Sleep_EO Flashcards
What’s to know about NREM?
75% of night
Slowed autonomic system (low BP, low T, low HR)
When Beta waves?
Awake
When alpha waves?
Drowsy but awake with eyes closed
When theta waves?
N1 507hz 5% of the night Hall hypnagogiques «Rolling eyes»
When k complexes and spindles?
N2 45% of night Also theta waves 12-14hz No eye mvt
When slow wave sleep?
N3
12-13% of night (most of it during first 1/3 of night)
0.5-4Hz
Delta waves
What’s to know about REM sleep?
25% of the night
Autonomic activity increased (BP, HR, T)
Fast, low voltage with sawtooth waves
Theta and beta
Penile erection
Paralysis
Dreams are abstract and weird (vs NREM dreams are lucid)
Majority of rem happens in the last third of the night
Q90 mins ; first REM is short (10min) and increases during the night ad 45min
No REM during naps
Elderly and changes in sleep
1- need stays the same
2- total sleep same
3- more fractionnated sleep
4- reduced N3 (SWS) but increased N1 and N2
5- sleep latency increased
6- reduced tot REM sleep (more frequent but shorter)
7-advances circadian cycle
what’s the purpose of the suprachiasmatic nucleus in sleep?
Circadien rythm
Site of action of melatonie
Which neurotransmitters are pro-REM and anti-REM?
Pre: Ach
Anti: NE and 5HT
Which neurotransmitters favor sleep and favor awake?
Sleep: Ach
Awake: NE, orexin (hypocretin), hist, dopamine, glutamate
Anatomic site of REM?
Reticular formation
Pons
What is the tx of narcolepsy?
Planned naps during the day
Modafinil for sleep attacks
SSRI/SNRI/TCA for sleep paralysis, cataplexie and hall
Sodium oxybate for all above
What can happen clinically in narcolepsy (4)?
1-sleep attacks (2-6 times per day)
2- cataplexie: sudden loss of tonus, preserved sensorium, precipitated by strong emotions
3-hypnopomp/hypnagog hall : REM sleep starts when almost awake, usually visual and vivid
4-sleep paralysis
DSM criteria for narcolepsy?
A. Sleep attacks at least 3x per week for at least 3 months
B. One of the following:
1-cataplexie several times per months
2-hypocretine deficiency in LCR
3-PSMG, REM latency < 15min OR sleep latency <8 min with >2 sleep-onset REM au MSLT (multiple sleep latency test)
What are the indications of polysomnography?
Hypersomnolence Narcolepsy Breathing related sleep disorders Violent behavior in sleep Uncertain dx Pt non-responding to tx
What’s measured in PSG?
EEG EOG *eye mvt EMG Airflow (oral and nasal) Oxiometry Respiratory effort (abdo thoraciq movement) EKG Capnography
Name the breathing related sleep disorders DSM diagnosis
What’s to know about breathing related sleep disorders?
1-Obstructive sleep apnea
2-central sleep apnea
3-sleep related hypoventilation
Risk factors for OSA: male, middle age, obesity, micrognatie, retrognatia, hypot4, acromegalia
Most frequent complaint is daily somnolence
20 % prevalence
tx: lose weight, sleep on back, CPAP, sx, stop etoh and sedatives
In central sleep apnea, there is no respiratory effort during apnea (*vs effort in OSA). Often secondary to carida and neurological issues. More often in elderly. No snoring.
What is the most important risk factor of insomnia?
Past episode of primary insomnia
What are the DSM criteria for insmonia disorder?
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one of:
- Diff initiating sleep
- Frequent awakenings
- Early-morning awakenings
B. Sleep disturbance cause significant distress/impairment
C. At least 3 nights per week
D. For at least 3 months
E. The sleep diff occurs despite adequate opportunity to sleep
F. The insomnia is not better explained by another sleep-wake do, substance or GMC
Specifyers: With non-sleep disorder mental comorbidity including SUD With other medical comorb With other sleep do Episodic (at least 1 mo less 3 mo) persistent (3 mo or longer) or recurrent (2 or more in 1 yr)
Treatent of insomnia do?
CTBi first line
- psychoed on sleep hygene and stimuli control (wake up same hour, use bed only for sleep, no nap)
- restriction of sleep (reduce time spent in bed to increase sleep efficacy. When 85% is reach, increae time in bed 15 min at a time)
Cogitive therapy is second line (decrease importance and consequence of lack of sleep, reduce rx, relaxation techniques)
Rx only temporary (<4 weeks), low dose, intermittent use, short-half life, no recommended for chronic insomnia
What is hypersomnolence disorder?
