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DSM5 > sleep/wake disorders > Flashcards

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
Q

severe hypersomnolence disorder

A

difficulty 5-7 days/week

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26
Q

sleep inertia

A

impaired performance/reduced vigilance following awakening from regular sleep episode (also called sleep drunkenness)

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27
Q

sleep efficiecy with hypersomnolence disorder

A

generally fall asleep quickly with good sleep efficiency

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28
Q

does cataplexy ever occur in hypersomnolence disorder

A

no

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29
Q

kleine-levin syndrome

A

recurrent episodes of hypersomnia

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30
Q

general description of narcolepsy narcolepsy

A

recurrent need to sleep, unintentional sleep, or napping within the same day along with 1 of 3 other manifestations

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31
Q

duration of symptoms for narcolepsy diagnosis

A

at least 3 days/week for 3 months

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32
Q

what are the three other manifestations of narcolepsy (of which you must have 1)

A

cataplexy
hypocretin deficiency in CSF
polysomnographic changes

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33
Q

cataplexy

A

brief sudden bilateral low muscle tone w/ maintained consciousness precipitated by joking/laughter

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34
Q

polysomnographic changes possible in narcolepsy

A

-REM sleep latency less than/equal to 15 minutes
-mean sleep latency less than 8 minutes on multiple tests
-2+ sleep onset REM episodes

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35
Q

narcolepsy type 1

A

with cataplexy or hypocretin deficiency

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36
Q

narcolepsy type 2

A

without cataplexy
without hypocretin deficiency (or unmeasured)

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37
Q

mild narcolepsy

A

need naps 1-2x/day
sleep disturbance mild
cataplexy absent/infrequent

38
Q

moderate narcolepsy

A

-multiple naps daily
-sleep moderately disturbed
-cataplexy daily or every few days

39
Q

severe narcolepsy

A

nearly constant sleepiness
highly disturbed sleep
cataplexy is drug resistant w/ multiple attacks daily

40
Q

muscles involved in cataplexy

A

neck, jaw, arms, legs, whole body
(awake/aware during cataplexy)

41
Q

associated features of narcolepsy

A

-automatic behaviors may occur
-hypnagogic hallucinations and sleep paralysis are common
-nocturnal eating may occur

42
Q

what happens to reflexes during cataplexy

A

they are abolished

43
Q

breathing-related sleep disorders

A

obstructive sleep apnea
central sleep apnea
sleep-related hypoventilation

44
Q

2 types of diagnostic criteria for obstructive sleep apnea

A

-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
Q

mild obstructive sleep apnea

A

apnea-hypopnea index <15

46
Q

moderate obstructive sleep apnea

A

apnea-hypopnea index 15-30

47
Q

severe obstructive sleep apnea

A

apnea-hypopnea index >30

48
Q

apnea

A

total absence of airflow

49
Q

hypopnea

A

diminished airflow

50
Q

common nonspecific symptoms of obstructive sleep apnea

A

-heartburn
-nocturia
-morning headaches
-dry mouth
-ED and reduced libido

51
Q

diagnostic criteria for central sleep apnea

A

polysomnography shows 5+ central sleep apnea episodes per hour not better explained by another sleep disorder

52
Q

specifiers for central sleep apnea

A

idiopathic
cheyne-stokes breathing
comorbid w/ opioid use

53
Q

cheyne-stokes breathing

A

periodic crescendo/decrescendo variation in tidal volume resulting in apneas/hypopneas

54
Q

onset of Cheyne Stokes breathing is typically associated with what

A

development of HF

55
Q

diagnostic criteria for sleep-related hypoventilation

A

polysomnography shows episodes of decreased respirations associated with increased CO2 levels

56
Q

specifiers for sleep-related hypoventilation

A

idiopathic
congenital central alveolar
comorbidities

57
Q

idiopathic hypoventilation

A

not attributable to any readily identifiable condition

58
Q

congenital central alveolar hypoventilation

A

perinatal shallow breathing or cyanosis/apnea during sleep

59
Q

comorbid sleep-related hypoventilation

A

occurs as a consequence of a medical condition

60
Q

diagnostic markers for sleep-related hypoventilation

A

-increased arterial pCO2 to >55mmHg during sleep
OR
-greater than or equal to 10mmHg increase in pCO2 levels over awake supine values

