14de Sleep and PTSD

Question 0

Stage 1 sleep

Answer 0

Theta waves

• 5% sleep
• 10 mins
• slow regular breathing, =HR, dec. BP temp and cranial blood flow,
• easily awoken

Question 1

Rem sleep

Answer 1

Random pattern with sawtooth waves

• 25% of sleep
• 90 minute cycles 10-40 minutes each
• ^ Bp, pulse, resp
• erection
• Skeletal muscle paralysis
• dreams

Question 2

Stage 2 sleep

Answer 2

K complexes and sleep spindles

• 45% sleep (MOST TIME)
• 20 mins
• slowing bodily functions
• blindness
• awoken by sounds

Question 3

Stage 3 and 4

Answer 3

Delta waves

• 25% sleep- most during first 1/2 of night
• 30-45 mins after start of sleep
• wakens only to loud noises and active wakening attempts
• Stage 4 is disoriented upon awakening

Question 4

Awake

Answer 4

Alpha and beta waves

Question 5

Aging sleep changes

Answer 5

• Increased latency and awakenings

* decreased REM and DELTA

Question 6

Depression sleep changes

Answer 6

• Frequent awakenings, early waking
• Decreased rem latency- INCREASED REM
• Decreased DELTA

Question 7

Dyssomnias

Answer 7

Abnormal timing

• Narcolepsy
• Cicadian rhythm sleep disorder

Abnormal quality

• RLS
• Apnea

Abnormal amount

• insomnia
• hypersomnia

Question 8

Parasomnia

Answer 8

Bruxism -stage 2
Night terror and sleepwalking - DELTA
REM sleep behavior disorder

Question 9

Narcolepsy

Answer 9

• Sleep attacks
• hallucinations hypnagogic(going to sleep)and(hypnopompic)post sleep
• cataplexy
• sleep paralysis

-decreased sleep latency, decreased rem latency, less rem

• Orexin D
• adolescent
• significant genetic component

Tx: Schedduled naps, stimulants: ritalin/methylphenidate and modafinil/provigil

Question 10

Circadian Rhythm sleep disorder

Answer 10

• inability to sleep at appropriate times (delayed or advanced)
• blindness, head trauma, shift work etc.

Tx: Melatonin for delayed, Light for Advanced
Modafinil/caffeine for shift work, Melatonin/hypnotic at bed

Question 11

RLS

Answer 11

• uncomfortable sensation in legs leading to jerking
• frequent awakenings
• older adults

TX:
Anti-parkinsonian agents
Levodopa, carbidopa, ropinarole

Question 12

Apnea

Answer 12

Cessation of breathing
Frequent reawakenings
increased risk sudden death

Tx: weightloss, CPAP, Medroxyprogesterone acetate, uvuloplasty/tracheostomy

Question 13

Insomnia

Answer 13

Increased sleep latency and awakenings
>3x/wk, one month or more
Daytime sleepiness
*30% population
*cognative impairment common

Tx:
No caffeine, AM exercise, Sleep routine and relaxation technicques, Hypnotics

Question 14

Bruxism

Answer 14

STAGE 2

Tx: dental appliance

Question 15

REM Sleep behavior disorder

Answer 15

Motor activity while dreaming
Awakens with dream memory
Associated with parkinson diseasee and LBD

Tx:
melatonin, low dose benzos, and environment protection

Question 16

PTSD

Answer 16

• repeated re-experiencing threat of death, serious injury, or sexual violence directly or in close proximity
• symptoms last > 1 month
• significant distress
• Repeated intrusions/relivings
• avoidance of stimuli associated with trauma
• Hyperarousal
• Emotional Numbing

Question 17

PTSD epidemiology

Answer 17

40-45% of natural disaster survivors, Disaster workers
6.8% US adults - 3.6% men, 9.7% women

30.9% male vietnam vets, 26.9% female vietnam vets
10-30%firefighters
19.3% EMS
13.8% Iraqi and enduring freedom
12% gulf war vets
10-15% law enforcement

Question 18

PTSD Neurophys

Answer 18

Increased Amygdala response:

• Safe or not safe barometer- ANXIETY
• Lateral amygdala input
• central amygdala output

Decreased Hippocampus
*contextualizes fear - is lion in cage or free

Less prefrontal cortex activation
*Shutoff of communication and higher level processing by amygdala

Question 19

PTSD Psychotherapy

Answer 19

• Traumatic memories stored with High arousal- Must be accessed wit high arousal
• Anxiety helps us avoid fear evoking stimuli
• Avoidance blocks exposure that promotes extinction - re-expose to fix

Question 20

PTSD CBT

Answer 20

• Most effective
• Stress inoculation- desensitization
• imagery rescripting and reprocessing
• Congnative restructuring within reliving
• Imaginal/In Vivo exposure
• Cognative processing therapy

Question 21

PTSD Screening Type I trauma

Answer 21

Have you experienced any vivd thoughts about event?
What do you believe caused event?
Are you able to return to the place of event?
What do you think could have been done to prevent event?

Question 22

PTSD screening tool

Answer 22

• Concentration problems?
• sleep disturbances?
• Hyper-vigilance/ increased startle
• Increased irritability
• Changes in mood
• appetite changes

Question 23

PTSD Type II trauma screening

Answer 23

• somatic complaints with neg diagnostic testing
• chronic depression/anxiety
• difficulty sleeping
• difficulty concentrating
• memory problems
• flashbacks/nightmares
• increased startle response
• difficult with certain foods
• difficulty with anger
• Trust issues