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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 ultimate regulator of normal sleep?

A

hypothalamus (suprachiasmatic nuclei)

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2
Q

Total sleep declines with (blank)

A

age

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3
Q

How long do neonates sleep?
How long do adolescent sleep?
How long do adults sleep?

A

10-12 hours
7-7.5 hours
6.5 hours

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4
Q

When you go to sleep what hormones decrease, increase, etc?

A

decrease-cortisol and TSH secretion
increase- growth hormone and prolactin secretion
melatonin production begins

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5
Q

The pineal gland makes melatonin when you sleep and ceases with exposure to (blank)

A

sunlight

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6
Q

When you read an EEG, what are the 2 things you look at?

A

voltage (is it high or low?)

frequency (fast or slow)

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7
Q

What are the frequencies of EEGs?

A

beta (fast wave), delta (slow wave), alpha, theta,

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8
Q

HOw many stages of sleep are there?

A

4 and then REM

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9
Q

What is stage 1 (NREM 1) of sleep?

A

(NREM1)-> drowsiness/slow, roving horizontal eye movements/reduced EEG voltage

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10
Q

What is stage 2 (NREM2) of sleep?

A

(NREM2)-> EEG shows “sleep spindles” (bursts of biparietal 12-14 Hz waves), slow “vertex waves”

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11
Q

What are stages 3 and 4 (NREM 3) of sleep?

A

EEG shows high amplitude slow waves (delta hz= <3)

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12
Q

What is stage 5 (REM) of sleep?

A

REM-> EEG nonsynchronized, shows fast wave; bursts of REMs

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13
Q

What stages of sleep have a synchronized EEG?

A

NREM 1-3

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14
Q

During normal sleep you have a succession of NREM-REM cycles (blank) times a night.

A

4-6

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15
Q

In the latter portion of your sleep you spend most your time in what stages?

A

NREM 2 (stage 2) and REM

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16
Q

How long do sleep cycles last?

A

60-90 mins/cycle

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17
Q

How long does it take after sleep onset to get to the FIRST rem stage?

A

70-100 minutes

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18
Q

When does most dreaming occur?

A

during REM sleep (some occurs during different stages)

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19
Q

WHen are you most easily aroused?

A

REM sleep (less so w/ NREM 3)

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20
Q

What stage decreases with aging?

A

NREM3

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21
Q

What do you see in REM sleep?

A
  • minimal tonic muscle activity,
  • conjugate REMs (can be horizontal (typically) or vertical)
  • Penile erection
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22
Q

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

A
  • increasing sleepiness, fatigue, irritability
  • difficulty concentrating
  • impaired skilled motor function (esp if require speed, perserverence)
  • inattention
  • impaired judgement
  • nystagmus, loss of accomodation, bilat hand remor, ptosis, expressionless face, thick speech, mispronunciations, word substit.
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23
Q

If you have persistant sleep deprivation what can happen?

A

you get visual/tactile hallucinations, psychosis, seizure activity

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24
Q

If you have chronic sleep deprivation what are you at risk for?

A
  • HTN
  • Stroke
  • MI
  • Pulmonary HTN
  • Early death
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25
Q

What are the 6 major categories of sleep disorders?

A
  • insomnias
  • narcolepsy
  • sleep apnea
  • restless leg syndrome (RLS) and periodic leg movements of sleep
  • REM sleep behavioral disorder
  • Excessive daytie somnolence
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26
Q

What is the difference between primary and secondary insomnia?

A

primary-> sleep disturbance for prolonged perios in absence of any causal psychiatric or medical disorder
secondary-> caused by something

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27
Q

What do doctors call people with primary insomnia?

A

sleep hypochondriacs

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28
Q

Is secondary insomnia consistant or transitory?

A

transitory

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29
Q

What are the 2 ways to get secondary insomnia?

A

non-medically and medically

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30
Q

What are some non-medical ways to get secondary insomnia?

A
  • EtOH or other drug abuse

- psychological

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31
Q

What are some medical ways to cause secondary insomnia?

A
  • arthritic pain
  • GERD, PUD
  • prostatism/nocturia
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32
Q

What is a sleep diary?

A

a real-time assessment of sleep ->

completed over 7 days, patient records bedtime, awakening, out of bed, naps, use of sedatives and stimulants, and symptoms

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33
Q

What are the 2 ways you can quantify somnolence?

