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sleep/wake disorders Flashcards

1
Q

REM sleep

A

20-25% total sleep
story-like dreams occur

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2
Q

NREM stage 1

A

5% total sleep
transition from wake to sleep

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3
Q

NREM stage 2

A

50% of total sleep
deep sleep

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4
Q

NREM stage 3

A

20% total sleep
deepest level of sleep

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5
Q

sleep continuity

A

overall balance of sleep/wakefulness during the night

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6
Q

sleep architecture

A

amount/distribution of specific sleep phases

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7
Q

sleep efficiency

A

ratio of time spent asleep to time spent in bed expressed as a percentage

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8
Q

generalized definition of insomnia disorder

A

recurrent unsatisfactory because or at least 1:

-difficulty falling asleep
-difficulty staying asleep
-early waking w/ inability to go back to sleep

occurs despite adequate opportunity for sleep

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9
Q

time duration of symptoms for insomnia diagnosis

A

at least 3 nights/week for at least 3 months

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10
Q

specifiers for insomnia disorder

A

w/ mental disorder
w/ medical condition
w/ comorbid sleep disorder
episodic
persistent
recurrent

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11
Q

episodic specifier for insomnia

A

symptoms for at least 1 month but less than 3

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12
Q

persistent insomnia disorder

A

symptoms for 3+ months

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13
Q

recurrent insomnia disorder

A

2+ episodes in a year

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14
Q

what counts as early morning awakening

A

at least 1 hour before scheduled wake time
OR
before total sleep time has reached 6.5 hours

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15
Q

symptoms of increased arousal r/t insomnia and generalized activation of HPA axis

A

increased cortisol levels
HR variability
stress reactivity
increased metabolic rate

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16
Q

diagnostic criteria for hypersomnolence disorder

A

subjective excessive sleepiness despite adequate sleep period of 7+ hours with at least one manifestation

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17
Q

3 manifestations (of which you must have 1) of hypersomnolence disorder

A

-recurrent periods of sleep/lapses into sleep in the same day
-sleep longer than 9 hours that is nonrestorative
-difficulty being fully awake after abrupt awakening

