Sleep Therapy

Question 1

What does REM and non-REM sleep support?

Answer 1

A person is either in REM (mind) or non-REM (bones and body)

Question 2

What are the stages of non-REM sleep?

Answer 2

Stage 1
Stage 2
Stage Slow Wave (the new 3 and 4)

Question 3

Stage 1

Answer 3

Transition from wakefulness to sleep
Twilight sleep
"I was not sleeping"
30s - 7 min
Disconjugate rolling eye movements
Theta waves

Question 4

Stage 2

Answer 4

Bridge from stage 1 to slow wave

Interesting to the sleep world boring to you…..

EEG tracings of sleep spindles and K complexes’ cause arousal of sleep architecture

Question 5

Stage 3 and 4

Answer 5

Restorative to bones and muscles
Consistent breathing pattern
Stable blood pressure – 10% lower – “dipping”
Most difficult to awaken from
Parasomnias occur (sleep talking, bed wetting)

Question 6

REM is associated with…

Answer 6

Neurological recovery
Blood pressure fluctuates
Breathing pattern fluctuates
Shuffle and organize days occurrences
Dreaming
Easiest to awaken from
Erections occur in males
Rapid conjugate eye movement

Question 7

Which stage is associated at the beginning and end of a night’s sleep?

Answer 7

More slow wave early in night
More REM at end of night

Cycle through stages every 90 minutes
Awakenings occur during lighter stages

Question 8

Sleep need at certain ages?
Children:
Adolescence:
Adults:
Seniors:

Answer 8

Children: 10 to 11 hours – increase in slow wave sleep

Adolescence: 9 to 10 hours – hormones cause a circadian shift – go to sleep later and wake later

Adults: 8 hours

Seniors: 8 hours – decreased slow wave sleep, more fragmented sleep, may need naps

Question 9

What are some good sleep hygiene habits?

Answer 9

Use bed for sleep and sex only
Downtime routine before bed
Maintain consistent rise time
Daily exercise
Make time during the day to worry/meditate
Limit effects of alcohol, caffeine, smoking

Question 10

In what stage do you see saw tooth waves?

Answer 10

REM

Question 11

How long do sleep stages last?

Answer 11

One cycle of all sleep stages is 70-120 minutes

Question 12

Who should get a sleep study?

Answer 12

Mainly, people who have daytime somnolence.

DIMS and DOES, mainly the latter.
Disorders of excessive sleep.

Question 13

What are some classic physical exam findings of sleep apnea?

Answer 13

Thick uvula, often overweight or bigger build.
Short neck.
Narrowed nasal passages.
Large tongues.

Question 14

DDx for excessive sleepiness?

Answer 14

Is this malaise or fatigue, or it is excessive sleepiness (persistent and unremitting).)
Chronic Insufficient Sleep
Asthma
Angina
Drugs
Depression 

Four general categories: Sleep quality or quantity, Circadian rhythm, Drugs, CNS pathologym

Question 15

Drugs that affect sleep

Answer 15

Benzos
Antihistamines
Antidepressants
Antipsychotcs
B-Blockers and antihypertensives.

Question 16

What causes morning headaches in patients with sleep apnea?

Answer 16

Hypoxia and hypercapnia.

Question 17

Why would you see a high blood pressure in OSA?

Answer 17

Hypoxia will ramp up sympathetic nervous system to increase HR, SV.

Question 18

Correctable processes for OSA

Answer 18

Tonsils/adenoids
Hypothryoidism
Acromegaly
Cushings
Drugs
Others

Question 19

When should you first see REM sleep?

Answer 19

After about 90 minutes.

Question 20

Narcolepsy is defined as:

Answer 20

Decrease in oxycretins in hypothalamus resulting in abnormal sleep tendencies. Pathologic REM sleep manifestation.

Question 21

Cataplexy is brought on by what?

Answer 21

Strong emotion

Question 22

What is alpha intrusion?

What conditions does it present in?

Answer 22

Alpha wave become present in other staged waves like delta waves
Common in fibromyalgia or other pain syndromes like RA.

Question 23

What is Oneirism?

DDx?

Answer 23

Dream acting out in physical movements.

Hypnic Jerks
Sleep walking
Pavor nocturnus (night terrors)
Sleep myoclonus
Sleep epilepsy