Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 8 week 1 > Sleep - Rothrock > Flashcards

Sleep - Rothrock Flashcards

1
Q

What brain structure is most likely the ultimate regulator of sleep?

A

The suprachiasmatic nuclei of the Hypothalamus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the association between sleep and age.

A

Total sleep time declines with age:

  1. 10-12 hours in a newborn
  2. > 7-1.5 hours in adolescence
  3. > 6.5 hours in late adult life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Secretion of what hormones decreases with sleep onset?

A

Cortisol and TSH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Secretion of what hormones increases with sleep onset?

A

Growth hormone and prolactin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Production of what hormone begins and ceases with exposure to sunlight?

A

Melatonin - made in the pineal gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Severe sleep deprivation in humans can lead to what?

A

Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 5 stages of sleep?

A
  1. Stage 1 or NonREM stage 1 - characterized by drowsiness, roving, horizontal eye movements and reduced EEG voltage
  2. Stage 2 or NonREM stage 2 - characterized by slow ‘vertex waves’, and sleep spindles on EEG (bursts of biparietal 12-14 Hz waves)
  3. Stages 3&4 or NonREM stage 3 - characterized by high amplitude slow waves (delta Hz of s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the architecture of normal sleep.

A
  1. successive NREM -REM cycles - about 4-6 per night
  2. primarily NREM-REM2 during the latter portion of the night
  3. cycles are about 60-90 minutes each
  4. The first REM cycle occurs about 70-100 minutes after sleep onset
  5. most, but not all, dreaming occurs during REM sleep
  6. easily aroused from REM sleep, less so with NREM 3 (NREM 3 decreases with age)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

REM sleep is characterized by what?

A
  1. minimal tonic muscle activity
  2. conjugate REMS - eyes move in same direction at the same time, typically horizontally
  3. penile erection occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A person spends the majority of their sleep time in what type of sleep?

A

Non REM sleep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens if a person is deprived of sleep for greater than 60 hours?

A
  1. increasing sleepiness, fatigue, irritability
  2. difficulty concentrating
  3. impaired skilled motor function - especially speed and perseverance
  4. increased inattention
  5. impaired judgement
  6. nystagmus, bilateral hand tremor, ptosis, expressionless face, thick speech, mispronunciations, word substitutions and loss of accommodation (change in pupil size with closer object distance)
  7. if lack of sleep persists - can get visual/tactile hallucinations, psychosis, seizure activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chronic sleep deprivation can causes and increased risk of what?

A
  1. hypertension
  2. stroke
  3. myocardial infarction
  4. pulmonary hypertension
  5. early death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some types of sleep disorders.

A
  1. insomnia
  2. narcolepsy and cataplexy
  3. sleep apnea - central and obstructive
  4. restless leg syndrome and periodic leg movements of sleep
  5. REM sleep behavioral disorder
  6. excessive daytime somnolence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What types of insomnia’s are there?

A

Primary or Secondary. Secondary insomnia is associated with an underlying condition - either medical or non-medical.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes of primary insomnia?

A

Primary insomnia is sleep disturbance for prolonged periods in the ABSENCE of any causal psychiatric or medical disorder and is associated with what are termed sleep hypochondriacs. This is a reference to sufferers who have seen a lot of physicians about their condition and who often exaggerate how little they sleep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of Secondary insomnia?

A
  1. often transitory
  2. non medical causes could be psychological, ethanol use or substance abuse
  3. medical causes could be arthritic pain, GERD, PUD, and prostatism/nocturia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a sleep diary?

A

This is a diagnostic tool in which the patient writes down - bedtime, awakenings, out of bed time, naps, use of sedatives or stimulants, and associated symptoms for seven days. It is a real time assessment evaluating the person’s sleep habits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name some other diagnostic tools for sleep disorders.

A
  1. Validated symptom assessment systems - Epworth sleepiness score and the Standford sleepiness score
  2. Polysomnography - includes multiple sleep latency test, maintenance of wakefulness test and EEG monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

To treat secondary insomnias what do you do?

A

Treat the underlying disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Are there great medications for treatment of primary insomnia?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some drugs that could be tried to treat primary insomnia?

A
  1. Trazedone - an antidepressant, not all patients respond to it
  2. Some Benzodiazepines such as Clamazepam - these are hard to get off of so should not be used long term - are only useful for PRN use since patients can easily develop tolerance
22
Q

What are some non-pharmacological ways to treat primary insomnia?

A 
Sleep hygiene:
1. re-set sleep cycle
2. no naps
3. decreased non-sleep time in bed
4. exercise
5. re-set circadian rhythm via quiet time with lights out
6. avoid caffeine, alcohol and tobacco
7. keep the bedroom quiet, dark and avoid clocks and bedtime rituals
CBTI may also help with insomnia
23
Q

What are some breathing disorder that can occur during sleep?

A
  1. obstructive sleep apnea
  2. central sleep apnea
  3. mixed sleep apnea
  4. complex sleep apnea
  5. upper airway resistance syndrome
    Polysomnography is essential for diagnosis.
24
Q

What is the main difference between central and obstructive sleep apnea?

A
  1. central - has a cause associated with the CNS

2. obstructive - has a cause associated with anatomic blocking of the airway

25
Q

What are the two types of Central Sleep Apnea?

A
  1. Primary - unknown CNS cause
  2. Secondary - associated with lower brain stem (Medulla) abnormalities such as stroke and syringobulbia (hole in the medulla)
26
Q

Describe the characteristics of OSA?

