Sleep Flashcards
(110 cards)
1
Q
how many hours of sleep per night
A
6-9
2
Q
physiologic functions reduced in
A
NREM
3
Q
when does first REM cycle start
A
90 minutes
4
Q
if REM cycle occurs in first 90 minutes of sleep
A
narcolepsy or depression
5
Q
NREM increases after
A
exercise or starvation
6
Q
stages of NREM
A
1-4 (light to deep)
7
Q
how are stages of NREM judged
A
EEG (3 & 4 have delta waves)
8
Q
when aroused from stages 3-4 of sleep
A
disorientation amnesia enuresis sleepwalking night terrors
9
Q
high levels of brain activity and physiological activity similar to wakefulness
A
REM
10
Q
poikilothermia
A
body temperature varies based on environment (shiver and sweats)
occur during NREM
11
Q
when do erections happen
A
REM
12
Q
skeletal muscle paralyzed or active in REM
A
paralyzed
13
Q
when do dreams occur?
A
REM (abstract and surreal)
occurs in NREM (lucid and purposeful)
14
Q
ratio of NREM to REM
A
3:1
15
Q
how often does REM cycle
A
ever 90-100 minutes
16
Q
how short does REM start?
A
10 minutes –> 40 minutes
17
Q
how much REM does a neonate get?
A
50:50
18
Q
lack of serotonin and melatonin results in
A
sleep reduction
19
Q
elevated ____ & ____ cause decreased total sleep time
A
dopa and norepi
20
Q
increased ____ decreases sleep time and increases REM proportion
A
acetylcholine
21
Q
reduced levels of ______ decreases REM sleep
A
L-tryptophan
22
Q
most common sleep complaint
A
insomnia
23
Q
two forms of insomnia
A
primary
circadian rhythm disturbances
24
Q
drugs for primary insomnia
A
Benzos
Z-Drugs
Melatonin
25
how long should you use meds to sleep
not usually more than 2 weeks
26
benzos effect
reduce time to onset of sleep, prolong stage 2 sleep, prolong total sleep time
27
benzos may decrease
relative REM sleep
28
benzos may help with underlying
anxiety
29
short acting benzo
triazolam (halcion)
30
onset for triazolam
2-3h
31
intermediate acting benzo
estazolam (prosom)
lorazepam (ativan)
temazepam (restoril)
32
long acting benzos
flurazepam (dalmane)
| quazepam (doral)
33
Z-drugs affect which receptor
GABA (more selective so no muscle relaxant or anticonvulsant effect like benzos)
34
are z-drugs metabolized fast or slow
fast
35
4 Z-drugs
Zalepon (sonata)
Zolpidem (Ambien)
Zolpidem XR (Ambien CR)
Eszopiclone (Lunesta)
36
which Z drug has the shortest half life
Zalepon (Sonata)
37
which Z-drug is best for those who have trouble falling asleep
Zalepon
38
which 2 Z drugs shouldnt be used long-term
Zalepon and Zolpidem
39
persistent sleepiness or rebound insomnia not in
Zalepon
40
Z drug that comes in tablet, oral spray, and disolving tablet
ZOlpidem
41
developed to help improve sleep onset and can be used for maintenance
Zolpidem XR
42
longest half life of the Z drugs
Eszopiclone (lunesta)
43
alcohol potentiates effects of this Z drug
Eszopiclone (lunesta)
44
melatonin agonist
ramelteon (Rozerem)
45
Rozerem more or less active than melatonin
more
46
rozerem contraindicated in patients with _____
liver insufficiency
47
drug with little evidence of insomnia improvement and tends to sedate the next day
benadryl
48
type of side effect benadryl has
anticholinergic
49
melatonin secreted by
pineal gland
50
increased secretion of melatonin with
darkness
51
melatonin regulates
sleep-wake cycles (circadian rhythm)
52
how melatonin is made
tryptophan --> serotonin --> melatonin
53
3 off-label drugs for insomnia
seroquel
remeron
trazadone
54
major SE of trazadone
priapism
55
excessive sleepiness and trouble waking up to be functional
hypersomnolence disorder
56
daytime naps
normal sleep architecture
persistent and progressive sleepiness
hypersomnolence disorder
57
treatment for hypersomnolence disorder
amphetamines
| non-sedating antidepressants (Wellbutrin)
58
sleep attacks
narcolepsy
59
how many sleep attacks per day and how long in narcolepsy
2-6 lasting 10-20minutes
60
when does narcolepsy present
adolesence (before 30)
61
onset of narcolepsy
abrupt or progressive
62
treatment for narcolepsy
forced naps
nodanfinil (provigil)
tricyclics or SSRIs
tx social anxieties
63
class of provigil
alpha blocker
64
MOA of provigil
unknown
decreases number of attacks
also used for those who must stay awake!!!
