Sleep-wake d/o Flashcards
where is the “biological clock”
the suprachiasmatic nucleus
REM vs NREM
REM characateristics
NMRE
REM – Pulse, BP, RR higher;
sexual arousal; skeletal paralysis, abstract dreams; last third of the night (deep)
Majority of infants sleep
25% of adult sleep
NREM- Decreased RR, Pulse, BP Less sexual arousal Skeletal muscles active Dreams can be lucid and purposeful (acting out dreams) 50% of adult sleep
NTs involved in sleep
5HT, DA, ACH, NE
Name a few sleep-wake d/o
Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing-Related Sleep Disorders
Circadian Rhythm Sleep-Wake Disorders NREM Sleep Arousal Disorders Nightmare Disorder REM Sleep Behavior Disorder Restless Legs Syndrome Substance/Medication-Induced Sleep Disorder
Criteria for ALL sleep wake d/o
linically significant distress or impairment in functioning
not attributable to the physiological effects of a substance
Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint
Insomnia
Criteria
Dissatisfaction with sleep quantity or quality, plus ≥ 1 sxs:
- can’t initiate sleep; can’t maintain sleep; early morning awakening
- 3nights/week x 3 months at least
what is the most preveleant Sleep wake d/o
Insomnia
Treatment for insomina
sleep hygeine
CBT
Benadryl, Melatonin
Rozerem – melatonin agonist
Short term -- BZDs (never for longer than 1 month --risk of withdrawal; amnesia) NEVER ALPRAZOLAM (short acting) Reduce slow wave sleep
Z drug treatment
dose/course
side effects
Z Drugs – GABA-a agonists; preserve slow wave
take EVERY OTHER NIGHT
amnesia
halluciations
parasomnias
Hypersomnolence Disorder
criteria
Treatment
excessive sleepiness
3x/week x 3 months
: Stimulants, or non-sedating SSRIs (buproprion)
Narcolepsy
criteria –
other characteristics
REM sleep attacks which occur 2-6 times per day and last 10 to 20 minutes each
Hypocretin deficiency
hypnagogic and hypnopompic hallucinations, cataplexy (50%), and sleep paralysis
Narcolepsy treatment
Modafinil (Provigil) reduces sleep attacks and improves psychomotor performance by stimulating α1-adrenergic receptors, with fewer side effects than traditional stimulants
Amphetamines
TCAs or SSRIs for cataplexy
Obstructive Sleep Apnea Hypopnea
criteria –
five obstructive apneas or hypopneas per hour of sleep
+ sleep symptoms (snoring, snorting/gasping, or breathing pauses during sleep.
Daytime sleepiness, fatigue, or unrefreshing sleep)
Obstructive Sleep Apnea Hypopnea
treatment
CPAP, weight loss, nasal surgery
SSRIs and TCAs may reduce amount of time in REM, (reduce REM apneic episodes)
Avoid sedatives, including alcohol
Circadian Rhythm Sleep Disorder
Misalignment between desired and actual sleep periods
NREM Sleep Arousal Disorders
name 2
general characteristics
Sleepwalking
Sleep terrors –
Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode
usually cannot remember the dreams or the episodes themselves
NREM Sleep Arousal Disorder: Sleepwalking
treatment:
perform perseverative motor tasks
Usually return to sleep without any recollection of the event
Enact measures to ensure safety and prevent injury (hide the car keys, block stairs). Medications which suppress NREM slow-wave sleep.
NREM Sleep Arousal Disorder: sleep terrors
if these begin later in life, what could it be a sign of
Scream or cry + behavioral manifestations resembling panic
Temporal lobe epilepsy
REM Sleep DIsorder: Nightmare Disorder
Criteria
Treatment
Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams
On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.
Treat: No specific treatment is available. Agents that suppress REM sleep (TCAs, SSRIs
REM Sleep Behavior Disorder
what disease might be associated?
Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
REM sleep without atonia on polysomnographic recording.
Motor activity, often violent in nature
., Parkinson’s disease, MSA
Restless Legs Syndrome
criteria –
usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs: urge to move legs;
3x/week x 3 months
Treatment of RLS
sleep changes in MDD
Reduced slow-wave sleep (SWS)
Sleep-onset REM
