Sleep HB Flashcards
How we feel and how we perform our daily tasks during our waking hours is greatly influenced by duration and quality of (blank)
nighttime sleep
Sleep is affected by what processes?
physiological and psychological
(blank) percent of patients present to primary care physicians for sleeping problems
50%
What are the 5 determinants of sleep?
duration of prior wakefulness circadian (biological clock) aging drugs sleep disorders
What is disruption of circadian associated with?
tumors and shortens life
What determines circadian rhythm?
wake/sleep hormonal temperature immune drug metabolism renal function airway function
When is melatonin the highest?
in the middle of being asleep
What are the stages of sleep?
you have four non-REM stages and REM
12344321REM REM 1235 (cycle)
What are the deepest stages of Sleep?
3 and 4 (Slow Wave Sleep)
What is considered normal sleep latency?
10 minutes
How long do you spend in each stage (percentage wise)?
5% stage 1
50% stage 2
15-25% stages 3 & 4 (slow wave sleep)
25% REM
What is considered Slow wave sleep (SWS)?
stage 3 and 4
When do you dream and have inhibition of muscular activity?
during REM sleep
When do you have restorative sleep, disinhibition of muscular activity, parasomnias?
during stage 3 and 4 (SWS)
The longer you sleep the longer your (blank) cycle.
REM
When does SWS typically occur?
during the earlier portion of the night and REM sleep last third of night
What are some age-related changes in sleep architecture?
- Increase in light/transitional sleep
- Reduction in slow-wave sleep
- Decline in overall sleep time
- Increased awakenings and arousals
- Decreased REM sleep
- Reduced sleep efficiency
(i. e light sleeping)
REM sleep occurs cyclically throughout the night at intervals of app. (blank) minutes in all age groups
90
(blank) sleep decrease slightly in elderely, whereas (blank) sleep decreases progressively with age, so that little, if any, is present in the elderly.
REM
Stage 4
What are these: Tiredness, fatigue, sleepiness Trouble sleeping Poor sleep quality Inadequate sleep quantity Abnormal behavior during sleep Loud snoring
Chief complaints and symptoms in sleep medicine.
What kind of history should you take and why?
sleep history because a lot of people suffer from sleep disorders
What four questions should you ask to assess sleep disoders?
Is your sleep at night satisfactory?
Do you tend to fall asleep or struggle to stay alert during the day?
Are you bothered by fatigue, tiredness, lack of energy most of the time?
Do you have unusual behaviors which arise from the sleep period?
What kind of problem is linked to sleep disorders?
car accidents
Which is more closesly associated with car accidents, insomnia or sleep apnea?
insomnia
What is this:
Difficulty initiating, maintaining, or non - restorative sleep
Most common sleep disorder
insomnia
What kind of insomnia is this:
Difficulty falling asleep
Longer time to sleep onset
sleep onset insomnia
What kind of insomnia is this:
difficulty staying asleep
frequent nocturnal awakenings
sleep maintenance insomnia
What kind of insomnia is this:
waking too early in the morning
sleep offset or late insomnia
What kind of insomnia is this:
fatigue despite adequate sleep duration
nonrestorative sleep
What kind of insomnia can these cause:
acute illness, jet lag, shift change
transient insomnia: episodic
What kind of insomnia can these cause:
major life event
substance abuse
short-term insomnia: few days to 3 weeks
What kind of insomnia can these cause:
chronic illness
psychiatric illness
Chronic insomina: longer than 3 weeks
How long does short-term insomnia last?
few days to 3 weeks
How long does chronic insomnia last?
longer than 3 weeks
What are some main category causes of insomnia?
medical conditions (COPD, asthma) psycological disorders (anxiety) sleep disorders (apnea) pharmacological agents (nicotine, alcohol) environmental factors (temp, light)
What is the economic impact of insomnia?
30-107 billion dollars
What are direct costs of insomnia?
drugs-> 1.7 billion
services -> 11.96 billion
What are some indirect costs of insomnia?
decreased productivity
higher accident rate
increased absenteeism
inreased comorbidity
What is the most common treatment approach to insomnia? Are meds used in chronic insomnia?
meds
NO, used only for short term insomnia (couple of weeks)
What are some adverse responses to sleep meds?
tolerance and dependency can develop
withdrawal, rebound, relapse may occur
What cauess chronic insomnia?
circadian dysreg
hyeractive arousal system
sleep-incompatible conditioning (wake->sleep transiont, sleep fragmentations)
What is the first step to getting sleep organized?
anchor the body clock (wake up at same time)
What are the nonpharm treatments of sleep insomnia?
sleep hygience stimulus control sleep restriction relaxation training cognitive therapy cognitive behavior therapy
What technique should you use to promote habits that help sleep?
sleep hygiene
What technique should you use to strengthen bed and bedroom as sleep stimulus?
stimulus control
What technique should you useto retrict time in bed to consolidate sleep and improve depth of sleep?
sleep restriction
What technique should you use to reduce arousal and decrease anxiety?
relaxation training
What technique should you use to address thoughts and beliefs that interfere with sleep?
cognitive therapy
What technique should you use to tackle all problems of insomnia?
behavioral therapy
How can you get better sleep hygiene?
reduce arousal and regulate sleep homeostatic and circadian system.