65
TCAS and SSRIs tx narcolepsy by
decreasing cataplexy
66
4 types of breathing related sleeping disorders
obstructive sleep apnea hypopnea
central sleep apnea
sleep related hypoventilation
comorbid sleep related hypoventilation
67
who does central sleep apnea occur in and why
elderly because CNS system fails to stimulate
68
3 types of sleep related hypoventilation
idiopathic
hypoventilation
congenital central hypoventilation (Ondine's curse)
69
Ondine's curse AKA
congenital central hypoventilation
70
atleast 5 obstructive apneas or hypopneas/hour of sleep AND nocturnal breathing disturbances or daytime sleepiness
obstructive sleep apnea hypopnea
71
evidence of 15+ obstructive apneas or hyponeas per hour without any symptoms
obstructive sleep apnea hypopnea
72
when can obstructive sleep apnea hypopnea occur
REM or NREM
73
mild apnea/hypopnea
moderate
severe
74
CV effects of obstructive sleep apnea hypopnea
hypotension and arrhythmias
75
tx
CPAP
weight loss
nasal or oral Surgery
76
apnea defined by length of
10+ seconds
77
5+ central apneas per hour
central sleep apnea
78
idiopathic central sleep apnea
without evidence of airway obstruction
79
cheyne stokes breathing
type of central sleep apnea
crescendo decrescendo of tidal volume
frequent arousal 5/ hour
80
central sleep apnea with opioid use
effect respiratory rhythm generators in the medula
81
central sleep apneas associated with hyperventilation alternating with hypoventilation
idiopathic central sleep apnea
| cheyne stoke's
82
misalignment between desired and actual sleep periods
circadian rhythm sleep disorder
83
3 types of circadian rhythm sleep disorder
delayed sleep phase type
non 24h sleep-wake type
shift work type
84
delayed onset and awakening time
cant fall asleep and wake up at desired times
normal sleep quality and quantity
delayed sleep phase type
85
wake cycles not synchronized to 24 hour environement
| daily drift
non-24 hour sleep wake type
86
non 24 h sleep wake type most common in
blind or visually impaired
87
series of disorders of insomnia, hypersomnia, and circadian rhythm issues that don't meet criteria of another disorder
parasomnia
88
types of parasomnias
```
NREM sleep arousal d/o
nightmare d/o
REM sleep behavior disorder
RLS
nocturnal myoclonus
sleep drunkenness
```
89
recurrent episodes of incomplete awakening from sleep in first third of episodes with sleep walking or sleep terrors
non-REM sleep arousal d/o
90
are sleep terrors remembered
unlikely
91
sleepwalking occurs during
NREM 3-4 (first third of night)
92
in childhood sleepwalking more common in
females
93
in adulthood sleepwalking more common in
men
94
tx for sleepwalking
prevent injury
95
when do sleep terrors occur
NREM
96
sleep terrors most common in
boys
97
which is more common sleep walking or sleep terrors
terrors
98
temporal lobe epilepsy associated with
sleep terrors
99
repeated occurrences of bad dreams in second half of major sleep episode
nightmare disorder
100
when wake up from dream awake and oriented
nightmare disorder
101
nightmare disorder occurs during
REM
102
repeated episodes of arousal during sleep with vocalization, motor hebaviors, during REM, awake and oriented quickly, act out dream
REM sleep behavior disorder
103
treatment for REM sleep behavior disorder
clonazipine
104
frequency criteria for RLS
3x/week for 3months
105
causes of secondary RLS
```
iron deficiency
ESRD
DM neuropathy
MS
parkinson's
pregnancy
```
106
if discomfort of RLS perceived as painful may tx w/ (3)
Z drugs
benzos
neurontin
107
what therapy is suggested for all RLS pts
iron replacement
108
pharmacologic therapy for RLS
ropinerol (requip)
| pramipexole (Mirapex)
109
SE of requip and mirapex
nausea
dizzy
fatigue (resolving in 10-14 days)
impulsive control disorder
110
onset of requip and mirapex takes
2 hours
