Sleep Therapy Flashcards
What does REM and non-REM sleep support?
A person is either in REM (mind) or non-REM (bones and body)
What are the stages of non-REM sleep?
Stage 1
Stage 2
Stage Slow Wave (the new 3 and 4)
Stage 1
Transition from wakefulness to sleep Twilight sleep "I was not sleeping" 30s - 7 min Disconjugate rolling eye movements Theta waves
Stage 2
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
Stage 3 and 4
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)
REM is associated with…
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
Which stage is associated at the beginning and end of a night’s sleep?
More slow wave early in night
More REM at end of night
Cycle through stages every 90 minutes
Awakenings occur during lighter stages
Sleep need at certain ages? Children: Adolescence: Adults: Seniors:
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
What are some good sleep hygiene habits?
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
In what stage do you see saw tooth waves?
REM
How long do sleep stages last?
One cycle of all sleep stages is 70-120 minutes
Who should get a sleep study?
Mainly, people who have daytime somnolence.
DIMS and DOES, mainly the latter.
Disorders of excessive sleep.
What are some classic physical exam findings of sleep apnea?
Thick uvula, often overweight or bigger build.
Short neck.
Narrowed nasal passages.
Large tongues.
DDx for excessive sleepiness?
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
Drugs that affect sleep
Benzos Antihistamines Antidepressants Antipsychotcs B-Blockers and antihypertensives.
What causes morning headaches in patients with sleep apnea?
Hypoxia and hypercapnia.
Why would you see a high blood pressure in OSA?
Hypoxia will ramp up sympathetic nervous system to increase HR, SV.
Correctable processes for OSA
Tonsils/adenoids Hypothryoidism Acromegaly Cushings Drugs Others
When should you first see REM sleep?
After about 90 minutes.
Narcolepsy is defined as:
Decrease in oxycretins in hypothalamus resulting in abnormal sleep tendencies. Pathologic REM sleep manifestation.
Cataplexy is brought on by what?
Strong emotion
What is alpha intrusion?
What conditions does it present in?
Alpha wave become present in other staged waves like delta waves
Common in fibromyalgia or other pain syndromes like RA.
What is Oneirism?
DDx?
Dream acting out in physical movements.
Hypnic Jerks Sleep walking Pavor nocturnus (night terrors) Sleep myoclonus Sleep epilepsy
