Week 04: Sleep

Question 1

What is SDB?

Answer 1

Sleep-disordered breathing

Question 2

What is leptin?

Answer 2

satiety hormone

Question 3

What does leptin have to do with sleep and obesity?

Answer 3

lack of sleep increases leptin resistance which leads to obesity

Question 4

When does the sleep cycle/circadian rhythm start to establish in a child?

Answer 4

2-4 months of age

Question 5

How long does a typical sleep cycle last?

Answer 5

90 minutes

Question 6

How many non-REM stages are there?

Answer 6

3

Question 7

What are the non-REM stages?

Answer 7

NREM 1: eye movements/eye rolling
NREM 2
NREM 3: difficult to arouse

Question 8

What happens during REM sleep?

Answer 8

muscle paralysis

vivid dreams

Question 9

How much of sleep is REM sleep for infants?

Answer 9

50%

Question 10

How much of sleep is REM sleep at age 5?

Answer 10

25%

Question 11

symptoms of lack of sleep

Answer 11

excitable
more anxiety
intense fatigue

Question 12

At what age do babies no longer need nighttime feeds?

Answer 12

6 months onward

Question 13

At what age do most babies start sleeping through the night?

Answer 13

3 months

Question 14

How long do babies keep the 2nd nap?

Answer 14

age 1

Question 15

When do children often give up the afternoon nap?

Answer 15

age 3

Question 16

DEFINE: night wakening

Answer 16

a child awakens >= 1x between 12A-5A
4-7x per week
>4 consecutive weeks

Question 17

What is the FERBER METHOD?

Answer 17

a sleep training method that teaches self-soothing

Question 18

Define SIDS

Answer 18

death of an infant (< age 1) during sleep

Question 19

Known associations with SIDS

Answer 19

not breastfeeding
smokers in the house
sleep on tummy

Question 20

School-age sleep struggles: when to cut out screen time?

Answer 20

at least 1 hour before bed

Question 21

Define PARASOMNIAS

Answer 21

sleep disorder that causes abnormal behavior while sleeping

Question 22

Parasomnia: normal or abnormal

Answer 22

COMMON in childhood; decreases with age

Question 23

What can lead to parasomnias?

Answer 23

fever
sleep deprivation
overly busy day
some medications
alcohol in a teenager
emotional stress
stimulants
antihistamines
menstruation

Question 24

Should kids use Benadryl?

Answer 24

generally not due to respiratory depression effects; NOT recommended to aid with sleep; if child needs something like Benadryl, use Allegra or Claritin instead

Question 25

DEFINE: bruxism

Answer 25

grinding of teeth at night

Question 26

Name some parasomnias

Answer 26

``` sleepwalking sleeptalking night terrors RLS enuresis bruxism ```

Question 27

What parasomnias do boys tend to experience more?

Answer 27

sleep talking

Question 28

What parasomnia do girls tend to experience more?

Answer 28

RLS

Question 29

Parasomnias tend to decrease except for which 3, which are more common at age 13?

Answer 29

sleeptalking RLS bruxism

Question 30

Night terrors: more in boys or girls?

Answer 30

boys

Question 31

What kind of family history makes night terrors more common?

Answer 31

FHx enuresis/sleepwalking in 1st degree relatives

Question 32

When do sleep terrors tend to occur?

Answer 32

During 1st 3rd of sleep, stage 3-4

Question 33

What medications can be beneficial for sleep terrors? Who prescribes them?

Answer 33

benzodiazepines, typically prescribed by sleep clinic

Question 34

For whom are sleep terrors associated with a neurological or psychiatric disorder?

Answer 34

Child: generally not Adult: can be manifestation of PTSD **Can be manifestation of a seizure

Question 35

When do NIGHTMARES tend to occur?

Answer 35

LATE in the sleep cycle | 3-6 years

Question 36

When do NIGHT TERRORS tend to occur?

Answer 36

EARLY in sleep cycle | ages 4-8

Question 37

Issues with sleep bruxism

Answer 37

can damage teeth --> refer to dentist IF CHILD doesn't outgrow it

Question 38

For whom does sleepwalking more commonly occur?

Answer 38

FHx of sleepwalking

Question 39

Major concern with sleepwalking

Answer 39

safety

Question 40

Treatment for sleepwalking

Answer 40

benzodiazepines or sedating anti-depressants: these are prescribed by a sleep clinic and NOT primary care

Question 41

DEFINE: nocturnal enuresis

Answer 41

bedwetting

Question 42

Why does nocturnal enuresis occur?

Answer 42

child develops bladder pressure during deep sleep

Question 43

For whom does nocturnal enuresis more commonly occur?

Answer 43

FHx of nocturnal enuresis kiddos with: OSA constipation

Question 44

What is PRIMARY ENURESIS vs. SECONDARY ENURESIS?

Answer 44

PRIMARY: never attain dryness SECONDARY: previously potty trained and dry for 6 months and nighttime wetting is happening again

Question 45

Treatments for nocturnal enuresis

Answer 45

- behavior modifications (until ages 6-8): adequately hydrate earlier in the day; limit at night - double void: pee when dressing for bed; do bedtime routine; void right before bed - nighttime voids: wake child prior to when child typically wets the bed - alarm systems (try for 2-3 months): to arouse child enough that they awaken before an accident

Question 46

If using an alarm system for nocturnal enuresis, how many nights in a row does a child need to be dry in order to stop using it?

Answer 46

14

Question 47

Drug used to treat nocturnal enuresis

Answer 47

DDAVP (desmopressin 0.2mg)

Question 48

ISSUEs with using DDAVP for nocturnal enuresis

Answer 48

reduces urine volume at night, but there is high relapse rate nasal spray not recommended due to higher adverse effect of hyponatremia

Question 49

If prescribing desmopressin for nocturnal enuresis, how long should a child use it?

Answer 49

stop it every 3 months to see if child has stopped bedwetting

Question 50

Tips for SLEEP HYGIENE

Answer 50

cut off screen time 1 hour before bed comfortable environment all night lights > 6' from bed; dark if possible nothing high energy right before bed; do something relaxing

Question 51

When do nocturnal penile erections typically begin?

Answer 51

13 years, 2 months | but can happen in utero; occurs throughout life

Question 52

What is Delayed Sleep Phase Syndrome?

Answer 52

difficulty falling asleep until early morning hours, but no trouble sleeping once they fall asleep

Question 53

With what is Delayed Sleep Phase Syndrome associated?

Answer 53

melatonin off vitamin D deficiency vitamin B12 deficiency

Question 54

What is used to treat Delayed Sleep Phase Syndrome?

Answer 54

melatonin, 1mg - 10mg 40-60min before bed short term is the best so you don't throw off innate melatonin and circadian rhythm

Question 55

What is associated with OSA?

Answer 55

obesity | large adenoids

Question 56

Medical word for sleep study

Answer 56

polysomnography

Question 57

What are nocturnal seizures?

Answer 57

can mask as disturbed sleep more common in children more common in 1st 2 hours of sleep