Sleep Medicine Flashcards
Sleep is
A reversible behavioral state of perceptual disengagement from an unresponsiveness to the environment
Stage 2 NREM
SS
KC
Sleep spindles and K complexes
SS- inc frequency
Kc- turning into delta waves
Stage 3 and 4 NREM
Delta waves
Sleep Structure
REM onset 75-90 min in
Recurs every 90 min
Late at night, early in mornign
HR/RR/BP/Muscle Tone/ O2 cons/ Ventil resp/Temp/Sex changes
NREM vs REM
NREM- reg, reg, reg, preserved, -, Nl, Nl, Rare
REM- irreg, irreg, varies, absent, +, -, Poikilothermic, Freq
Sleep Architecture
Sleep Latency
10-20 min, above 30 is pathologic
mostly N2
Sleep Architecture as we age
WASO increase
REM is less
Slow wave sleep is less
Sleep eficiency ____ as we age
Duration
Dec, more time in bed awake
7 hours+ as adult
How we go to sleep
Homeostatic vs Circadian
To sleep- longer awake, more sleepy
To be awake- alertness varies in day
Circadian Rhthym
Tract
Entrained by zeitgebers
Light (photic) is strongest
Meals/Temp/Sleep vs wake/ Social activities
Occurs via retinohypothalamic tact to SCN which affects melatonin production via pineal gland
Homeostatic and Circadian
Work together
C- rises with light, drops at 2
H- always there
Sleep Deprivation
Confounder in many disorders
Dec Leptin, Inc Ghrelin
Leads to weight gain
Delayed sleep phase
Typical pop
Confusion
Drives
Stable tendence towards later sleep onset and awakenings
Teens
Similar to hyper/insomnias
Light in AM, melatonin in PM
Advanced sleep phase disorder (CRD)
Pop
Association
Confusion
Stable tendency to wake up early and go to bed early
Elderly
Familial
Excessive daytime sleepiness, depression, insomnia
Irregular sleep rhythm disorder (CRD)
Seen with
Absence of
Disorg sleep schedule, several periods in 24 time
Mental retardation, dementia, head trauma, institutions, comorbids
Poor sleep hygiene
External clues (light), social activities
Narcolepsy (hypersomnias)
Excessive daytime sleepiness Hypagogic/pompic hallucinations Sleep paralysis Naps refreshing Sleep attacks, poor quality sleep Caplexy (loss of bmt in response to emotion/laughing)- maintain consciousness
Narc 1
Narc 2
1- cataplexy, HLA DQB1-0602
Loss of hypothalamic hypocretin/orexin secreting neurons
Low CSF hypocretin levels
2- no cataplexy, normal CSF hypocretin
Dx Narcolepsy
Rule out other causes
Overnight psg
multiple sleep latency test: sleep latency <8, 2 sleep onset REM periods
Kleine Levin Syndrome
Recurrent hypersomnia Young male Head trauma, Febrile illness Hypersomnia/normal for periods associated with hyperphagia/sexuality
disorder of disinhibition
Insomnia
Difficulty falling/staying asleep
No excessive daytime sleepiness
Treatment is never hypnotic agent
REM Behavior disorder
Associated with
Acting out dream content Remember dream when awake Late night/early morning Lost REM atonia Treat= melatonin/benzos Assoc with PD or MSA (may be 10yrs early)
NREM Parasomnias
Confusional arousals
sleep walking/terrors
sleep eating d/o
RLS vs PLMB
Exclude
Treatment
Abnormal sensation in legs close to bedtime- temp alleviated by movement, interferes with sleep
PLMB (PSG) together/sep
Exclude iron def, inciting meds (Benadryl/SRRIs)
Sleep initiation/maintenance w/ dopaminergic agents
Rop, prami, levo, gaba, opiods
Beware augmentation
O v C Sleep Apnea
O- trying to breathe, but cant
C- no attempt, no air
OSA physiology
RF
Children
Throat is narrowed, weight gain, loss of muscle tone in REM
Age, postmen, Male, Familial, Obesity, Mallamati, Comorbids (DM, HTN, CHD)
Enlarged tonsils/adenoids
Signs/symp of OSA
Snoring Apneas Freq night awakenings Nocturia Non restorative sleep Morning headaches Excessive daytime sleepiness
Dx OSA
Treat OSA
PSG/Home sleep study
CPAP- keeps airway open
Oral- 2nd line, custom fit, mild OSA, better compliance
CSA
Common pops
Treatment
Children
CNS d/o (HT, stroke)
CHF most common
Treat underlying cause
Hypoventilation
Common dz
CO2 retention COPD Obesity hypoventilation syndrome CCH- PHOX 2B gene NMD (ALS) Chest wall deformity (Scoliosis)