A
  • Validated symptom assessment systems

- Polysomnography

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34
Q

What are the 2 types of validated symptom assessment systems?

A
  • epworth sleepiness score

- stanford sleepiness score

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35
Q

What are the 2 types of polysomnographies (basically an EEG)?

A
  • multiple sleep latency test

- maintenance of wakefulness test

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36
Q

What is a drug that you can use for sleep and doesnt make you feel that groggy the next day?

A

trazidone

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37
Q

(blank) can be used as a sleep promotor but can cause motor and cognitive impairment.

A

Clonazepam

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38
Q

Why do sleep drugs sort of suck?

A

because you cant really get off them and patients develop tolerance

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39
Q

How can you treat chronic primary insomnia?

A
  • sleep hygiene
  • CBT
  • Medications
40
Q

Wht is sleep hygiene?

A
  • Re-set sleep cycle: no naps; dec non-sleep time in bed, exercise
  • Re-set circadian rhythm: ights out, quiet time
  • Avoid caffeine, alcohol, tobacco
  • Bedroom: quiet, dark, rituals, no clock
41
Q

What can CBT teach you to help with chronic primary insomnia?

A

Relaxation and stimulus control

42
Q

Does rozarum work?

A

no

43
Q

What are the breathing disorders in sleep?

A
  • obstructive sleep apnea
  • central sleep apnea
  • mixed sleep apnea
  • complex sleep apnea
  • upper airway resistance syndrome
44
Q

How do you diagnose breathing disorders in sleep?

A

Polysomnography

45
Q

What are the 2 causes of sleep apnea? Which is more common?

A

central (nervous system) or Obstructive (physical blockage)

Obstructive apnea is more common, central apnea is super rare

46
Q

What is Ondine’s curse?

A

central sleep apnea

47
Q

Why do you typically get secondary sleep apnea?

A

destructive lesions in the medulla (lower brain stem abnormalities)

48
Q

What can cause the lower brain stem abnormalities found in secondary sleep apnea?

A

stroke and syringobulbia

49
Q

What happens in obstructive sleep apnea?

A

posterior pharyngeal muscles collapse and narrow the upper airway

50
Q

What are the clinical manifestations of obstructive sleep apnea?

A

noisy, cycic snoring> apnea (10 to 30 seconds) > breathing resumes/ brief arousal

51
Q

During what stages of sleep do you get OSA?

A

during REM and non-REM sleep

52
Q

What is the usual presentation of OSA?

A

excessive daytime somnolence

53
Q

What is the clinical phenotype of people with OSA?

A

overweight, middle-aged men (BMI over 34)

54
Q

What is the STOP-BANG?

A

validated screening tool for OSA

55
Q

When taking the STOP-BANG, answering yes to (blank) or more items indicates a high risk of OSA

A

3

56
Q

Does the STOP-BANG have good sensitivity?

A

YESSSSS
for mild OSA-83.6%
for moderate -92.9%
for severe- 100%

57
Q

TO evaluate sleep you often use a polysomnography, what all does a polysomnography encompass?

A
  • EMG (muscle movements)
  • Airflow
  • EEG
  • Oxygen sat
  • Cardiac Rhythm
  • Leg movements
58
Q

What are the pathological findings in OSA?

A
  • nasal obstruction
  • long, thick soft palate
  • retrodisplaced mandible
  • narrowed oropharynx
  • redundant pharyngeal tissues
  • large lingual tonsils
  • large tongue
  • large or floppy epiglottis
  • retro-displaced hyoid complex
59
Q

OSA narrows the (blank)

A

upper airway

60
Q

How do you treat central sleep apnea?

A
  • treat underlying cause
  • low-flow oxygen
  • meds dont really help
61
Q

How do you treat OSA?

A

CPAP (continous positive airway pressure) or BiPAP (bilevel positive airway pressure), Surgically, dental appliances, behavioral measures

62
Q

What does a CPAP do?

A

blows up the pharynx

63
Q

What are the surgical options for treating OSA?

A
  • uvulectomy

- mandibular advancement

64
Q

What are the behavioral measures for treating OSA?

