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R1 > Sleep Medicine > Flashcards

Sleep Medicine Flashcards

1
Q

Sleep is

A

A reversible behavioral state of perceptual disengagement from an unresponsiveness to the environment

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2
Q

Stage 2 NREM

SS
KC

A

Sleep spindles and K complexes
SS- inc frequency
Kc- turning into delta waves

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3
Q

Stage 3 and 4 NREM

A

Delta waves

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4
Q

Sleep Structure

A

REM onset 75-90 min in
Recurs every 90 min
Late at night, early in mornign

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5
Q

HR/RR/BP/Muscle Tone/ O2 cons/ Ventil resp/Temp/Sex changes

NREM vs REM

A

NREM- reg, reg, reg, preserved, -, Nl, Nl, Rare

REM- irreg, irreg, varies, absent, +, -, Poikilothermic, Freq

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6
Q

Sleep Architecture

Sleep Latency

A

10-20 min, above 30 is pathologic

mostly N2

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7
Q

Sleep Architecture as we age

A

WASO increase
REM is less
Slow wave sleep is less

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8
Q

Sleep eficiency ____ as we age

Duration

A

Dec, more time in bed awake

7 hours+ as adult

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9
Q

How we go to sleep

Homeostatic vs Circadian

A

To sleep- longer awake, more sleepy

To be awake- alertness varies in day

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10
Q

Circadian Rhthym

Tract

A

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

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11
Q

Homeostatic and Circadian

A

Work together
C- rises with light, drops at 2
H- always there

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12
Q

Sleep Deprivation

A

Confounder in many disorders

Dec Leptin, Inc Ghrelin
Leads to weight gain

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13
Q

Delayed sleep phase

Typical pop
Confusion
Drives

A

Stable tendence towards later sleep onset and awakenings

Teens
Similar to hyper/insomnias
Light in AM, melatonin in PM

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14
Q

Advanced sleep phase disorder (CRD)

Pop
Association
Confusion

A

Stable tendency to wake up early and go to bed early

Elderly
Familial
Excessive daytime sleepiness, depression, insomnia

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15
Q

Irregular sleep rhythm disorder (CRD)

Seen with
Absence of

A

Disorg sleep schedule, several periods in 24 time

Mental retardation, dementia, head trauma, institutions, comorbids
Poor sleep hygiene

External clues (light), social activities

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16
Q

Narcolepsy (hypersomnias)

A 
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
17
Q

Narc 1

Narc 2

A

1- cataplexy, HLA DQB1-0602
Loss of hypothalamic hypocretin/orexin secreting neurons
Low CSF hypocretin levels

2- no cataplexy, normal CSF hypocretin

18
Q

Dx Narcolepsy

A

Rule out other causes
Overnight psg
multiple sleep latency test: sleep latency <8, 2 sleep onset REM periods

19
Q

Kleine Levin Syndrome

A 
Recurrent hypersomnia
Young male
Head trauma, Febrile illness
Hypersomnia/normal for periods
associated with hyperphagia/sexuality

disorder of disinhibition

20
Q

Insomnia

A

Difficulty falling/staying asleep
No excessive daytime sleepiness
Treatment is never hypnotic agent

21
Q

REM Behavior disorder

Associated with

A 
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)
22
Q

NREM Parasomnias

A

Confusional arousals
sleep walking/terrors
sleep eating d/o

23
Q

RLS vs PLMB

Exclude

Treatment

A

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

24
Q

O v C Sleep Apnea

A

O- trying to breathe, but cant

C- no attempt, no air

25
Q

OSA physiology

RF

Children

A

Throat is narrowed, weight gain, loss of muscle tone in REM

Age, postmen, Male, Familial, Obesity, Mallamati, Comorbids (DM, HTN, CHD)

Enlarged tonsils/adenoids

26
Q

Signs/symp of OSA

A 
Snoring
Apneas
Freq night awakenings
Nocturia
Non restorative sleep
Morning headaches
Excessive daytime sleepiness
27
Q

Dx OSA

Treat OSA

A

PSG/Home sleep study
CPAP- keeps airway open
Oral- 2nd line, custom fit, mild OSA, better compliance

28
Q

CSA
Common pops

Treatment

A

Children
CNS d/o (HT, stroke)
CHF most common
Treat underlying cause

29
Q

Hypoventilation

Common dz

A 
CO2 retention
COPD
Obesity hypoventilation syndrome
CCH- PHOX 2B gene
NMD (ALS)
Chest wall deformity (Scoliosis)

R1 (4 decks)

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