TRANS 068: Sleep Disorders Flashcards by Amiel Lorenzo

what sleep induces EEG “ripples” in the
hippocampus and association cortex that
play a role in consolidating memories

nREM

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INTERMEDIATE SLEEP DEPRIVATION what will be the results?

More burn out
Worsened depression & anxiety
Less resilience
Lack of a sense of wellness

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Long term sleep deprivation what are the results?

• Correlates with less resistance to stress and immune function
• Correlates with obesity, Type 2 Diabetes, and atherosclerotic
diseases
• Degenerative Disease
 Correlate with dementia

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People with Poor [NREM/REM] sleep are more likely to develop dementia and Alzheimer’s disease

REM

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If you get the most [REM/NREM] sleep, your will actually have longer life than if you are in the bottom percentile

REM

Short REM sleep= short life expectancy

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how long is a sleep cycle?

90 mins

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in what sleep that when we wake up, we will feel we are at our best?

REM sleep

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All OTC sleep aids*, alcohol, barbiturates, most benzodiazepines, narcotics and anesthetics (including propofol) inhibit [REM/NREM] sleep.

REM

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Most sleepy times of day:

3-6am

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When you live in a place with no lighting, your circadian rhythm will stay in sync with the sun/daytime.
 When you have artificial light, your brain chooses when to sleep.

which statement is true?

BOTH

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CAUSES OF EXCESSIVE SLEEPINESS

• Too little sleep
o Fragmented sleep
o Circadian rhythm disturbance

• Other conditions that masquerade as fatigue
o Mood disorder/burnout
o Hypothyroidism
o Medications or other substances

• Primary sleep disorders
o Obstructive Sleep Apnea
o Parasomnias

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• Most young adults require_______sleep cycles. _______ hrs of sleep each night (52 hrs/wk)

5-6

7.5 – 9 hrs

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• Being awakened during sleep that disrupts sleep cycles also leads to fatigue. T or F?

• Knowing you MAY be awakened changes sleep patterns
o Examples: Nursing Moms
o Physicians being on call

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Increased following sleep deprivation

* Occurs after being asleep for 30mins while in deep (slow wave) sleep

Sleep drunkenness

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• AKA
o Sleep inertia
o Sleep confusion
• Symptoms
o Confusion
o Amnesia

Sleep drunkenness

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CIRCADIAN RHYTHM SLEEPINESS happens when?

Jet lag
Shift work
Physicians on call

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Blue spectrum light [decreases/increases] melatonin production and hence decreases sleepiness
o Especially in children and adolescents

decreases

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Gadgets themselves can disrupt sleep

* Content is stimulating T or F?

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Secondary causes of sleepiness?

Mood disorders

Metabolic derangements

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how does sleep lead to mood d/o?

Anxiety and depression disrupt sleep
Early morning awakening
Lack of sleep worsens mood disorders

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one of the cardinal symptoms of mood disorde

insomnia

You cannot effectively treat depression or anxiety unless you re-establish normal sleep/wake cycles. T or F?

The essential thing is getting the [NREM/REM] sleep or else, no matter what you do, if the patient is depressed or anxious, they will not be able to overcome their mood disorders.

REM

What kind of medicine re-establish normal REM sleep?

SSRI

what drug interfere with the natural sleep cycles.

Narcotics and barbiturates

what metabolic derangements interferes with sleep?

* Hypothyroidism * Most metabolic abnormalities * Many medications and drugs

```  One of the most common primary sleep disorder? • Loud snoring • Breathing cessation • Abrupt awakenings gasping • Excessive daytime sleepiness • Morning headaches ```

Obstructive sleep apnea

Factors that lead to obstructive sleep apnea?

``` • Factors: o Affects up to 10% of people over the age of 50 o Obesity o Men>women o Older age, HTN, smoking ```

Untreated OSA1 shortens life expectancy by up to____ years.

Tx of OSA?

* Weight loss * Exercise * Avoid alcohol, sedatives, smoking * Sleep on side, not back * CPAP2 * Dental Device * Uvulopalatopharyngoplasty

Cutting off the uvula

Uvulopalatopharyngoplasty

Loss of hypothalamic neurons that produce hypocretins (orexins) • Associated with changes in HLA-DQB1 • Leads to instability of REM sleep

Narcolepsy Cataplexy

REM sleep instead of coming mid(?)-late at the end of your 90-min sleep cycle, tends to come in at times you are not expecting it.

Narcolepsy Cataplexy

sudden attacks of sleepiness

Narcolepsy

sudden loss of muscle tone while awake

Cataplexy

In [REM/NREM] sleep, all the muscle tone are turned off, so even though you are dreaming, you don’t move your arms/legs.

REM

In __________, you don’t go to sleep, you’re just falling down, you can’t move and then you gradually get up.

cataplexy

vivid dreams are known as

Hypnogogic Hallucinations

transient paralysis while awakening  Lasts for a bout a minute or two. The first time that it happens, you are panic stricken. A horrible feeling to have. You don’t die of sleep paralysis.

Sleep paralysis

Tx for narcolepsy cataplexy

* Treat with good sleep hygiene * Antidepressants * Na Oxibate

``` • About 1% • More common o >50 years of age o Men o Parkinson’s Disease and MSA • Easy to awaken • Remember dream ``` what diosrder?

REM BEHAVIORAL D/o

``` o Deep sleep o Children o Seem awake but amnestic o Inconsolable screaming o Very hard to awaken ``` what sleep disorder?

Night terror

o Deep sleep o Children o Seem awake but amnestic o Walking, eating, driving, having sex waht sleep diosrder?

Sleep walking

• Patient feels like they want to move legs • Worse at night  This is a lack of dopamine phenomenon

RESTLESS LEG SYNDROME

Tx for Restless leg syndrome?

• Iron supplementation • Exercise • Dopamine agonists o Ropinirole, Rotigotine, and Pramipexole

How to improve sleep in general?

• Exercise daily o Most people do better if strenuous exercise is not just before bedtime o As little as 10 minutes of moderate exercise helps • Expose yourself to sunlight during the day • Address mood disorders • Naps o 30 to 90 minutes okay if that is part of your routine o Not close to bedtime • Avoid: o Drugs o Cigarettes o Alcohol o Sleeping pills o Large meals close to bedtime

How to listen to your circadian rhythm?

* Go to bed when you are tired * As much as possible, maintain a regular bedtime and a regular awakening time * Follow a relaxing bedtime routine * Plan for sleep based on 90 minutes * Never “toss and turn” in bed for longer than 20 minutes

how to make bedrooms pleasant?

``` • Dark • Comfortable temperature • Well-ventilated • Quiet o White noise • Comfortable bed • Use bedroom only for sleeping and sexual intimacy o Do not treat the bedroom as a lounge ```

how to schedule worry time?

• Suggestions: o Schedule a time to worry prior to bedtime o Resolve to write down concerns that you think about so you can deal with them in the morning

how to practice relaxation

• Relax muscles • Think of three things you are thankful for o Write them down • Imaging a pleasant scene

Some bedtime routine?

``` • Think of three things you are thankful for o Thank God for them • Set aside problems o Turn them over to God • Contemplate o God’s wonderfulness ```