Sleep stuff Flashcards
penile erections
REM sleep
Easily awakened with hypnic myoclonia
Stage 1 NREM
periods of muscle tone and relaxation
stage 2 NREM sleep
enerusis, somnambulance, night terrors
stage 3-4 NREM
deeper levels of mental functioning occur
stage 3-4 NREM
strengthens immune system
stage 3-4 NREM
time of mending for repairing and regenerating muscle
stage 3-4 NREM sleep
delta wave sleep
Stage 3-4 NREM
disoriented w amneisa if woken in this stage
Stage 3-4 NREM
constant waking during this stage may cause immunodeficiency conditions
stage 3-4 NREM
what stage is increased physiologic activity
RR, BP, HR
spontaneous penile erections
REM Sleep
what stage is near total paralysis of muscles
REM sleep
low serotonin
less sleep
more NE
less sleep
more melatonin
more sleep
more dopamine
less sleep
at what age is Stage 4 NREM nearly absent by
70
What is the diagnostic criteria for insomnia?
1+ of the following for 1 month:
* Difficulty initiating/maintaining sleep
* Nonrestorative or poor quality sleep
* Early morning awakening
Symptoms occur DESPITE adequate opportunity/circumstances for sleep
Impaired sleep producing daytime function deficits
Decreased REM, decreased sleep latency, increased stage 1, increased wakefullness
alcohol abuse effects on sleep
Consider TCA’s or anxiolytics (benzos) for the SE of sedation and somnolence…
secondary insomnia
primarily you want to treat underlying cuase
first line Tx for insomnia
CBT
what are the OTC 1st gen antihistamines
Benadryl
doxylamine
what are the benzo receptor agonists
sonata
ambien
lunesta
what are the melatonin agonists
melatonin OTC, ramelteon/rozerem
what are the benzos used for insomnia
restoril (remazepam)
fluazepam (dalmane)
what are the dual orexin receptor antagonists
all end in orexin
what antidepressents do we use in insomniacs
doxepin (TCA)
trazodone (zzzzzzz)
mirtazapine/remeron
what insomnia drug is preferred in pregnancy
doxylamine
what drug is avoided in obese patients
mirtazapine/remeron
occurs for 3+ months at least 2-6 times/day
narcolepsy
Multiple sleep latency test
narcoolepsy diagnosis
Treated with modafinil, methylphenidate or dextroamphetamine
these are stimulant drugs used in narcolepsy
also treated w SSRIs/SNRIs and forced naps
treated w SSRIs/SNRIs and forced naps
narcolepsy
also treated w modafinil, methylphenidate or dextroamphetamine (stimlulants)
Risk factors of sleep deprivation, GERD, sleep apnea and acute stress
somnambulism
what phase of sleep does bruxism occur
NREM sleep
pt has headaches and TMJ, what sleep disorder do they likely have
bruxism
is advanced sleep phase type more common in younger patients or elderly
elderly
what patients have non-24 hour sleep wake rhythm type circadian rhythm disorders
blind paients
what type of patients are likely to have irregulat sleep-wake circadian rhythm disorder
developmental issues with children
how to treat advanced sleep circadian rhythm disroder
bright liht in evening
what are the pharm treatments for circadian rhythm disorders
melatonin (resynchronize)
stimulants (caffeine and modafinil)
sleep apnea criteria
breath cessation for 10 seconds
hypopnea criteria
decreased airflow resultsing >4% decrease in O2
central sleep apnea
Absent ventilatory effort throughout episode
obstructive sleep apnea
Persistent ventilatory effort but obstructed
mixed sleep apnea
Absent ventilatory effort precedes the obstruction
RV dysfunction
obstructive sleep apnea
overnight polycomnography
what for and what include
obstructive sleep apnea
includes EEG, electrooculography, EMG, EKG, pulse ox, and end tidal co2 monitoring
sinus arrest or AV block may occur
bradydysrhythmias in sleep apnea
paroxysmal SVT or v tach
tachydysrhythmias in sleep apnea
Facilitate GABA-mediated inhibition of cell firing
MOA of a benzo receptor agonist
stage 1 NREM sleep reduction, decrease in REM, does not reduce stage 3.
what med
benzo receptor agonist
benzo receptor agonist w short half life that is not indicated in long term use
zaleplon/sonata
BBW for no use in complexsleep related disorders
benzo receptor agonistrs
avoid with grapefruit juice, meals, sedatives
ambien
good sleep onset and sleep maintenance insomnia medication
ambien and lunesta
good sleep onset med, bad sleep maintenance med
sonata
ramelteon/rozerem
benzo receptor agonist w longest half life
lunesta
desensitized receptors can occur with chronic use of this med
melatonin
avoid w coumadin and hypotension
OTC melatonin
avoid use w fluvoxamine/luvox
ramelteon/rozerem
interacts w CYP3A4
orexin receptor antagonists
requires dose adjustment for elderly
daridorexant
only schedule 3 drug in sleep lecture and why
sodium oxybates, date rape drug.
strong CNS depressant
