Flashcards in Normal Sleep and Sleep Disorders Deck (89):
Awake state - Which waves characterize the EEG:
Beta + Alpha waves.
Beta waves over the frontal lobes are commonly seen with ...?
ACTIVE MENTAL CONCENTRATION.
Alpha waves over the occipital and parietal lobes are seen when a person ...?
Relaxes with closed eyes.
Period of time from going to bed to falling asleep = Typically less than 10min.
Sleep is divided into:
REM + Non-REM.
Non-REM consists of:
Stages 1, 2, 3, and 4.
Mapping the transitions from one stage of sleep to another during the night produces a structure known as:
Sleep architecture changes with ...?
The elderly often have poor sleep quality because ...?
1. Aging is associated with reduced REM sleep and delta sleep (Stages 3-4, or slow wave).
2. Increased nighttime awakenings, leading to poor sleep efficiency (percent of time actually spent sleeping per percent of time trying to sleep).
Sedative agents, such as alcohol, barbs, and benzos, also are associated with ...?
Reduced REM sleep and delta sleep.
Most delta sleep occurs during the ...?
First half of the sleep cycle.
Longest REM periods occur during ...?
The 2nd half of the sleep cycle.
Awake - Associated EEG pattern:
1. Beta waves.
2. Alpha waves.
Stage 1 - Associated EEG pattern:
Stage 1 - % Sleep time in young adults:
Stage 1 - Characteristics:
Lightest stage of sleep characterized by:
2. Slowed pulse + respiration.
3. Decr. BP.
4. Episodic body movements.
Stage 2 - Associated EEG patterns:
Sleep spindle and K-complex.
Stage 2 - % Sleep time in young adults:
Stage 2 - Characteristics:
Largest percentage of sleep time - BRUXISM.
Stages 3-4 - Associated EEG pattern:
Delta (slow-wave sleep) waves.
Stages 3,4 - % Sleep time in young adults:
25% (decr. with age).
Stages 3,4 - Characteristics:
1. Deepest, most relaxed stage of sleep.
2. Sleep disorders such as night terrors.
3. Sleepwalking (somnambulism).
4. Bed-wetting (enuresis) may occur.
REM sleep - Associated EEG pattern:
"Sawtooth", beta, alpha, and theta waves.
REM sleep - % sleep time in young adults:
25% (decr. with age).
REM sleep - Characteristics:
2. Penile and clitoral erection.
3. Incr. pulse, respiration, and BP.
4. Absence of skeletal muscle movement.
Average ime to the 1st REM period after fallng asleep (REM latency) is ...?
REM periods of 10-40min occur about every ...?
90min throughout the night.
A person who is deprived of REM sleep one night (eg because of inadequate sleep, repeated awakenings, or sedative use) ...?
Has INCREASED REM SLEEP THE NEXT NIGHT = REM rebound.
Extended REM deprivation or total sleep deprivation may also result in ...?
The transient display of psychopathology, usually anxiety or psychotic symptoms.
Summary of characteristics of sleep in typical, depressed, and elderly people - Sleep latency:
Typical young adult --> About 10min.
Depressed young adult --> >10min.
Typically eldelry adult --> >10min.
Summary of characteristics of sleep in typical, depressed, and elderly people - REM latency:
Typical young adult --> About 90min.
Depressed young adult --> About 45min.
Typical elderly adult --> About 90min.
Summary of characteristics of sleep in typical, depressed, and elderly people - Sleep efficiency:
Typical young adult --> About 100%.
Depressed young adult -->
Summary of characteristics of sleep in typical, depressed, and elderly people - Percentage delta:
Typical young adult --> About 25%.
Depressed young adult -->
Summary of characteristics of sleep in typical, depressed, and elderly people - Percentage REM:
Typical young adult --> About 25%.
Depressed young adult --> >25%.
Typical elderly adult -->
Neurotransmitters are involved in the production of sleep - Incr. levels of ACh in the reticular formation does what to sleep?
Increase BOTH sleep efficiency + REM Sleep.
ACh levels, sleep efficiency, and REM sleep DECREASE in ...?
1. Typical aging as well as in Alzheimer disease.
2. Alzheimer disease.
Patients taking anticholinergic agents show ...?
DECREASED REM sleep.