How do you reduce arousal?
elimintate stimulants (caffeine, tobacco) exercise sleep conducive environment relax avoid clock watching
How do you regulate sleep homesotatic and circadan system?
regular sleep-wake schedule
avoid nap
avoid excessive amount of time awake in bed
minimize alcohol use
What are some relaxation techniques?
progressive muscle relaxations (PMR) -> tense release exercises
passive muscle relaxation (body scan)
imagery
meditation (mindfulness)
biofeedback
diaphragmatic breathing (slow, deep breathing)
How do you reduce arousal?
wind down closure review to do list and set plans for tomorrow schedule worry time stress managament
What should you do if you think of “to dos” in the middle of the night?
jot them down and move on
What are ways you can get stimulus control?
wake up at the same time go to bed only when sleepy use bed only for sleep and sex get out of bed when unable to fall asleep avoid daytime napping
What are some indicators of cicadiat dysregulation?
sleep disturbance GI distress daytime fatiue or waves of sleepiness tired muscles headached reduced cognitive skills poor psychomotor coord. moodiness general malaise
What can these result in or indicate:
erratic or variable schedule, lack of consitent time cue anchors (get up time, meal times, routine), sedentary, shiftwork, presence of “jet lag” symptoms?
circadian dysregulation
What is this:
pattern of delayed sleep onset and awakening times with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time.
delayed sleep phase
What is this:
pattern of advance sleep onset and awakening times with an inability to remain awake or sleep until the desired or conventionally acceptable later sleep or wake time.
Who is this more common in?
advanced sleep phase
older adults
Jet lag results from rapid changes in time zone.
Travelin which way results in worse jet lag?
westbound travel is less disruptive than east bound travel
How can shift work become a persistent disorder?
with continual shift changes
What is the purpose of circadian rhythm shifting?
to shift underlying core body temperature rhythm to desired sleep-wake schedule
What is light therapy for?
to improve ease of falling asleep and getting alert quicker in the morning.
When would you use evening light exposure?
for advanced sleep phase (i.e to improve ability to stay up later and sleep continutation in the 2nd half of the night)
What is this:
recurrent periods of irrepressible need to sleep, lapsing into sleep or napping occurring within the same day.
narcolepsy
Wht are the four symptoms of narcolepsy?
excessive daytime sleepiness
cataplexy- sudden loss of muscle tone often triggered by strong emotions
sleep paralysis- inability to move at sleep onset or upon awakening
hyponagogic hallucinations- REM sleep occuring during wakefulness
Can you have narcolepsy without cataplexy?
yes
How can you diagnose narcolepsy?
polysomnography (PSG) and multiple sleep latency (MSLT)
How do you treat narcolepsy?
with stimulant meds, timed naps, and good sleep hygience
What are 2 things that will tell you if a person has narcolepsy?
2 sleep onset REM periods (REM sleep within 15 minutes)
Average sleep latency of 6 minutes or less
Unlike people with insomnia, OSA is a (blank) problem with physiological consequences
structural
How do you treat obstructive sleep apnea?
CPAP/Bi-level, oral appliance or surgery
What all improves with treatment of OSA?
sleep maintenance insomnia, parsomnias (such as sleep walking)
What does a high epworth score indicate/
need for a referral to a sleep physician
What are the four levels of the epworth sleepiness scale?
0 would never doze
1 slight chance of dozing
2 moderate chance of dozing
3 high chance of dozing
on an epworth sleepiness scale, there is a range between 0-24, what happens if you are at 10? what about over 12?
borderline
abnormal
Which is more common, central or obstructive sleep apnea?
obstructive
What is this:
patient has recurrent obstruction of upper airway durin sleep produces apnea
obstructive sleep apnea
What are risk factors for obstructive sleep apnea?
middle aged men and post-menopausal women, neck circumference (larger the worse) and structural abnormalities
What is this:
symptoms include insomnia, mild or absent snoring, no obstruction, but absence of venilatory effort=cessation of airflow
central sleep apnea
What should you ask to assess for sleep apnea?
whether they snore loudly or if someone has noticed that they snore loudly
What is this:
Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions
parasomnias
Do parasomnias cause insomnia or escessive sleepiness?
no (they are like sleep walkin)
When do nightmares occur?
during REM
When do nightmares typically occur, during the 1st half or the 2nd half of the night?
2nd half closer to the morning
Who are nightmares most common in?
children, and decrease with age
What is this:
confused arousals, person may cry out
night terrors
When do night terrors occur?
during slow wave sleep, more often in irst half of the night.
Do you remember night terrors?
no
When are night terrors most common?
in children under 10 years old, often disappear with age
(blank) is one of the most common complaints of patients with mood disorders
disturbed sleep
(blank) is a diagnostic criteria of mood disorders and anxiety disorders.
Seep disturbance
Fatigue is a diagnostic criteria for (blank)
sleep and affective disorders
What are these subjective complaints of: difficulty falling asleep frequent nocturnal awakenings early morning awakenings non-restorative sleep decreased total sleep time disturbing dreams
sleep and major depression
narcolepsy diagnosis requires (blank) and (Blank)
PSG and MSLT
when should you refer a sleep disorder to a specialist?
if they are suspected of having sleep apnea or narcolepsy
Sleep apnea diagnosis requires (blank)
PSG
Insomnia, sleep deprivation, medication effects are usually diagnosed (blank)
clinically
You should refer a patient for non-medication treatment of (blank) where (Blank) can be used for treatment
insomnia
cognitive behavioral therapy (CBT)
What is an on-going assessment technique that can be used for sleep disorders?
sleep diary
