sleep

Question 1

stage 1 sleep pattern

Answer 1

NREM

Transition from week to sleep

5% of total normal sleep cycle

Question 2

stage two sleep pattern

Answer 2

NREM

EEG waveforms

50% of total sleep cycle

Question 3

stage three and four sleep pattern

Answer 3

NREM

Slow wave sleep period

deepest level of sleep

20 to 25% of total sleep cycle

Question 4

when does stage three and four of sleep tend to occur?

Answer 4

In first one 3rd to 1/2 of sleep.

Question 5

How often does REM alternate with NREM?

Answer 5

REM is cyclical throughout the night alternating every 80 to 100 minutes

Question 6

How do sleep patterns vary with age?

Answer 6

child/adolescent have larger, slow wave sleep

Sleep continuity and depth decreases with age

Consider age when assessing for sleep, rest problems

Question 7

insomnia, diagnosis

Answer 7

Significant inability to initiate or maintain sleep or early morning awakening with inability to return to sleep

At least three nights per week

Present for at least one month (episodic)

May persist for greater than three months (persistent)

Question 8

hypersomnolence disorder

Answer 8

Self reported excessive sleepiness despite adequate sleep

Difficulty being fully awake/groggy

At least three times per week for several months

Causes significant distress or impairment

Not better explained by another disorder

May occur within 18 months of experiencing head trauma

Comorbid for various depressive disorders

Question 9

obstructive sleep apnea

Answer 9

Hallmark of disorder is snoring and repeated apnea during sleep

Daytime sleepiness

Headache on awakening

Consequences include panic attacks/ADHD/depression/hypertension/motor vehicle and workplace accidents

Question 10

polysomnography

Answer 10

Used to make a definitive diagnosis

Question 11

pharmacologic management of sleep disorders

melatonin

Answer 11

Melatonin for sleep onset issues. May be helpful for ADHD.

Question 12

Pharmacologic management of sleep disorders

benzos

Answer 12

BZD/hypnotics
- not for obstructive sleep apnea

Flurazepam
-long lasting agent
- may cause excessive drowsy
- not for older adults

temazepam
-immediate acting

triazolam
-short acting
-no access sedation
-side effects include impaired memory, efficacy, decrease overtime, should not be used long-term

Question 13

pharmacologic management of sleep disorders

Non-benzodiazepines

Answer 13

Zeleplon (sonata)
-very short half-life so useful for initial or middle phase

Zolpidem
-short half-life but may affect next morning
-give on empty stomach

Eszopiclone (LUNESTA)
-intermediate acting

Rozerem
-melatonin, receptor agonist

Suvorexant (belsomra)

Orexin antagonist
-suppress wakefulness
-must consider long half-life

Question 14

pharmacological management of sleep

Antidepressants

Answer 14

Used for sedating properties

Amitriptyline, doxepin
-generally avoid use in older adults

Mirtazapine

Trazodone

Question 15

pharmacologic management of sleep

Wake promoting drugs

Answer 15

Armodafinil
-indicated for daytime sleepiness associated with OSA

Question 16

considerations regarding insomnia in children

Answer 16

Most commonly related distress

Children within insomnia, often have poor sleeper since birth

Pharmacologic treatment not recommended for most children

Question 17

considerations regarding insomnia in older adults

Answer 17

If new onset, then probably related to changes in Chrono biological rhythms

Although adults often sleep earlier in the evening and wake up early

often manifest confusion/restlessness as aspects of insomnia

Careful complete assessment is necessary when considering pharmacological intervention