Incr. levels of dopamine does what to sleep efficiency?
DECREASE SLEEP EFFICIENCY.
--> Tx with antipsychotics, which block dopamine receptors, may improve sleep in patients with psychotic symptoms.
Incr. levels of NE does what to sleep?
Decrease BOTH sleep efficiency + REM sleep.
Increased levels of serotonin does what to sleep?
INCREASE BOTH sleep efficiency + delta sleep.
--> Damage to the dorsal raphe nuclei, which produces serotonin, decreases BOTH of these measures.
Treatment with antidepressants, which increase serotonin availability, can ...?
Improve SLEEP EFFICIENCY in depressed patients.
Classification of sleep disorders - 2 types:
3. Amoung of sleep.
Dyssomnias include (7):
2. Breath-related sleep disorder (sleep apnea).
4. Circadian rhythm sleep disorder.
5. Nocturnal myoclonus.
6. Restless legs syndrome.
7. The primary hypersomnias (eg Kleine-Levin syndrome and menstrual-associated syndrome).
Abnormalities in PHYSIOLOGY or in BEHAVIOR associated with sleep.
Parasomnias include (5):
3. Sleep terror.
4. REM sleep behavior.
5. Nightmare disorders.
Sleep terror disorder - Characteristics:
1. Repetitive experiences of fright in which a person screams in fear during sleep (usually normal in children).
2. The person cannot be awakened.
3. The person has NO MEMORY OF HAVING A DREAM.
4. Occurs during delta sleep.
5. Onset in adolescence may indicate TEMPORAL LOBE EPILEPSY.
Nightmare disorder - Characteristics:
1. Repetitive, frightening dreams that cause nighttime awakenings.
2. The person usually can recall the nightmare.
3. Occurs during REM sleep.
Sleepwalking disorder - Characteristics:
1. Repetitive walking aroung during sleep.
2. No memory of the episode on awakening.
3. Begins in childhood (usually 4-8yrs of age).
4. Occurs during delta sleep.
Circadian rhythm sleep disorder:
1. Inability to sleep at appropriate times.
2. Delayed sleep phase type involves falling asleep and waking later than wanted.
3. Jet lag type lasts 2-7 days after a change in time zones.
4. Shift work type (eg in physician training) can result in work errors.
Nocturnal myoclonus - Features:
1. Repetitive, abrupt muscular contraction in the legs from toes to hips.
2. Causes nighttime awakenings.
3. Treat with benzodiazepine, quinine, or antiparkinsonian, ie dopaminergic agent (eg levodopa, ropinirole).
Restless legs syndrome - Characteristics:
1. Uncomfortable sensation in the legs necessitating frequent motion.
2. Repetitive limb jerking during sleep.
3. Causes difficulty falling asleep and nighttime awakenings.
4. More common with aging, PD, pregnancy, and kidney disease.
5. Treat with antiparkinsonian agent, iron supplements, or Mg supplements.
Primary hypersomnias (Kleine-Levin syndrome and menstrual-associated syndrome [symptoms only in the pre-menstruum]) - Characteristics:
1. Recurrent periods of excessive sleepiness occurring almost daily for weeks to months.
2. Sleepiness is not relieved by daytime naps.
3. Often accompanied by HYPERPHAGIA (overeating).
Kleine-Levine syndrome is more common in males or females?
Sleep drunkenness - Features:
1. Difficulty awakening fully after adequate sleep.
2. Rare, must be differentiated from substance abuse or other sleep disorder.
3. Associated with genetic factors.
Bruxism - Features:
1. Tooth grinding during sleep.
2. Can lead to tooth damage and jaw pain.
3. Treat with dental appliance worn at night or corrective orthodontia.
REM sleep behavior disorder - Features:
1. REM sleep WITHOUT the typical skeletal muscle paralysis.
2. While dreaming, patients can injure themselves or their sleeping partners.
3. Associated with PD + Lewy Body Dementia.
4. Treat with Anti-PD agents, REM suppressor (eg benzos) or anticonvulsants (eg carbamazepine).
Difficulty falling asleep or staying asleep that lasts for AT LEAST 1 MONTH.
Insomnia is present in ...% of the population.
Psychological causes of insomnia include:
Mood + Anxiety disorders.
