A

familial, not Mendelian

genetic predisposition w/ superimposed autoimmune disorder affecting hypocretin neurons

51
Q

What’s awesome about carbidopa?

A

doesn’t cross BBB

doesn’t have side effects of dopamine

52
Q

What is the pathophysiology of narcolepsy?

A

involves hypothalamic neuropeptide–hypocretin.

projects to sleep structures–locus ceruleus, ventral tegmentum

53
Q

T/F Narcolepsy involves reversal of REM & non-REM sleep.

A

True. ANd latency to sleep reduced. Sudden sleep b/c REM comes first.

54
Q

What is cataplexy?

A

sudden loss of muscle tone provoked by emotions

55
Q

How do you diagnose narcolepsy?

A

overnight polysomnography
multiple sleep latency test
measured CSF levels of hypocretin

56
Q

What is the treatment for narcolepsy?

A

short naps
stimulant drugs
tricyclic antidepressants
immune globulin infusions

57
Q

GIve more specifics of the narcolepsy drugs.

A 
modafinil
provigil
dextroamphetamine
methylphenidate
protriptyline
imipramine

Block 8; Week 1 (13 decks)

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