A. Self reported excessive sleepiness despite a main sleep period lasting at least 7hrs, with at least one:
- recurrent periods of sleep or lapses into leep within the same day
- 9 hours of sleep per day that is nonrestorative
- difficulty being fully awake after abrupt awakening
B. At least 3 timers per wekk for at least 3 months
Usually starts 15-25 yo and tends to become chronic
What are the main types of circadian rythm sleep-wake disorders?
1) Delayed sleep phase type: most common, normal sleep once initiated, endogenous rythm affected (T, melatonin)
2) Advance sleep phase type: tx: luminothx in evening
3) Irregular sleep-wake type: associated with neurodegenerative do
4) Non-24 hours sleep-wake type: in 50% of blind, tx: melatonine HS
5) Shift work type: in 5-10% of night shift workers, tx: naps before work, minimise sun before going to bed (wear sunglasses)
6) Unspecified
7) jet-lag: atteinte proportionnelle au nombre de fuseaux horaire traversés (worse if 8 or more in less than 24hrs). Travel toward east is worse. Tx: melatonin
What are the criteria of circadian rythm sleep-wake do?
A. A persistent patter of sleep disruption that is due to an alteration of the circadian system (misalignement between the endogenous circadian rythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B. The sleep disruption leads to excessive sleepiness or insomnia or both
C. Cause distress impairment
What is the DSM criteria for non-REM sleep arousal disorder?
A. recurrent episodes of incomplete awakening from sleep, usually occuring during the first third of the night, accompanied by one of:
1. Sleepwalking
2. Sleep terro
B. No or little dream imagery is recalled
C. Amnesia for the episode is present
What’s to know about sleep terrors?
- Non-REM
- intense fear
- autonomic signs: mydriases, tachycardia, tachypnea, sweating
- Hx familiale
- R/O temporal epilepsia
- M>F
- unconsolable
- Tx: SSRI, psychotherapy, avoid Etoh, sedativs, stress, sleep deprivation
What’s to know about sleep walking?
- Non-REM paraspmnia
- first third of night in SWS
- family Hx
- automatism, eyes open, no facial expression
- Peaks 4-8 yo, usually disapears spontaneously in adolescence
- specify if sleep-related eating or sleep-related sexsomnia
- Tx: SSRI, during episode bring back person to bed, avoid Etoh, benzo, zolpidem, stress…
What are DSM criteria of nightmare disorder?
A. Repeated occurence of extended extremly dysphoric and well-remembered dreams that usually involve efforts to avoid threats to survival, security or physical integrety and that generally occur during the second half of the night
B. On awakening, the individual becomes rapidly oriented
What’s to know about nightmare disorders?
Usually starts between 3-6 yo
Rare in adults
BPD, schizotypal and scz are at riks
During REM, so no mvt
Specify if acute (less one months), subagute (1-6mo), persistant (+ 6 mo)
Specify severity (mild = less than one per week) (moderate=one episode or more per week), severe is Qnight
Tx: SSRI and ATD because it supresses REM sleep
Avoid L-dopa, B-blockers
What are the DSM criteria for REM sleep behavior disorder?
A. Repeated episodes of arousal during sleep associated with vocalization and or complex motor behaviors
B. These behavior arise during REM and are more frequent during the end of the night
C. Upon awakening fom these episode, the individual is completely alert and not confused
D. Either of the following
-REM sleep without atonia on PSG
-a hx suggestive of REM sleep behavior do and an established alpha synucleiopathy
What’s to know about REM sleep behavior do?
Remembers dream with violent content (acts the dream)
Tx: melatonine, clonazepam
Precipitants: SSRI, IMA, TCA, B-blocker, Etoh withdrawal
What are the DSM criteria for restless legs syndrome?
A. Urge to move the legs, accompanied with uncomfortable sensations in the legs and all of
-urge to move the legs begins or worsens during period of inactivity
-urge relieved by mvt
-urge worsens in evening or at night
B. Sx in A occur at least 3 times per week for at least 3 months
What’s a synonyme for restless legs syndrome?
Willis-Ekbom disease
What causes restless legs syndrome?
Idiopathic Anemia (baisse de fer serique) Acid folic deficits Renal insufficiancy Rhumatoir arthritis Diabetes Thyroid anomalies Neuropathies periph SSRI, antipsychotics, alcohhol, cafeein, nicotine NOT MENOPAUSE
What’s to know about restless leg syndrome?
Usually starts around 20-30 yo
50-90% family hx
If starts after 45, predicts alpha synucleopathies
International restelss legs scale is gold standard
Pharmaco tx: pramipexole, L-Dopa, gabapentin, bzd
