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Block 8 Week 1 Colt > Sleep and Medicolegal Issues - Rothrock > Flashcards

Sleep and Medicolegal Issues - Rothrock Flashcards

1
Q

what part of the brain regulates sleep? (be specific!!)

A

suprachiasmatic nuclei of the hypothalamus

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2
Q

What is the average sleep time in a newborn/

A

10-12 hours

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3
Q

What is the sleep time in an adolescent?

A

7-7.5 hours

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4
Q

What is the sleep time in late adult life?

A

6.5 hours

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5
Q

What two hormones drop with sleep onset?

A

Cortisol and TSH secretion

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6
Q

What two hormones increase during sleep/

A

growth hormone and prolactin

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7
Q

What hormone production begins at sleep onset and ceases with sunlight?

A

melatonin

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8
Q

T/F: sleep deprivation is lethal

A

true

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9
Q

How many stages of Non-rem NREM sleep are there?

A

4 “stages”

3 NREM

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10
Q

How many REM stages are there?

A

1

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11
Q

Stage (blank) is drowsiness, slow, roving horizontal eye movements and reduced EEG voltage

A

stage 1

NREM 1

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12
Q

Stage (blank) shows EEG SLEEP SPINDLES and slow VERTEX WAVES

A

stage 2

NREM 2

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13
Q

Stages (blank and blank) shows high amplitude slow waves

A

stage 3 and 4

NREM 3

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14
Q

In what stages is the EEG synchronized?

A

stages 1-4

NREM 1-3

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15
Q

In what stage is the EEG nonsynchronized?

A

stage 5/REM

shows fast waves and bursts of REM

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16
Q

How many NREM-REM cycles do we do in a night?

A

4-6

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17
Q

NREM-NREM2 happens during what portion of the night?

A

later portion of the night

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18
Q

How long is a REM cycle?

A

60-90 mins

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19
Q

How long after sleep onset does the first REM cycle begin?

A

70-100 minutes

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20
Q

T/F: all dreaming occurs during REM sleep

A

false; just most of it

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21
Q

T/F: you are easily aroused from REM sleep

A

true

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22
Q

In what stage of sleep are you hard to wake from?

A

NREM 3

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23
Q

what stage of sleep decreases with age?

A

NREM 3

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24
Q

REM has minimal (tonic/phasic) muscle activity

A

tonic

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25
Q

What are the effects of sleep deprivation for >60 hours

A
  1. increasing sleepiness, fatigue, irritability
  2. difficulty concentrating
  3. impaired skilled motor function (esp if require speed, perseverance)
  4. inattention
  5. impaired judgement
  6. nystagmus, loss of accomodation, bilat hand tremor, ptosis, expressionless face, thick speech, mispronunciations, word substit.
  7. if persists: visual/tactile hallucinations, psychosis, seizure activity
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26
Q

What are the long term complications of chronic sleep deprivation?

A 
hypertension
stroke
MI
pulmonary HTN
early death
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27
Q

what are primary sleep disturbances?

A

sleep disturbances for prolonged periods of time in the absence of any psychiatric or medical disorders
aka sleep hypochondriacs
i.e. the sleep disorder itself causes insomnia

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28
Q

(Primary/secondary) sleep disturbances are often transitory

A

secondary

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29
Q

What are some non-medical causes of secondary insomnia?

A

EtOH or drug abuse

psychological

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30
Q

What are some medical causes of secondary insomnia?

A

arthritic pain
GERD, PUD
prostatism, nocturia

31
Q

What is your firstline sleep diagnostic/

A

sleep journal

32
Q

What things do you include in a sleep journal?

A 
7 consecutive days
bedtime, awakening, out of bed
naps
use of sedatives and stims
symptoms
33
Q

What are the two validated symptom assessment systems?

A

epworth sleepiness score

stanford sleepiness score

34
Q

What are the two polysomnography tests?

A

multiple sleep latency test

maintenance of wakefulness test

35
Q

if secondary insomnia, then you treat….

A

the underlying disorder

36
Q

What makes good sleep hygeine?

A

Re-set sleep cycle: no naps; dec non-sleep time in bed; exercise
Re-set circadian rhythm: lights out, quiet time
Avoid caffeine, alcohol, tobacco
Bedroom: quiet, dark, rituals, no clock

37
Q

What are the components of CBT for insomnia

A

Relaxation, stimulus control

38
Q

What are the three Rx for primary insomnia?

