Sleep Wake Flashcards
Briefly describe NREM sleep
- slower brain waves on EEG
- harder to arouse
Briefly describe REM sleep
- faster waves on EEG
- atonia, eye movements
- lower arousal threshold
- waking during REM= memory of dreams
- higher HR, BP, RR
Two types of sleep disorders
- parasomnia: unusual sleep-related behavior
- dyssomnia: insufficient/excessive/altered sleep
MC sleep related disorders
-assc with breathing OSA/CSA
When should insomnia disorder be ruled out?
If it is part of another psych disorder (ie anxiety)
Contrast acute and chronic insomnia disorder
- acute: less than 3 months
- chronic: more than 3 months
Treatment for insomnia
- CBT
- Benzos, Z drugs, antidepressants
What antidepressants are used in the treatment of insomnia
- mirtazapine
- trazadone
- amitryptiline, doxepin
What are the three Z drugs?
- zaleplon (sonata)
- zolpidem (ambien)
- eszopiclone (lunesta)
Risk assc with zolpidem
more than 10mg can cause increased cognitive impairment in women
Effects of zolpidem in eldery
falls + cog impairment
In what ways are Z drugs better than benzos?
-lower incidence of orthostatic hypotension and daytime sleepiness
Hypersomnolence disorder description
excessive daytime sleepiness despite getting 7+ hours of sleep
Causes of hypersomnolence disorder
- viral infections
- head trauma
- genetic
Treatment for hypersomnolence disorder
-modafinil
-stimulants
-atomextine
(+/- scheduled naps)
Dx of OSA
- excessive daytime sleepiness
- apneic episodes (more than 15/hour)
CSA causes
- idiopathic
- with Cheyne Strokes Breathing
- assc with opioid use
Describe Cheyne Strokes breathing
- periodic crescendo decrescendo breathing
- heart/renal failure, stroke, DKA assc
Sleep related hypoventilation:
- polysomnography finding
- common physical complaint
- poly: descreased breathing, elevated CO2
- morning headaches
What is the narcolepsy tetrad?
- daytime sleepiness
- hallucinations (hypnogognic/pompic)
- cataplexy
- REM related parasomnias
CSF finding in Narcolepsy?
-low hypocretin
Cause of narcolepsy
loss of hypothalamic neurons +/- autoimmune component
Treatment of daytime sleepiness in narcolepsy
- modafinil, methylphenidate, sodium oxybate
- amphetamines
Treatment of cataplexy in narcolepsy:
- sodium oxybate
- TCAs
- SSRIs
- SNRIs
What is the DOC for cataplexy, which also treats daytime sleepiness?
-sodium oxybate
Sleep disorder assc with recurrent patterns of sleep disruption due to alteration between circadian rhythym and individuals environment/work schedule
-circadian rhythm sleep wake disorders
Part of brain responsible circadian rhythym
suprachiasmatic nucleus
Non-REM sleep arousal D/O:
characteristics
-non-conscious arousal during first third of sleep leading to sleep walking/ sleep terrors
How to treat refractory cases of sleep walking
-low dose BDZ
Are sleep terrors remembered?
No, occur during NREM sleep
Autonomic signs of sleep terrors
- tachycardia
- tachypnea
- diaphoresis
- mydriasis
Nightmare D/O treatment
- desensitization/imagery rehearsal therapy
- prazosin/SSRIs if assc with PTSD
REM sleep behavior disorder cause
loss of muscle atonia during REM sleep
Coniditions assc with sleep behavior disorder
- neurodegenerative disorders
- parkinsons
- lewey body
- multiple systems atrophy
Treatment of REM sleep behavior d/o
- clonazepam
- melatonin
Screen for _____ always in restless leg
- iron deficiency anemia
- drug related cause
First line treatment for RLS
- dopamine agonists
- BDZ