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18
Q

time duration for dx of hypersomnolence disorder

A

at least 3/wk for at least 3 months

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19
Q

specifiers for hypersomnolence disorder

A

with mental disorder
with medical condition
with comorbid sleep disorder

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20
Q

duration of acute hypersomnolence disorder

A

less than 1 month

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21
Q

duration of subacute hypersomnolence disorder

A

1-3 months

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22
Q

duration of persistent hypersomnolence disorder

A

3+ months

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23
Q

mild hypersomnolence disorder

A

trouble 1-2 days/week

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24
Q

moderate hypersomnolence disorder

A

difficulty 3-4 days/week

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25
severe hypersomnolence disorder
difficulty 5-7 days/week
26
sleep inertia
impaired performance/reduced vigilance following awakening from regular sleep episode (also called sleep drunkenness)
27
sleep efficiecy with hypersomnolence disorder
generally fall asleep quickly with good sleep efficiency
28
does cataplexy ever occur in hypersomnolence disorder
no
29
kleine-levin syndrome
recurrent episodes of hypersomnia
30
general description of narcolepsy narcolepsy
recurrent need to sleep, unintentional sleep, or napping within the same day along with 1 of 3 other manifestations
31
duration of symptoms for narcolepsy diagnosis
at least 3 days/week for 3 months
32
what are the three other manifestations of narcolepsy (of which you must have 1)
cataplexy hypocretin deficiency in CSF polysomnographic changes
33
cataplexy
brief sudden bilateral low muscle tone w/ maintained consciousness precipitated by joking/laughter
34
polysomnographic changes possible in narcolepsy
-REM sleep latency less than/equal to 15 minutes -mean sleep latency less than 8 minutes on multiple tests -2+ sleep onset REM episodes
35
narcolepsy type 1
with cataplexy or hypocretin deficiency
36
narcolepsy type 2
without cataplexy without hypocretin deficiency (or unmeasured)
37
mild narcolepsy
need naps 1-2x/day sleep disturbance mild cataplexy absent/infrequent
38
moderate narcolepsy
-multiple naps daily -sleep moderately disturbed -cataplexy daily or every few days
39
severe narcolepsy
nearly constant sleepiness highly disturbed sleep cataplexy is drug resistant w/ multiple attacks daily
40
muscles involved in cataplexy
neck, jaw, arms, legs, whole body (awake/aware during cataplexy)
41
associated features of narcolepsy
-automatic behaviors may occur -hypnagogic hallucinations and sleep paralysis are common -nocturnal eating may occur
42
what happens to reflexes during cataplexy
they are abolished
43
breathing-related sleep disorders
obstructive sleep apnea central sleep apnea sleep-related hypoventilation
44
2 types of diagnostic criteria for obstructive sleep apnea
-polysomnography show 5+ OSAs/hypopnea per hour and either there is nocturnal breathing disturbance of daytime sleepiness OR -polysomnography shows 15+ OSAs/hypopneas per hour regardless of other symptoms
45
mild obstructive sleep apnea
apnea-hypopnea index <15
46
moderate obstructive sleep apnea
apnea-hypopnea index 15-30
47
severe obstructive sleep apnea
apnea-hypopnea index >30
48
apnea
total absence of airflow
49
hypopnea
diminished airflow
50
common nonspecific symptoms of obstructive sleep apnea
-heartburn -nocturia -morning headaches -dry mouth -ED and reduced libido
51
diagnostic criteria for central sleep apnea
polysomnography shows 5+ central sleep apnea episodes per hour not better explained by another sleep disorder
52
specifiers for central sleep apnea
idiopathic cheyne-stokes breathing comorbid w/ opioid use
53
cheyne-stokes breathing
periodic crescendo/decrescendo variation in tidal volume resulting in apneas/hypopneas
54
onset of Cheyne Stokes breathing is typically associated with what
development of HF
55
diagnostic criteria for sleep-related hypoventilation
polysomnography shows episodes of decreased respirations associated with increased CO2 levels
56
specifiers for sleep-related hypoventilation
idiopathic congenital central alveolar comorbidities
57
idiopathic hypoventilation
not attributable to any readily identifiable condition
58
congenital central alveolar hypoventilation
perinatal shallow breathing or cyanosis/apnea during sleep
59
comorbid sleep-related hypoventilation
occurs as a consequence of a medical condition
60
diagnostic markers for sleep-related hypoventilation
-increased arterial pCO2 to >55mmHg during sleep OR -greater than or equal to 10mmHg increase in pCO2 levels over awake supine values
61
types of circadian rhythm sleep wake cycle disorders
delayed sleep phase type advanced sleep phase type irregular sleep phase type non-24 hour sleep wake cycle shift work type unspecified type
62
definition of delayed sleep phase type
delayed sleep onset/awakening (usually greater than 2 hours) w/ inability to sleep/wake at desired times
63
definition of advanced sleep phase type
advanced sleep onset/awakening with inability to stay awake/asleep until desired time
64
definition of irregular sleep phase type
temporarily disorganized sleep-wake cycle w/ variable timing of sleep/wake periods throughout the day
65
definition of non-24-hour sleep/wake type
sleep/wake cycle not synced to 24 hour environment with consistent daily drift of onset/wake times
66
episodic circadian rhythm disorders
lasting at least 1 month but less than 3
67
duration for persistent circadian sleep wake disorders
lasts 3+ months
68
recurrent circadian rhythm sleep wake cycles
2+ episodes in a year
69
definition of irregular sleep wake type
complete lack of circadian rhythm no major sleep period sleep is fragmented into at least 3 periods during 24 hours
70
definition of non-24 hour sleep wake type
c/o insomnia/hypersomnia r/t lack of synchronization between light/dark and circadian cycles
71
sleep latency/sleep phase in non-24-hour sleep-wake type
sleep latency gradually increases until sleep onset insomnia. Sleep phase drifts so sleep is in daytime w/ c/o hypersomnia
72
what types of patients typically develop non-24-hour sleep wake cycle type
visually impaired. Rare in sighted people
73
dx and symptoms of shift-work type
dx made primarily based on hx of shift work w/ c/o sleepiness at work and difficulties sleeping at home
74
list the different parasomnias
NREM sleep arousal disorders nightmare disorder REM sleep behavior disorder
75
diagnostic criteria for NREM sleep arousal disorder parasomnia
episodes of incomplete waking accompanied by either sleepwalking or sleep terrors that the patient doesn't remember2
76
types of sleepwalking
with sleep eating with sleep-related sexual behavior
77
onset of sleepwalking in adulthood should prompt suspicion of what
sleep apnea, nocturnal seizures, or medication side effects
78
diagnostic criteria for nightmare disorder
repeated nightmares that rapidly awake patient and cause clinically significant distress
79
specifiers for nightmare disorder
during sleep onset comorbidity duration severity
80
comorbidity specifiers for nightmare disorder
with mental disorder with medical condition with another sleep disorder (code comorbid disorder after nightmare disorder)
81
duration specifier for nightmare disorder
acute - 1 month or less subacute - >1 month, <6 months persistent - longer than 6 months
82
severity specifiers for nightmare disorder
mild - <1 episode/week moderate - 1+ episode/week, less than nightly severe - nightly
83
diagnostic criteria for REM sleep behavior disorder parasomnia
repeated arousals w/ vocalization and/or complex behaviors
84
what phase of sleep does REM sleep behavior disorder arise from
REM usually in later half of night
85
main adverse effect of REM sleep behavior disorder parasomnia
significant injury from "acting out dreams"
86
definition of restless leg syndrome
frequent urge to move legs in response to uncomfortable sensations
87
characteristics of urges in RLS that are required for dx
-worsens during rest/inactivity -partially/totally relieved by movement -worse in the evening/night
88
duration of symptoms for RLS dx
at least 3x/wk for at least 3 months
89
what is NOT typical on exam for RLS
-leg cramps relieved w/ 1 position change -joint limitations -soreness on palpation
90
type specifiers for substance/medication-induced sleep disorder
insomnia type daytime sleepiness type parasomnia type (abnormal sleep behaviors) mixed type
91
what are onset specifiers for substance/medication-induced sleep disorder
onset during intoxication onset during withdrawal onset after medication use

DSM5 (18 decks)

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