Sleep and Sleep D/o

Question 1

What % of life is spent sleeping?

Answer 1

33%

Question 2

What would getting no sleep lead to physiologically? (x3)

Answer 2

neurocognitive impairment, lower immune fxn, and physiological dysfxn

Question 3

(Young/old) people need more sleep than (young/old) people.

Answer 3

young, old

Question 4

What are the 4 stages of sleep and what are they characterized by?

Answer 4

Stage 1: 5% of total sleep, alpha/beta waves
Stage 2: 45-55% of total sleep, theta waves, sleep spindles, k-complex
Stage 3: 15-20% of sleep, delta waves, slow wave, deep sleep high voltage, low frequency
Stage 4: REM, 20-25% of sleep, EEG similar to Stage 1, desynchronized

Question 5

How long do sleep stages usually last for? How many NREM/REM cycles occur nightly?

Answer 5

70-120 minutes

3-6 cycles

Question 6

First REM period lasts ____ minutes and each successive cycle (decreases/increases) in length and frequency so the “density” of REM sleep (decreases/increases) over the night

Answer 6

~5-10

increases, increases

Question 7

What is Stage 0 of the sleep cycle?

Answer 7

Considered wakefulness with eyes closed, occurs just before sleep onset

Question 8

In wakefulness, there is more ______ brain activity, ____ waves predominate (___ amplitude, ____ frequency).

When more relaxed and during sleep, brain activity is more _____–> closing eyes will result in ____ waves predominating (____amplitude, ____ frequency)

Answer 8

desynchronous
beta
low
high

synchronous
alpha
high
slower/lower

Question 9

In what parts of the brain is wakefulness regulated? (x4)

Answer 9

Brainstem, thalamus, hypothalamus, basal forebrain

Question 10

What is the one area of the brain in the hypothalamus that is particularly involved in the switch between wakefulness and sleep (inhibits wakefulness regions in the _____)

Answer 10

Ventrolateral preoptic nucleus (VLPN/VLPO)

brainstem

Question 11

What are some neurotransmitters that are involved in wakefulness?

Answer 11

ACh, histamine, DA, NorEpi, and serotonin

Question 12

Located in the _______, the Perifornical Area contains neurons that secrete _________, which stimulate VLPO and promote ________, “unique” to the phenomenon of wakefulness

Answer 12

lateral hypothalamus
hypocretin/orexin
wakefulness

Question 13

What is included as part of a polysomnography sleep study? (x4)

Answer 13

EEG (electroencephalography)
EOG (electrooculography)
EMG (electromyography)
Vitals (SpO2, HR, RR, EKG)

Question 14

What is the multiple sleep latency test used for?

How is it performed?

Answer 14

Excessive sleepiness
Performed during normal period of wakefulness
Every 2 hrs pt is placed in a dark room
Given opportunity to fall asleep for 20 mins
Latency to sleep is measured w/ full polysomnography

Question 15

If a pt’s average sleep latency _____ (time), they are dx with excessive daytime sleepiness

Answer 15

<5 min

Question 16

Insomnia is more common in (adolescents/middle age/elderly), (men/women), and in individuals with chronic ____ issues, (low/high) income, and (low/high) levels of education

Answer 16

elderly
women
medication
low
low

Question 17

Insomnia is defined as inability to sleep at least ____ nights/week for at least ___ months

Answer 17

3, 3

Question 18

For a formal dx of insomnia, a pt must have difficulty with _____, _____, or have _____

Answer 18

initiating sleep, maintaining sleep, early awakening and cannot fall back asleep

Question 19

What is the tx for insomnia? What should be started with?

Answer 19

Start with sleep hygiene
Sleep Rx (avoid BZDs) --> use Zolpidem, Eszopiclone, Doxepin, Ramelteon

Question 20

_____ medications can be habit forming, but will not form dependence or tolerance to in the tx of insominia

Answer 20

hypnotic

Question 21

____ have sleep promoting effects, but tolerance can develop over time, same with ____ medications (tx of insomnia)

Answer 21

BZD

antihistamines

Question 22

Hyper-somnolence d/o occurs in ___% of the population

Answer 22

5%

Question 23

For at least ___ nights per week, for at least ___ months, a patient must have excessive daytime sleepiness/somnolence for dx of Hyper-somnolence d/o

Answer 23

3, 3

Question 24

Hyper-somnolence d/o is characterized by prolonged ____ and continual _____

Answer 24

nocturnal sleep, daytime drowsiness

Question 25

Often , pts with Hyper-somnolence d/o will take ____ naps per day, lasting ____

Answer 25

1-2 | 1 hour

Question 26

T/F: Hyper-somnolence d/o is a dx of exclusion

Answer 26

True

Question 27

pts with Hyper-somnolence d/o have a diminished ____ sleep stage and short latency to ____

Answer 27

delta stage 3 | REM

Question 28

How to tx Hyper-somnolence d/o?

