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Diagnosis_Management 1 > sleep/wake disorders > Flashcards

sleep/wake disorders Flashcards

1
Q

clinical presentation of insomnia disorder

A

difficulty falling asleep, staying asleep, or early morning awakening with inability to return to sleep sufficient enough to impair function

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2
Q

clinical presentation of hypersomnolence disorder

A

excessive sleeping/sleepiness not d/t disrupted circadian rhythm problems

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3
Q

clinical presentation of narcolepsy

A

overwhelming desire to fall asleep (may do so spontaneously) when inappropriate. May experience cataplexy

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4
Q

definition of cataplexy

A

sudden loss of muscle tone while conscious ranging from transient weakness to complete paralysis that is often precipitated by laughter or strong emotions

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5
Q

what is psychophysiologic insomnia

A

conditioned to remain awake when thinking of sleeping

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6
Q

what is idiopathic insomnia

A

lifelong difficulty obtaining adequate sleep

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7
Q

what is paradoxical insomnia

A

person thinks they are awake and having insomnia but EEG shows healthy sleep

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8
Q

definition of klein-levin syndrome

A

recurrent periods of prolonged sleep with intermittent periods of healthy sleep and alert waking

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9
Q

classic presentation of klein-levin syndrome

A

18-20 hour sleep period with waking time characterized by voracious eating, hypersexuality, and disinhibition

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10
Q

what deficit is highly associated with narcolepsy

A

hypocretin

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11
Q

what are the types of central sleep apnea

A

idiopathic
cheyne-stokes breathing
comorbid with opioids
high altitude periodic breathing
d/t medical disorder
d/t substance
primary sleep apnea of infancy

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12
Q

types of circadian rhythm sleep wake disorders

A

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

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13
Q

difference between irregular sleep-wake type and non-24-hour sleep-wake type

A

irregular is unpredictable w/ no discernable circadian rhythm and non-24-hour circadian cycle is longer or shorter than 24 hours so sleep phases drift

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14
Q

types of parasomnias

A

NREM-related parasomnias
REM-related parasomnias

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15
Q

types of NREM-related parasomnias

A

sleepwalking
sleep terrors
confusional arousals
sleep-related eating disorder

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16
Q

what sleep phase does sleepwalking occur in

A

slow-wave sleep

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17
Q

another term for sleepwalking

A

somnambulism

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18
Q

sleep phase that sleep terrrors occur in

A

slow-wave sleep

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19
Q

REM related parasomnias

A

nightmare disorder
REM sleep behavior disorder
recurrent isolated sleep paralysis

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20
Q

when does sleep paralysis become a parasomnia

A

when it occurs at sleep onset or arousal

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21
Q

what are the other, less common parasomnias

A

exploding head syndrome
sleep-related hallucinations
sleep enuresis
d/t substance
d/t medical condition

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22
Q

what do yo always check in RLS

A

ferritin level

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23
Q

definition of periodic limb movement disorder

A

brief stereotypic repetitive movements of limbs usually in NREM approximately every 20-40 seconds and frequently associated with brief arousals and involves extension of big toe

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24
Q

which conditions can cause periodic limb movement disorder

A

folate deficiency
renal disease
anemia
antidepressant use

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25
Q

what is sleep-related bruxism?

A

grinding teeth in sleep

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26
Q

definition of sleep-related rhythmic movement disorder

A

repetitive movements typically involving head/neck occurring during transition from wakefulness to sleep or in light sleep

27
Q

clinical tests for sleep disorders

A

polysomnography
home sleep test
multiple sleep latency test
maintenance of wakefulness test
actigraphy

28
Q

what clinical test is needed for dx of narcolepsy

A

multiple sleep latency test

29
Q

what confirms dx of narcolepsy

A

REM sleep on 2+ nap occasions

30
Q

what is a multiple sleep latency test

A

provided opportunity for 20 minute nap every 2 hours without resisting sleep to determine sleep stage and sleep latency

31
Q

what is a maintenance of wakefulness test

A

40 minutes sessions every 2 hours where patient sits in a dark room in a comfortable chair with a pillow and sleep latency is measured

