Sleep Medicine

Question 1

Sleep

Answer 1

1/3 of our time spent sleeping

• lack of sleep can lead to physical disease/mental illness
• one of highest reported diseases in population

Question 2

REM Sleep

Answer 2

neurological recovery (Rapid Eye Movement)

• BP and breathing fluctuate -> shuffle and organize days events
• Dreaming
• easiest to awaken from
• erections occur
• paralysis and increased brain O2 use
• beta waves

Question 3

Non-REM Sleep

Answer 3

bones and muscle recovery

- stages 1, 2, and 3 (slow wave)

Question 4

Stage 1 Non-REM

Answer 4

transition from wakefulness to sleep
twilight sleep
Theta Waves

Question 5

Stage 2 Non-REM

Answer 5

bridge from stage 1 to slow wave

- sleep spindles and K complexes

Question 6

Slow wave sleep Non-REM (3 & 4)

Answer 6

restorative to bones/muscles -> deepest non-REM sleep

• consistent breathing and BP (low)
• most difficult to awake from
• sleepwalking, bed-wetting, sleep talking occur
• delta waves

Question 7

Sleep Architecture

Answer 7

cycle through stages every 90 minutes

• more slow wave in early night
• more REM sleep at end of night

Question 8

Good sleep hygiene

Answer 8

use bed for sleep and sex only
downtime routine before bed
maintain consistent rise time
daily exercise
make time to worry/meditate
alcohol, caffeine, smoking

Question 9

Sleep physiology

Answer 9

regulated by circadian rhythm –> driven by suprachiasmatic nucleus of hypothalamus –> NE release –> pineal gland –> melatonin

Question 10

Sleeping and increasing age

Answer 10

Still need same amount of sleep –> but sleep is more fragmented in elderly –> need naps

Question 11

Who needs a sleep study?

Answer 11

loud snorers, witnessed apneas, daytime somnolence, lifelong sleepiness with adequate sleep

Question 12

Excessive Daytime Sleepiness

Answer 12

persistent and unremitting sleepiness
increasing sleep time may not solve it
loss of energy, motivation, memory loss and fatigue
*it is a serious problem –> affects life!!

Question 13

4 General Causes of EDS

Answer 13

1. Quality/quantity
2. Circadian Rhythm
3. Drugs
4. CNS pathology

Question 14

Obstructive sleep apnea

Answer 14

• excessive sleepiness after adequate sleep
• loud snoring and witnessed apnea
• irritability and memory loss
• morning headaches
• impotence

Question 15

Cardiac changes with abnormal sleep

Answer 15

Increased HR, BP, HRV, arrhythmias

• surge in catecholamines from decreased O2
• the worse the OSA –> more severe the BP
• OSA is commonest, treatable form of secondary HTN

Question 16

Cure of OSA

Answer 16

Positive Airway Pressure device
Surgery
Oral Appliances –> less effective than CPAP
Weight loss

Question 17

Narcolepsy

Answer 17

deficiency in the hypothalamus (decreased orexin)

• either awakeness intruding sleep or REM intruding awake state
• REALLY sleepy –> pathologic
• instantly become paralyzed (cataplexy)
• sleep paralysis (can’t move after nap)

Question 18

Hypnic jerk

Answer 18

excessive reaction to minimal external stimuli (stage 1 phenomena)

Question 19

Restless leg syndrome

Answer 19

problem in the substantia nigra

- uncomfortable feeling you can’t hold legs still

Question 20

REM behavior disorder

Answer 20

acting out dreams –> area in the pons has to be stimulated for paralysis to occur
50% of these individuals can develop Parkinson’s or Lewy Body dementia