Lecture 50: Sleep

Question 1

Stage 1 Sleep EEG and corresponding body state

Answer 1

Light sleep, less alpha, theta waves; muscle activity slows, twitching

Question 2

Stage 2 Sleep EEG and corresponding body state

Answer 2

Theta waves, sleep spindles, K complexes; slowed breathing, HR

Question 3

Stage 3 & 4 Sleep EEG and corresponding body state

Answer 3

Delta waves; very limited muscle activity

Question 4

What stage is the most common? %

Answer 4

Stage 2; about 50%

Question 5

Restorative sleep is which stage?

Answer 5

Stages 3 & 4

Question 6

REM Sleep EEG and corresponding body state

Answer 6

Similar to waking state; paralysis, rapid eye movements, dreaming, increased HR, rapid breathing

Question 7

How much time a night do we spend in REM? (% and # cycles)

Answer 7

25%, 5 cycles

Question 8

Sleep cycle. How long does the pattern take?

Answer 8

Awake –> stage 1 –> 2 –> 3 –> 4 –> 3 –> 2 –> REM (like stage 1) –> 2; repeats every 90-120 minutes

Question 9

Sleep latency

Answer 9

Time from lights out to stage 1 (10-20 min)

Question 10

REM latency

Answer 10

Time from sleep onset to first REM (90-100 min)

Question 11

Sleep efficiency

Answer 11

Amount of sleep/total time in bed

Question 12

For infants, how much time do you spend sleeping?

Answer 12

2/3 of the day

Question 13

As we age, what happens to our sleep cycle?

Answer 13

Increased sleep latency, noctural awakenings and stage 1, decreased REM latency, sleep efficiency, and stage 4

Question 14

What are some key pieces of information for a patient with disordered sleep?

Answer 14

Sleep hx, meds, family/psych hx, bed partner hx, physical exam, sleep measurements

Question 15

Scale for measuring sleepiness and structure

Answer 15

Epworth Sleepiness Scale asks likelihood to fall asleep in various situations

Question 16

What does the multiple sleep latency test assess?

Answer 16

Objective daytime sleepiness: sleep/REM latency during day

Question 17

What suggests narcolepsy

Answer 17

REM sleep in 2+ naps

Question 18

Primary sleep disorders (2)

Answer 18

Dyssomnias = too much or too little sleep; Parasomnias = abnormal sleep behaviors

Question 19

Sleep-related breathing disorders are categorized as…

Answer 19

A dyssomnia

Question 20

Define sleep apnea

Answer 20

Repetitive episodes of complete or partial cessation of air flow during sleep that often result in oxygen desaturation and terminate with brief arousals

Question 21

Two types of sleep apnea

Answer 21

Central = reduction in respiratory drive; Obstructive = upper airway obstruction

Question 22

Two causes of obstructive sleep apnea

Answer 22

Obesity or craniofacial abnormalities (leading to soft tissue collapse of airway)

Question 23

Signs of obstructive sleep apnea (3)

Answer 23

Excessive daytime sleepiness, loud/choking snoring, pauses in breathing while sleep

Question 24

Consequences of sleep apnea on all causes of mortality

Answer 24

3-6 x fold in all-causes of mortality

Question 25

Cardio consequences of sleep apnea

Answer 25

CHF, stroke, hypertension

Question 26

Neurocognitive consequences of sleep apnea

Answer 26

Accidents, decreased vigilance, executive functioning

Question 27

Metabolic consequences of sleep apnea

Answer 27

Increased insulin resistance

Question 28

Prevalence of sleep apnea (%)

Answer 28

15%

Question 29

Main sleep apnea treatments (3)

Answer 29

Weight loss, positional therapy, C-pap (positive airway pressure therapy)

Question 30

Central sleep apnea means what? What people get it?

Answer 30

No respiratory effort at time of airflow cessation; patients w/ lower brainstem lesions

Question 31

Clinical feature of narcolepsy

Answer 31

Frequent attacks of irresistible daytime sleepiness; REM sleep INTRUDING when it's not supposed to

Question 32

What is the "classic tetrad" of narcolepsy

Answer 32

"Classic Tetrad" = daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations

Question 33

T/F: Narcoleptics get normal amounts of sleep per 24 hours

Answer 33

True! Also have normal polysomnogram

Question 34

Hypnagogic hallucinations (def)

Answer 34

Vivid hallucinations during transition between wakefulness and sleep

Question 35

Cataplexy (def)

Answer 35

Sudden intrusion of REM sleep into wakefulness resulting in emotionally-triggered, transient muscle weakness

Question 36

Narcolepsy can involve what hormone?

Answer 36

Orexin (reduced or absent)

Question 37

Narcolepsy diagnosis involves...

Answer 37

Clinical assessment, REM latency via polysomnography

Question 38

Pharmacologic narcolepsy treatments (2 categories)

Answer 38

Stimulants and cataplexy modifying agents (sodium oxybate, REM-suppressing antidepressants)

Question 39

Board sleep disorders (2)

Answer 39

Ondine's curse (sleep --> stop in breathing); Kleine-Levin syndrome (daytime somnolence and other hypers-)

Question 40

Circadian rhythm disorders (def)

Answer 40

Recurrent or persistent misalignment between the desired sleep-wake schedule (external physical or social environment) and the endogenous circadian rhythm-related propensity for sleeping and waking

Question 41

Circadian rhythm disorders are often associated with...

Answer 41

Night & early-morning shift schedules

Question 42

Shift work sleep disorder (def)

Answer 42

Excessive sleepiness during work hours that are scheduled during the usual sleep period and insomnia when attempting to sleep during the usual wake period

Question 43

Sleep-related movement disorders include which two disorders with brief description

Answer 43

Restless leg syndrome (urge to move legs) and periodic limb movements of sleep (partner notes this one)

Question 44

RLS and PLMS are primarily; most important secondary cause? One associated disease

Answer 44

Idiopathic; iron deficiency; Parkinson's disease

Question 45

Non-REM Parasomnias (2) and stage. Amnesia? Confusion? Dreaming? Patients?

Answer 45

Sleepwalking and sleep terror disorder; delta sleep (Stage 3 & 4); yes, yes, no, children

Question 46

REM Sleep Parasomnias (2) and stage. Amnesia? Confusion? Dreaming? Patients?

Answer 46

Nightmare disorder, REM behavior disorder (REM); no, no, yes, older men

Question 47

Pathophysiology of non-REM parasomnia

Answer 47

Brief, incomplete awakening during Stage 3 & 4 sleep

Question 48

What's behind/presentation of sleep terror

Answer 48

Waking from Stage 3 & 4 with gasping, panic, and then return to sleep w/out fully waking

Question 49

Pathophysiology of REM behavior disorder and important association

Answer 49

Loss of muscle atonia during REM sleep resulting in acting-out of dreams; early manifestations of neurodegenerative disorders