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Flashcards in Sleep Disorders Deck (23):
1

EEG
awake
eyes closed
NREM1
NREM2
NREM3
REM

low amplitude
alpha

theta (vertex waves)

sleep spindles and K
complexes (precursors to slow waves (gen via thalamic reticular complex)

slow waves (delta: large amplitude) coordinated waves

2

parasomnias

undesirable physical, experiential, behavioral phenomena occur during sleep

arise when elements of specific brain states co=occur

3

physiology of sleep

NREM: up PS, down HR, CO, BP, EMG activity

REM: up sympathetic, paralysis, rapid eye mvmts

4

NREM + wake co-occur

sleepwalking/terrors, confusional arousals

5

REM + wake co-occur

RBD
sleep paralysis/nightmares

6

sleepwalking

resolves by adolescense
STRONG genetic component

7

sleep terrors

motor behavior w/affective discharge

up ANS activity

caution

8

PSG if?

co-morbid sleep d/o
dangerous parasomnia

9

evaluation & MGT

modify factors: avoid sleep deprivation/stress; improve safety of env; meds

BZD: clonazepam

10

REM parasomnias

RBD assoc w?

during REM: paralysis, dreaming, up ANS activity

RBD: loss of paralysis, act out dreams, eyes closed, unresponsive, rapid alertness on awakening, self-injury

elderly men
assoc w parkinsons!

11

Causes of RBD

rx?

antidepressants (serotonergics can cause loss of atonia during REM)

BZDs (clonazepam), melatonin, pramipexole

12

NREM parasomnias
REM parasom: RBD

common in kids, resolve spontaneously

elderly men, assoc w/parkinson's

13

narcolepsy: 4 cardinal sx

excessive daytime sleepiness
sleep paralysis
hypnagogic/hypnopompic imagery
cataplexy (highly specific for narc)
and automatic behaviors

14

narcolepsy

tx?

onset in kids/teens/YA
w/ and w/o cataplexy
w/: loss of hypocretin/orexin neurons in lateral hypoT; autoimmune rxn

w/o: less clear

antidepressants for cataplexy
sodium oxybate: stabilize sleep

15

restless leg syndrome
4 cardinal sx?

more in women and elderly
N. European descent
dx made clinically
assoc w/periodic limb movements

URGE
U: urge to move legs (akasthesia)
R: rest-induced
G: get better w/movement
E: evening predominance

16

primary/secondary RLS causes?
tx?

primary: CNS iron metabolism dysfxn
secondary: iron def anemia, renal failure, pregnancy, med-induced (antidepressants, antiemetics, antipsychotics, antihistamines)

iron supplementation
DA agonist (prami/ropinir)
a2 Ca channel (pregabalin)

17

delayed sleep phase syndrome

advanced sleep phase syndrome

adolescents; initial insomnia and difficulty waking
think: alerting signal shifts right

elderly; early AM awakening
think: alerting signal shifts left

18

circadian rhythm d/o tx

regularizing sleep/wake patterns, light exposure, melatonin

19

vast majority type of insomnia?

co-morbid

women>men
smoking/alcohol/drugs

20

depression w/insomnia?

2 fold RR of developing depression if you have insomnia

21

most medications for insomnia focus on what factors?

perpetuating (these stick around after precipitating ones are gone)

22

CBT is...

just as effective as meds for insomnia

23

drugs for insomnia

BZDs: zolpidem
melatonin agonists (ramelteon) but not good for maintenance bc short half-life

orexin antagonists (suvorexant)

doxepin for sleep maintenance