A

Sleep hygeine
CBT
Meds

39
Q

What type of test is essential for diagnosing sleep breathing disorders?

A

polysomnography

40
Q

Ondine’s curse is (primary/secondary) apnea

A

primary

41
Q

Secondary sleep apnea is cuased by abnormalities in what area of the brain?

A

lower brain stem

42
Q

In obstructive sleep apnea, the (ant/post) pharyngeal muscles collapse and narrow the airway

A

posterior

43
Q

What is the snoring like in OSA?

A

noisy, cyclic snoring

44
Q

T/F: OSA only occurs during NREM

A

false, in both NREM and REM

45
Q

What is the usual presentation of OSA?

A

excessive daytime sleepiness

46
Q

what is your clinical phenotype for OSA?

A

overweight, middle aged man

47
Q

what is THE best screening tool for OSA?

A

STOP-BANG

48
Q

Da fuck is STOP-BANG?

A

Snoring
Tired
Observed stopped breathign
Pressure–HTN

BMI >35
Age over 50
Neck circumfrence >40cm
Gender male

49
Q

How many yes’s do you need to be at high risk of OSA based on STOP-BANG?

A

three or more

50
Q

how many yes’s do you need to be at low risk of OSA based on STOP-BANG?

A

yes to less than three items

51
Q

What are the components of polysomnography?

A 
EMG
Airflow
EEG
Oxygen Saturation
Cardiac Rhythm
Leg Movements
52
Q

what are the potential pathophys etiologies of OSA?

A 
Findings in Obstruction:
Nasal obstruction
Long, thick soft palate
Retrodisplaced mandible
Narrowed oropharynx
Redundant pharyngeal tissues
Large lingual tonsil
Large tongue
Large or floppy epiglottis
Retro-displaced hyoid complex
53
Q

What are the Tx for CENTRAL sleep apnea?

A

Tx underlying cause (like CHF)

low flow oxygen

54
Q

T/F: meds are first line therapy for sleep apnea

A

false; little to no help

55
Q

What are the non-surgical non-behavioral treatments for sleep apnea?

A

CPAP, BiPAP, dental appliances

56
Q

What are the surgical options for OSA?

A

uvulectomy

mandibular advancement

57
Q

What are the behavioral treatments for OSA?

A 
weight loss
avoidance of alcohol
avoidance of sedatives
avoidance of smoking
non-supine sleep
58
Q

How common is RLS?

A

prevalence >2%

59
Q

what diseases is RLS associated with?

A

Fe def. anemia
dysthryroidism
pregnancy
certain drugs(anti-histamines, TCAs)

60
Q

Is most RLS idiopathic or cuased by an underlying dz?

A

idiopathic

61
Q

what is the MOA of TCA related RLS?

A

decreased dopamine production and binding

62
Q

What are the Tx for RLS

A 
Fe supps if Fe def
dopamine agonissts
long acting carbidopa/ L-dopa
gabapentin
clonazepam
63
Q

What is the narcoleptic tetrad?

A
  1. recurrent attacks of irresitible sleep
  2. cataplexy (70%)
  3. sleep paralysis
  4. hallucinations (hynagogic)
64
Q

When does narcolepsy onset?

A

15-35

65
Q

how long are the sleep periods in narcolepsy?

A

<15 mins 2-6x per day

66
Q

T/F: narcoleptics are generally pretty sleepy during the day

A

true

67
Q

Narcolepsy is often familial but not (blank)

A

mendelian

68
Q

the hypothalamic neuropeptide implicated in narcolepsy is…

A

hyocretin

69
Q

To what structures does hypocretin project?

A

locus ceruleus
ventral tegmentum
aka sleep structures

70
Q

the really weird thing about REM and NREM in narcolepsy is…

A

reversal of REM and NREM sleep

71
Q

In narcolepsy the sleep latency is greatly (inc/dec)

A

decreased

72
Q

How do you Dx narcolepsy?

A

overnight polysomnography followed by MSLT
MSLT: naps at 2 hour intervals and detect REM w/i 15 minutes of sleep onset
measure CSF levels of hypocretin

73
Q

what are the Tx strategies for narcolepsy?

A

strategically placed short naps
stimulant drugs (provigil)
TCAs
Ig infusions

Block 8 Week 1 Colt (10 decks)

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