32
Q

what is actigraphy

A

device worn on wrist that measures and records movement

33
Q

treatment options for insomnia

A

meds
CBT
universal sleep hygeine
stimulus control therapy
sleep restriction therapy
cognitive therapy
paradoxical intention

34
Q

First-line pharmacologic treatment for insomnia

A

benzodiazepine receptor agonists (Z drugs)

35
Q

pharmacologic treatments for insomnia other than Z drugs

A

benzodiazepines
low-dose antihistamine (doxepin)
melatonin
ramelteon
suvorexant

36
Q

what is sleep restriction therapy

A

decreasing time spent awake in bed and avoid naps

37
Q

what is stimulus control therapy

A

rules for sleep routines that must be followed consistently

38
Q

types of relaxation therapy techniques

A

self-hypnosis
progressive muscle relaxation
guided imagery
breathing exercises

39
Q

what is used to treat hypersomnolence disorder

A

usually stimulants

40
Q

what are the wake-promoting agents utilized for narcolepsy

A

pitolisant
solriamfetol

41
Q

REM sleep-repressing drugs used for narcolepsy

A

imipramine
protriptyline
sodium oxybate

42
Q

therapeutic approaches to treating narcolepsy

A

scheduled naps
lifestyle adjustments
counseling
drug holidays

43
Q

treatment options for obstructive sleep apnea

A

CPAP
BiPAP
oral appliance
position therapy
surgery
weight loss

44
Q

treatment options for circadian rhythm sleep-wake disorders

A

light therapy
medication
chronotherapy

45
Q

medication to treat nightmares

A

prazosin

46
Q

behavioral techniques for nightmare disorder

A

desensitization and exposure therapy
image rehearsal therapy
lucid dream therapy
cognitive therapy

47
Q

medication for sleep enuresis

A

desmopressin

48
Q

first line medications for RLS

A

pramipexole
rotigotine
ropinirole
(dopaminergic agonists)

49
Q

second-line meds for RLS

A

levodopa (dopamine precursor)
benzodiazepines
opiates
antiepileptics

50
Q

benzodiazepines used to treat insomnia

A

flurazepam
temazepam
quazepam
estazolam
triazolam

51
Q

nonbenzodiazepine agonists used to treat insomnia

A

zolpidem (Ambien)
zaleplon (Sonata)
eszopiclone (Lunesta)

52
Q

zolpidem peak concentration and half-life

A

peak in 1.5h
half-life 2.6h

53
Q

peak concentration and half-life of zaleplon

A

peak: 1h
half-life: 1h

54
Q

peak concentration and half-life of eszopiclone

A

peak: 1h
half-life 6h

55
Q

what is given for benzodiazepine OD that can also reveres ambien and sonata

A

flumazenil

56
Q

does tolerance develop to ambien/sonata

A

no

57
Q

dosage and clinical guidelines for Zaleplon

A

start 10mg (elderly and hepatic impairment 5mg)
need 4 hours of sleep
max dose 20mg

58
Q

dosage and clinical guidelines for eszopiclone

A

2-3mg
startin dose NTE 1mg w/ hepatic impairment or if taking CYP3A4 inhibitors

59
Q

dosage and clinical guidelines for zolpidem

A

5mg for females, elderly, and frail
5-10mg for males
impairs for 7-8 hours

60
Q

melatonin agonists used for insomnia

A

melatonin
ramelteon

61
Q

peak concentration and half-life of ramelteon

A

peak: 45 minutes
half-life: 1-2.6 hours

62
Q

dosage and clinical guidelines of ramelteon

A

8mg within 30min of bedtime
do not take w/ high-fat meals

63
Q

peak concentration and half-life of prazosin

A

peak: 3 hours
half-life: 2-3 hours

64
Q

dosage and clinical guidelines for prazosin

A

6-15mg in divided doses
(higher than 20mg not more effective)
reduce to 1-2mg TID if on diuretic or antihypertensive

Diagnosis_Management 1 (16 decks)

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