61
Q

types of circadian rhythm sleep wake cycle disorders

A

delayed sleep phase type
advanced sleep phase type
irregular sleep phase type
non-24 hour sleep wake cycle
shift work type
unspecified type

62
Q

definition of delayed sleep phase type

A

delayed sleep onset/awakening (usually greater than 2 hours) w/ inability to sleep/wake at desired times

63
Q

definition of advanced sleep phase type

A

advanced sleep onset/awakening with inability to stay awake/asleep until desired time

64
Q

definition of irregular sleep phase type

A

temporarily disorganized sleep-wake cycle w/ variable timing of sleep/wake periods throughout the day

65
Q

definition of non-24-hour sleep/wake type

A

sleep/wake cycle not synced to 24 hour environment with consistent daily drift of onset/wake times

66
Q

episodic circadian rhythm disorders

A

lasting at least 1 month but less than 3

67
Q

persistent circadian sleep wake disorders

A

lasts 3+ months

68
Q

recurrent circadian rhythm sleep wake cycles

A

2+ episodes in a year

69
Q

definition of irregular sleep wake type

A

complete lack of circadian rhythm
no major sleep period
sleep is fragmented into at least 3 periods during 24 hours

70
Q

definition of non-24 hour sleep wake type

A

c/o insomnia/hypersomnia r/t lack of synchronization between light/dark and circadian cycles

71
Q

sleep latency/sleep phase in non-24-hour sleep-wake type

A

sleep latency gradually increases until sleep onset insomnia. Sleep phase drifts so sleep is in daytime w/ c/o hypersomnia

72
Q

what types of patients typically develop non-24-hour sleep wake cycle type

A

visually impaired. Rare in sighted people

73
Q

dx and symptoms of shift-work type

A

dx made primarily based on hx of shift work w/ c/o sleepiness at work and difficulties sleeping at home

74
Q

list the different parasomnias

A

NREM sleep arousal disorders
nightmare disorder
REM sleep behavior disorder

75
Q

diagnostic criteria for NREM sleep arousal disorder parasomnia

A

episodes of incomplete waking accompanied by either sleepwalking or sleep terrors that the patient doesn’t remember2

76
Q

types of sleepwalking

A

with sleep eating
with sleep-related sexual behavior

77
Q

onset of sleepwalking in adulthood should prompt suspicion of what

A

sleep apnea, nocturnal seizures, or medication side effects

78
Q

diagnostic criteria for nightmare disorder

A

repeated nightmares that rapidly awake patient and cause clinically significant distress

79
Q

specifiers for nightmare disorder

A

during sleep onset
comorbidity
duration
severity

80
Q

comorbidity specifiers for nightmare disorder

A

with mental disorder
with medical condition
with another sleep disorder
(code comorbid disorder after nightmare disorder)

81
Q

duration specifier for nightmare disorder

A

acute - 1 month or less
subacute - >1 month, <6 months
persistent - longer than 6 months

82
Q

severity specifiers for nightmare disorder

A

mild - <1 episode/week
moderate - 1+ episode/week, less than nightly
severe - nightly

83
Q

diagnostic criteria for REM sleep behavior disorder parasomnia

A

repeated arousals w/ vocalization and/or complex behaviors

84
Q

what phase of sleep does REM sleep behavior disorder arise from

A

REM
usually in later half of night

85
Q

main adverse effect of REM sleep behavior disorder parasomnia

A

significant injury from “acting out dreams”

86
Q

definition of restless leg syndrome

A

frequent urge to move legs in response to uncomfortable sensations

87
Q

characteristics of urges in RLS that are required for dx

A

-worsens during rest/inactivity
-partially/totally relieved by movement
-worse in the evening/night

88
Q

duration of symptoms for RLS dx

A

at least 3x/wk for at least 3 months

89
Q

what is NOT typical on exam for RLS

A

-leg cramps relieved w/ 1 position change
-joint limitations
-soreness on palpation

90
Q

type specifiers for substance/medication-induced sleep disorder

A

insomnia type
daytime sleepiness type
parasomnia type (abnormal sleep behaviors)
mixed type

91
Q

what are onset specifiers for substance/medication-induced sleep disorder

A

onset during intoxication
onset during withdrawal
onset after medication use

DSM5 (18 decks)

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