Major depressive disorder - Characteristics of the SLEEP PATTERN in depression:
1. LONG sleep latency.
2. Repeated nighttime awakenings leading to poor sleep efficiency.
3. Waking too early in the morning (terminal insomnia).
What is the MC sleep characteristic of depressed patients?
Waking too early in the morning (terminal insomnia).
Characteristics of the SLEEP STAGES in depression:
1. Short REM latency (appearance of REM within about 45min of falling asleep).
2. Incr. REM early in the sleep cycle + decr. REM later in the sleep cycle (eg in the early morning hours).
3. Long 1st REM period + INCREASED TOTAL REM.
4. Reduced delta sleep.
Bipolar disorder and sleep:
Manic and hypomanic patients have trouble falling asleep + sleep fewer hours.
Anxious patients often have ...?
Trouble falling asleep.
Physical causes of insomnia:
1. Use of CNS stimulants (eg caffeine) is the MCC of insomnia.
2. Withdrawal of agents with sedating action (eg alcohol, benzos) can result in wakefulness.
3. Medical conditions causing pain also result in insomnia, as do endocrine and metabolic disorders.
Breathing-related sleep disorder (sleep apnea) - Patients with sleep apnea ...?
Stop breathing for brief intervals.
--> Low O2 or high CO2 level in the blood REPEATEDLY AWAKENS THE PATIENT during the night, resulting in daytime sleepiness and respiratory acidosis (blood pH
In patients with CENTRAL sleep apnea (more common in the elderly) what happens?
Little or NO respiratory effort occurs, resulting in LESS AIR reaching the lungs.
What happens in patients with OSA?
Respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs.
OSA - Epidemiology:
8:1 male-to-female + In obese - 40-60.
Patients often SNORE.
What is the Pickwickian syndrome?
A related condition in which airway obstruction results in daytime sleepiness.
Sleep apnea occurs in ...-...% of the population.
Sleep apnea is related (3):
2. Morning headaches.
3. Pulm. HTN.
Sleep apnea - Sudden death:
During sleep in elderly and infants!
Patients with narcolepsy have ...?
Sleep attacks (ie fall asleep suddenly during the day) despite having a normal amount of sleep at night.
Patients with narcolepsy - While typical in amount, their nighttime sleep is characterized by ...?
1. Decr. sleep latency.
2. Very short REM latency (
Decr. REM sleep at night leads to the ...?
Intrusion of characteristics of REM sleep (eg paralysis, nightmares) while the patient is AWAKE!
Intrusion of characteristics of REM sleep (eg paralysis, nightmares) while the patient is AWAKE result in:
1. Hypnagogic or hypnopompic hallucinations.
3. Sleep paralysis.
Hypnagogic or hypnopompic hallucinations:
These are strange perceptual experiences that occur just as the patient falls asleep or wakes up, respectively, and occur in 20-40% of patients.
This is a sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus (eg laughter, fear) and occurs in 30-70% of patients.
This is the inability to move the body for a few seconds after waking.
Narcolepsy is common or uncommon?
Narcolepsy occurs most frequently in ...?
Adolescents and young adults.
Narcolepsy - Etiology:
There may be a genetic component.
Narcolepsy - Role of daytime naps:
Allow the patient to make up some lost REM sleep and, as such, leave the patient feeling refreshed.
Management of the major sleep disorders - Insomnia:
1. Avoidance of caffeine, especially before bedtime.
2. Development of a series of behavior associated with bedtime (ie "a sleep ritual" or "sleep hygiene").
3. Maintaining a fixed sleeping and waking schedule.
4. Daily exercise (but not just before sleep).
5. Relaxation techniques.
6. Psychoactive agents (ie limited use of sleep agents to establish an effective sleep pattern + antidepressants or antipsychotics, if appropriate).
Management of major sleep disorders - OSA:
1. Weight loss (if overweight).
2. Continuous positive airway pressure (CPAP).
3. Breathing stimulant, eg medroxyprogresterone acetate, protriptyline, fluoxetine.
4. Surgery to enlarge the airway, eg uvulopalatoplasty.
5. Tracheostomy (as a last resort).
Management of the major sleep disorders - Narcolepsy:
1. Stimulant agents (methylphenidate, modafinil, if cataplexy is present, sodium oxybate or an antidepressant may be added.
2. Scheduled daytime naps.