A
  • weight loss
  • avoidance of alcohol
  • avoidance of sedatives
  • avoidance of smoking
  • non-supine sleep
65
Q 
What is this:
unpleasant sensation (leg>arms) with irresistible urge to move the affected limb
A

restless leg syndrome

66
Q

Restless leg syndrome (RLS) delays sleep onset and occures in (Blank) stages of sleep

A

early

67
Q

Is RLS common?

A

Prevalence >2%

68
Q

Symptoms of RLS are provoked by (blank) and is alleviated (briefly) by (Blank)

A

rest

moving limbs

69
Q

RLS worsens with (blank) and (blank)

A

fatigue and warm weather

70
Q

What causes RLS?

A

it’s idiopathic but there is an association with iron deficiency anemia, dysthryoidism, pregnancy, certain drugs

71
Q

RLS may persist for (blank)

A

years

72
Q

What drugs are associated with RLS?

A

anti-histamines and tricyclic antidepressants

73
Q

RLS may possibly be related to decreased (Blank) production and/or binding

A

dopamine

74
Q

What is the treatment for RLS?

A
  • iron supplementation
  • dopamine agonists
  • long-acting carbidopa/L-dopa
  • gabapentin
  • clonazepam
75
Q

How do you treat periodic leg movements of sleep?

A

All the same as RLS treatment except you dont give iron

76
Q

Why do you give carbidopa with L-dopa?

A

to prevent the L-dopa from becoming decarboxylated in the periphery and becoming dopamine before it had a chance to cross the BBB (carbidopa cant cross the BBB)

77
Q

What is this:
a medical condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.

A

Cataplexy

78
Q

What is the narcoleptic tetrad?

A
  • recurrent attacks of irresistible sleep
  • cataplexy (70%)
  • sleep paralysis (hypnagogic)
  • hallucinations (hypnagogic)
  • hypnagogic->of or relating to the state before falling asleep*
79
Q

Is it typical to have cataplexy with narcolepsy?

A

absolutely, if you dont have cataplexy you should be suspicious of a faker of narcolepsy

80
Q

In narcolepsy, do you have a gradual or immediate onset of symptoms?

A

gradual onset b/w ages 15-35 (by age 25 in 90%)

81
Q

What are the sleeping periods like in narcolepsy?

A

sleep periods less than 15 mins, 2-6/day

82
Q

Narcoleptic patients will experience excessive daytime (blank)

A

somnolence

83
Q

Is narcolepsy familial?

A

yes

84
Q

Narcolepsy is caused by an abnormality involving a hypothalamic neuropeptide called (blank)

A

hypocretin

85
Q

Where do hypocretin neurons project to?

A

sleep structures ->locus ceruleus, ventral tegmentum (bottom roof of midbrain)

86
Q

Researchers think that narcolepsy can be caused by a genetic predisoposition with a superimposed (blank) disorder that affect hypocretin neurons

A

autoimmune disorder

87
Q

In narcolepsy you have a reversal of (blank) and (Blank) sleep

A

REM and non-REM sleep. I.e you go straight into REM and your sleep cycle is backward.

88
Q

In narcolepsy, sleep (blank) is greatly reduced

A

latency

89
Q

How do you diagnose narcolepsy?

A

overnight polysomnography followed by mutliple sleep latency tests
also measure CSF levels of hypocretin**

90
Q

How does the multiple sleep latency test (MSLT) work?

A

naps at 2 hour intervals/detect REM activity w/in 15 minutes of sleep onset.. if they numerous episodes of early onset REM with their napping then they have narcolepsy

91
Q

How do you treat narcolepsy?

A
  • strategic napping
  • stimulant drugs
  • tricyclic antidepressants
  • immune globulin infusion
92
Q

What are the stimulants you can give to narcoleptics?

A

modafinil/Provigil, dextroamphetamine, methylphenidate (ritalin)

93
Q

What are the tricyclic antidepressants you can give to narcoleptics?

A

protriptyline

imipramine

94
Q

What is imipramine more commonly used for?

A

to suppress cataplexy

95
Q

What are the 2 things that consitute medicolegal malpractice?

A
  • liability (perform below the standards)

- causation (if you had done what you were supposed to do, the patient would have more than likely had a better outcome)

96
Q

Should you practice defensive medicine as a successful means to avoid being sued?

A

hell no

Block 8 Week 1 (13 decks)

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