Sleep Flashcards
Stages of Sleep
Awake - open eyes, active concentration
-Beta waves
Awake - eyes closed, relaxation
-alpha waves
Stage N1- light sleep
-Theta waves
Stage N2 - deeper sleep, bruxism
-sleep spindles and K complexes
Stage N3 - Deep sleep, sleep walking, night terrors, bed wetting
-Delta waves
REM - dream, loss of motor tone, erections, vagal tone, active PPRF
- Beta waves
- 90 min intervals
1st half - in order, 2nd half alt between stage N2 and REM
Sleep pattern in elderly
decreased slow-wave sleep - N3
Decreased REM
Increased REM latency - longer to get there if they even do
More time in light sleep
frequently wake up
Sleep patterns in depressed
decreased slow wave sleep N3
increased REM
decreased REM latency
repeated awakenings throughout night
early morning awakening
Restless leg syndrome
causes: iron deficiency, ESRD, DM neuropathy, PD, pregnancy, RA, varicose veins/venous insufficiency, caffeine intake
Tx: check iron, replace
Pramipexole
Ropinirole
If comorbid pain: gabapentin, pregabalin
Night terrors
occur during N3
no memory of event
difficulty to get into wake cycle
Tx: benzodiazepines to decrease N3 stage
Obstructive sleep apnea
occurs in REM, obesity esp with short thick necks
tx: CPAP and wt loss
Nocturnal enuresis
not dx until 5 yo, tx delayed until 7 yo
- behavior interventions
- enuresis alarms
Desmopressin -DDAVP
- ADH - decrease need to urinate
- returns when stopped
Imipramine - TCA
- decrease time in N3
- short term, up to 6 weeks
- returns when stopped
Indomethacin
-decreased renal blood flow, decreases GFR, don’t make as much urine
Melatonin as insomnia treatment
nonaddictive
otc
good safety profile
questionable efficacy
Antihistamines (diphenhydramine) as insomnia treatment
commonly used OTC by its first line “PM” meds
anticholinergic side effects - avoid in elderly
next day fatigue
Benzodiazepines (triazolam, temazepam, lorazepam) as insomnia treatment
increase GABA, addictive, short term only
Zolipidem, zaleplon as insomnia treatment
act at benzo receptor, short term only (less than 35 days)
rebound insomnia when stopped
assoc w/ sleep walking
Eszopiclone as insomnia treatment
longer half-life than zolpidem, may be used long term
sleep maintenance
ramelteon as insomnia treatment
nonaddictive, works at melatonin receptors
avoid if hepatic insufficiency
safe in geriatric its
long term studies lacking
Orexin receptor antagonists (suvorexant) as insomnia treatment
block effects of orexin A and B which promote wakefulness
Narcolepsy
excessive daytime sleepiness
awake –> REM
hallucinations, cataplexy
