Flashcards in Neurology: Sleep Deck (30):
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
As people age, which stage of sleep increase and which stages decrease?
Stage II increases
Stage III and IV decrease
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.
1. Basal Forebrain
2. Anterior Hypothalamus (suprachiasmatic nucleus)
3. Dorsolateral Medullary reticular formation
What is the most common sleep disorder?
Insomnia (60 million people)
-sleep apnea: 10 mil.
-sleep schedule disturbance: 20 mil.
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?
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?
What are medications that can treat restless leg syndrome?
1. Ropinirole or Pramipexole (PD meds)
4. 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?
CPAP: continuous positive airway pressure, it's a mask that maintains a specific pressure in the airway to prevent it from closing
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?
1. Excessive Daytime sleepiness (only if they dream: REM sleep)
2. Cataplexy: loss of muscle tone mainly in head and neck
3. Sleep paralysis
4. 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?
TCAs (inhibit REM sleep)
sodium oxybate (mostly if caused by cataplexy)
What is REM suppression and rebound?
Condition caused by alcohol, drugs (MAOIs, TCAs) that leads to sleep deprivation. When REM is suppressed for a long time and then finally allowed to occur the patients have really bizarre dreams.
What stages of sleep does somnambulism occur?
Stage III and IV
What stages of sleep does Pavor Nocturnus occur?
Stage III and IV
What is the drug class used to treat somnambulism and pavor nocturnus and why?
-inhibits stage III and IV of sleep
What other conditions must be ruled out when a patient presents with nocturnal enuresis?