Neurology: Sleep Flashcards
As people age, which stage of sleep increase and which stages decrease?
Stage II increases
Stage III and IV decrease
Describe the 5 stages of sleep as defined by EEG, EMG, and eye monitors.
Stage 1: light sleep
2: K complexes and sleep spindles
3&4: slow wave sleep; restorative sleep
REM: dream sleep
Which region of the brain is the primary regulator of the circadian rhythm?
Suprachiasmatic Nucleus of the Hypothalamus
List the 3 major structures in the brain important for sleep.
- Basal Forebrain
- Anterior Hypothalamus (suprachiasmatic nucleus)
- Dorsolateral Medullary reticular formation
What is the most common sleep disorder?
Insomnia (60 million people)
- sleep apnea: 10 mil.
- sleep schedule disturbance: 20 mil.
- narcolepsy: 250,000
What is insomnia and what are risk factors associated with causing insomnia?
Inability to fall asleep or to maintain sleep.
-increasing age, medical, psychiatric, substance abuse can increase chances of getting insomnia.
What is transient insomnia?
Insomnia that only lasts a few days.
-results from acute stress or environmental changes
(jet lag, acute illness, caffeine, alcohol, other drugs)
What is short term insomnia?
Insomnia that lasts 3 weeks.
- more severe causes than transient insomnia: bereavement (death in the family), emotional trauma, pain
- marriage, divorce, moving
What is chronic insomnia?
Insomnia lasting greater than 3 weeks.
- associated with physical and emotional stress
- use of meds, alcohol, illicit drugs
How is insomnia diagnosed?
H&P thru primary care physician
What are some things to ask about in the H&P when trying to diagnose insomnia?
Alcohol use, SNORING, dreams, nightmares, reflex movements
What are the goals in treating insomnia?
Resolve underlying problem, improve quality of life, prevent progression of transient to chronic insomnia.
What are some ways to improve sleep hygiene and prevent insomnia?
- avoid going to be hungry
- avoid alcohol or caffeine
- avoid exercising too late
- use bedroom for sleep and masterb…..i mean sex
- make bedroom comfortable
- maintain a regular schedule
What is non-pharmacological factor to address before prescribing sleep medication?
heavy snoring
What is a risk in using sedating antidepressants like amitriptyline?
Contraindicated in patients with BPH or cardiovascular disease.
-be careful when using in the elderly, can increase risk of falling
What is a problem with using hydroxyzine or diphenhydramine in patients with insomnia?
They are antihistamines that may worsen insomnia and can half anti-cholinergic effects
What are some medical conditions that can lead to restless leg syndrome?
- pregnancy
- uremia
- RA
- iron deficiency
- peripheral neuropathy
What are medications that can treat restless leg syndrome?
- Ropinirole or Pramipexole (PD meds)
- Benzodiazepines
- Opiates
- Amitriptyline (TCAs)
What is the mechanism of sleep apnea.
The airway becomes relaxed in sleep and closes off causing the patient to wake up.
-obesity and altered nasopharyngeal structure are risks
What are some treatments for sleep apnea?
Lose weight
CPAP: continuous positive airway pressure, it’s a mask that maintains a specific pressure in the airway to prevent it from closing
Tennis balls
Surgery
What is the genetic and biochemical defect of Narcolepsy?
Deficiency of production of hypocretin 2 because of a defective gene on chromosome 6.
Linked to HLA-DR2 and HLA-DQ1
What is the classic tetrad features assocaited with narcolepsy?
- Excessive Daytime sleepiness (only if they dream: REM sleep)
- Cataplexy: loss of muscle tone mainly in head and neck
- Sleep paralysis
- Hypnagogic hallucinations: occur as the pt. falls asleep
What other risk does cataplexy carry other than narcolepsy?
Increased risk of stroke
What are the meds used to treat narcolepsy?
Caffeine Methylphenidate TCAs (inhibit REM sleep) modafinil sodium oxybate (mostly if caused by cataplexy)