Answer 28

No effective cure, sx tx sleep hygiene and sleep therapy Stimulant medications i.e. Dextroamphetamine and Methylphenidate (multiple divided doses throughout the day)

Question 29

Is Narcolepsy more common in males or females?

Answer 29

Equal

Question 30

Does narcolepsy run in families?

Answer 30

Yes

Question 31

What is the definition of narcolepsy?

Answer 31

recurrent episodes of an irrepressible need to sleep

Question 32

T/F: Narcolepsy is one of the only dx with a known etiology

Answer 32

true

Question 33

In pts w/ narcolepsy, they experience sleep attacks that can last from ___ to ____, and occur with one of the following: 1. _______, most severe 2. ____ deficiency 3. Nocturnal polysomnography with ____ latency ___ min or a ____ sleep latency of ____ min

Answer 33

``` seconds to 30 min Cataplexy CSF hypocretin (Orexin) REM <15 min MSLT <8 min ```

Question 34

How to tx narcolepsy? | Tx Cataplexy?

Answer 34

Stimulants--> Dextroamphetamine and Methylphenidate (multiple divided doses throughout the day) Modafinil single dose in AM Cataplexy--> Sodium oxybate (can decrease frequency of episodes) May require naps at work/during day to reduce sx

Question 35

What are the three breathing related sleep d/o?

Answer 35

Obstructive sleep apnea hypopnea d/o Central Sleep Apnea d/o Sleep related hypoventilation d/o

Question 36

What is the most common breathing related sleep d/o?

Answer 36

Obstructive sleep apnea hypopnea d/o

Question 37

Obstructive sleep apnea hypopnea d/o is most common in pts who are ____ and ____

Answer 37

overweight, middle aged/older adults

Question 38

In Obstructive sleep apnea hypopnea d/o, breathing reportedly does what?

Answer 38

Stops and starts during sleep

Question 39

What is apnea?

Answer 39

pause in breathing, breathing stops

Question 40

What is hypopnea?

Answer 40

decrease in airflow during breathing

Question 41

In Obstructive sleep apnea hypopnea d/o, patients are (aware/unaware) that they stop breathing?

Answer 41

unaware

Question 42

In Obstructive sleep apnea hypopnea d/o, _______ during sleeping causes narrowing of the airway, or closure--> brain wakes pt up

Answer 42

muscle relaxation

Question 43

Tx for Obstructive sleep apnea hypopnea d/o?

Answer 43

CPAP, weight loss, sleep position training, surgery to remove oropharyngeal tissue, and or tracheostomy if extreme

Question 44

Central sleep apnea d/o comprises ___% of breathing related sleep d/o

Answer 44

<5%

Question 45

In Central sleep apnea d/o, there (is no/is) upper airway obstruction

Answer 45

is NO

Question 46

Is snoring common/uncommon in Central sleep apnea d/o?

Answer 46

common

Question 47

Describe the pathophysiology of Central sleep apnea d/o

Answer 47

CNS control, brain regions involved in regulating muscles of respiration fail to up regulate breathing

Question 48

Central sleep apnea d/o may be experience ______ with subsequent __, __, __, and may be due to ______

Answer 48

Cheyne stokes breathing (w/ HF, CVA, renal failure) | Opioid use

Question 49

tx for Central sleep apnea d/o?

Answer 49

``` Sleep study Avoid sedative/hypnotic meds CPAP device Tx underlying medical conditions Supplemental oxygen Adaptive servo ventilation (ASV)- provides positive expiratory airway pressure (EPAP) & inspiratory pressure support (IPAP); servo controlled based on detection of central sleep apnea ```

Question 50

Sleep related hypoventilation d/o is characterized by a _____ response to _____ CO2 levels

Answer 50

decreased response to higher CO2 levels

Question 51

Patients with Sleep related hypoventilation d/o will have frequent episodes of ____, which last ____

Answer 51

shallow breathing, >10 seconds

Question 52

Sleep related hypoventilation d/o is frequently associated with ____ and _____ (such as ____)

Answer 52

lung dz and neuromuscular/chest wall d/o (pectus excavatum)

Question 53

Pts with Sleep related hypoventilation d/o often have ___ upon waking, ____, and _____

Answer 53

HA, insomnia, ad daytime sleepiness

Question 54

____ and ____ may occur along with Sleep related hypoventilation d/o

Answer 54

OSA and CSA

Question 55

Sleep related hypoventilation d/o may result in ___, ___, and ____. (medical conditions)

Answer 55

polycythemia, pulmonary HTN, and right sided HF

Question 56

Tx for Sleep related hypoventilation d/o?

Answer 56

Sleep study Avoid sedative/hypnotic meds Tx underlying d/o→ bronchodilators if obstructive lung dz Supplemental O2 As underlying d/o progresses, may require more extreme support and ultimately mechanical ventilation/tracheostomy