Sleep Medicine Flashcards
SLeep
Reversible behavioral state of prceptual disengagement from and unresponsiveness to environemnt
Stage 2 and 3
2 - sleep spindles and K complexes
Delta - lower frequencyc and bigger WL
Sleep structure
More REM towards the end of sleep
NREM vs. REM sleep
HR Resp rate BP Muscle tone Brain O2 Ventilatroy Temp Sexual changes
HR, RR, and BP regulr in NREM, irregular in REM
No muscle tone in REm
More O2 in REM
Norma vent and temp in NREM, decreased response and poikilothermic in REM
Rare in NREM
Age and sleep architecture
WASO increases while SWS decreases
2 process model
Homeostatic pressure to sleep and circadian pressure to be awake
Circadian rhythm
Zerigebers entrained
Light, photic, meal times
Retinohypothalamic tract to suprachiasmatic nucleus which affects melatonin production from pineal gland
When to give melatonin
4-6 hours BEFORE bedtime
Sleep and endocrinology
Decrease leptin and increase ghrelin
Delayed sleep phase
Think teenagers
Confused with hypersominia and insomina
Lgiht exposure in AM, melatonin in PM
Later sleep onset and wake time
Advanced sleep phase
Earlier sleep and wake times
Confused wit hexcessive daytime sleepiness, depresison and insomnia
Ireegular sleep rhythm disorder
Disorganized
Occurs in several periods througout 24 hour cycles
Narcolepsty
Excessive daytime sleepiness
Hallucinations
Sleep paralysis
Under 25 onset
Naps ARE refrehsing (oppositve of OSA)
Sleep attacks
Narcolepsy type 1 and 2
Type 1 - With cataplexy…bilateral loss of muscle control mainting consciousness…HLA DQB-0602
Loss of hypothalamic hypocretin/orexin secreting neurons
Low CSF hypocretin-1 levels
Type 2 - without cataplexy, normal CSH hypocretin
Keline Levin
Recurrent hypersomnia
Young man
Head injury or febrile illness
Periods of hypersomnia followed by normal periods
Hyperphagia and hypersexuality
Dx of narcolepsy
Overnight polysomnography
MSLT - sleep latency less than 8 minutes and 2 sleep onset REM periods
Insomina
Difficulty falling and staying asleep
Not associated with daytime sleepiness
Tx NEVER a hyponotic agent
REM beahvior disorder
Acting out a dream content
Remember*** dream content
Late in night/early morning
Loss of REM aotnia
Tx with melatonin or benzos
Association with Pakrinsons and MSA
RLS
Abnormal sensation in legs close to bedtime alleviated by movement and interferes with falling asleeo
Similar to perioidc limb movement disordrr over 15/hr
Exclude Fe def, remove benadryl, SSRIs
Tx is dopaminergic agents
Beware of augmentation
Obstructive vs central sleep apnea
Obstructive- trying to breath
Central - not trying to breath
Risk factors for OSA
Post menopausal, age,
In children, tonsils and adenoids
Sx of OSA
SNoring
Witnessed apneas
Frwquent night time awakenings
Nocturia
Non restorative sleepp
Morning headaches
Execssive daytime sleepiness
Dx of OSA
Polysomnography and home sleep study
Tx of OSA
CPAP
Oral appliances have better compliacne
Central sleep apnea
Seen in children
CNS disorders
Most common cause is CHF
Tx is tx of underlying cause
Hypoventilation
CO2 retnetion
Congenital central hypoventilation - PHOX 2 B gene
ETCO2>50 for >10 minutes