A
  1. posterior pharyngeal muscles collapse and narrow the airway
  2. noisy, cyclic snoring present (2-30 secs of apnea followed by resumed breathing a brief arousal)
  3. occurs during REM and nonREM sleep
  4. ususal presentation includes excessive daytime somnolence
  5. clinical phenotype is most often the overweight, middle-aged man
27
Q

What is STOP-BANG?

A

A tool to screen patients for obstructive sleep apnea.

28
Q

What does STOP stand for?

A

S - Do you snore loudly?
T - Do you often feel tired etc. during daytime?
O - Has anyone observed your apnea?
P - do you have or are you being treated for hypertension?

29
Q

What does BANG stand for?

A

B - Is your BMI more than 35 kg/m2
A - Are you over the age of 50?
N - Is your neck circumference greater than 40 cm?
G - Is your gender male?

30
Q

What scoring scale does the STOP-BANG questionnaire use?

A
  1. High risk of OSA if answering yes to 3 or more items

2. Low risk of OSA if answering yes to less than 3 items

31
Q

Describe the sensitivity of the STOP-BANG questionnaire?

A

83.6% for mild OSA
92.9% for moderate OSA
100% for severe OSA

32
Q

What is the best diagnostic tool for diagnosing OSA?

A

Polysomnogram

33
Q

Describe the characteristics that are measured during polysomnography?

A
  1. EMG - looks at muscle activity
  2. airflow
  3. EEG
  4. oxygen saturation
  5. cardiac rhythm
  6. leg movements
34
Q

What are the pathophysiologic findings associated with OSA?

A
  1. nasal obstruction
  2. long, thick soft palate
  3. retro-displaced mandible
  4. narrowed oropharynx
  5. redundant pharyngeal tissues
  6. large lingual tonsil
  7. large tongue
  8. large or floppy epiglottis
  9. retro-displaced hyoid complex
35
Q

How is central sleep apnea/OSA treated?

A
  1. treat underlying cause is there is one - (central)
  2. can give low-flow oxygen - (central)
  3. medications typically don’t help - (central)
  4. CPAP - main therapy but some patient’s can’t stand it
  5. BiPAP
  6. dental appliances
  7. surgical options - such as uvulectomy, mandibular advancement, etc. (usually don’t work that well)
  8. behavioral measures
36
Q

What are some behavioral measures that can be used to help treat OSA?

A
  1. weight loss
  2. avoidance of alcohol
  3. avoidance of sedatives
  4. avoidance of smoking
  5. non-supine sleep
37
Q

What is Restless leg syndrome?

A

Characterized as an unpleasant sensation in the legs and sometimes arms that is paired with an irresistible urge to move the affected limb. Prevalence is around 2%.

38
Q

What are some characteristics associated with Restless leg syndrome?

A
  1. delays sleep onset and occurs early in stages of sleep
  2. symptoms provoked by rest, alleviated briefly by moving limbs
  3. may persist into daytime
  4. worsens with fatigue and warm weather
39
Q

What are some causes/associations of Restless leg syndrome?

A
  1. idiopathic
  2. associated with iron deficiency anemia
  3. associated with dysthyroidism, pregnancy, certain drugs such as antihistamines and try cyclic anti depressants
  4. may be related to decreased domaine production and binding
40
Q

How is Restless leg syndrome treated?

A
  1. iron supplementation
  2. dopamine agonists
  3. long-acting carbidopa/L–dopa
  4. gabapentin
  5. clonazepam
41
Q

How is periodic leg moments with sleep treated?

A

Treatments are the same as with Resteless leg syndrome except for iron supplementation.

42
Q

What is the Narcoleptic tetrad?

A
  1. recurrent attacks of irresistible sleep
  2. cataplexy (co-occurs 70% of time) - sudden loss of muscle tone provoked by emotionalism
  3. Hypnagogic - sleep paralysis at sleep onset and hallucinations
43
Q

When do the recurrent attacks of irresistible sleep happen?

A

Occurs in unusual situation - not at bedtime necessarily. Causes excessive daytime somnolence

44
Q

What is the age of onset of Narcolepsy?

A

Gradual onset usually occurs between ages 15-35 with 90% onset by age 25.

45
Q

How long are the sleep periods in narcolepsy?

A

About 15 minutes 2-6 times a day.

46
Q

What are some characteristics of Narcolepsy?

A
  1. often familial but not Mendelian
  2. abnormality involving a hypothalamic neuropeptide called Hypocretin
  3. Hypocretin neurons project to sleep structures such as locus ceruleus and the ventral tegmentum
  4. may be a genetic predisposition with superimposed autoimmune disorder that affects hypocretin neurons
  5. sleep latency is greatly reduced
  6. presents with a reversal of REM and non-REM sleep - REM sleep is at the onset
47
Q

How is Narcolepsy diagnosed?

A
  1. overnight polysomnography followed by multiple sleep latency test ( naps at 2 hour intervals)
  2. measure of CSF levels of hypocretin
48
Q

What findings of a multiple sleep latency test is highly suggestive of narcolepsy?

A

Detection of REM activity within 15 minutes of sleep onset.

49
Q

What are the treatments for narcolepsy?

A
  1. strategically placed short naps
  2. stimulants such as Provigil/Modafinil, Dextroamphetamine, Methylphenidate
  3. TCA’s such as Potriptyline and Imipramine
  4. possibly - immune globulin infusions
50
Q

What drug is good to treat cataplexy?

A

Imipramine

51
Q

What two drugs are often given together to treat narcolepsy?

A

Provigil to treat narcolepsy and Imipramine to treat cataplexy

Block 8 week 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions