Sleep Disorders Flashcards Preview

Psychiatry > Sleep Disorders > Flashcards

Flashcards in Sleep Disorders Deck (41):
1

What are teh two sleep states and NTs involved

 

- REM: acetylcholine (Ach)
- NREM: serotonin 

2

What does normal sleep architecture look like?

3

What EEG pattersns are seen during sleep cycle

4

How long is the human circadian cycle?

What do we see in awake EEG?

What is difference bwtn sleep latency and sleep efficiency?

Human Circadian Cycle = 25 hours

Awake EEG - beta and alpha waves

Sleep Latency = time it takes to fall asleep (less than 10 minutes)

Sleep Efficiency = time sleeping/time spent trying to sleep (100%) 

5

What are the sleep requirments for

Newborn – 

Adolescent – 

Adult – 
Older Adult – 

Newborn – 16-18

Adolescent – 9-10

Adult – 8
Older Adult – 7-8 

6

• 25% of all sleep
• Every 90 minutes
• Each  episode – 10-40 minutes
• Longer episodes – second half of night

REM sleep

7

During REM:

• Blood pressure, pulse rate, and respirations____

• Penile and clitoral ____
• Skeletal mm_____

 – increase 

erection

 paralysis

8

Why do we dream?

wish fulfilment, random neural impulses, what we learn during wake cycle or purging

threat simulaiton or process pain or problem solving

9

Non-REM Sleep

Non-REM = Stage 1, 2, 3, and 4

- Stage 1 = ___% sleep
- Stage 2 = __% sleep

- Stage 3 and 4 = ___% sleep : most deep sleep occurring during the first half of the night 

5

45

25

10

Stage 1 NREM

• Lasts about___ minutes
• Breathing - ____
• Heart rate – ___
• Blood pressure -____

Stage 1 NREM

• Lasts about 10 minutes
• Breathing - slow and even
• Heart rate – regular
• Blood pressure - decrease

11

• Temperature - decrease
• Blood flow to brain – decrease
• EEG – brain waves smaller, slower, irregular •

Sleeper easily awoken 

Stage 1 NREM 

12

• Lasts about 20 minutes
• Bodily functions continue to slow
• Even if eyes are opened, sleeper cannot see
• EEG – larger brain waves, occasional quick bursts of activity

• Sleeper can be awakened by sounds 

Stage 2 NREM 

13

• Begins about 30-45 minutes after sleep is initiated

• EEG – brain waves are slow and large (up to 5x as large as in Stage 2)

• Sleeper is much less easy to awake, requiring loud noise or active attempts to wake 

Stage 3 NREM 

14

• Bodily functions decline to the deepest state of rest
• EEG – brain wakes are large, slow and make a jagged pattern

• Sleeper experiences oblivion - if awakened, very disoriented 

Stage 4 NREM 

15

What happens to

REM

Stage 3 and 4 

as we get older?

Decreased REM

Decreased Stage 3 and 4 sleep

Increased night-time awakenings - decreased sleep efficiency 

16

What happens to REM in depressed pts? what about stage 3/4 sleep?

Decreased REM latenly: first REM within 45 mins!

Increased total REM

Decreased total 3/4

*wake alot, especially in morning

17

____– Abnormal timing, quality, and amount of sleep

_____– Abnormal behaviors associated with sleep 

Dyssomnias

Parasomnias

18

What dyssomnias are associated with: 

Timing

Quality

Amount

Timing : Narcolepsy and Circadian rhythm sleep disorder

Quality: Restless legs or Sleep apnea

Amount: Insomnia or  Hypersomnia 

19

Bruxism (tooth grinding)

Night terror
Sleepwalking
REM sleep behavior disorder 

all are examples of: 

Parasomnias

20

- Sleep attacks

- Hypnogogic/hypnopompic hallucinations

- Cataplexy
- Sleep paralysis 

Narcolepsy (dyssomnias)

21

Changes seen in Narcolepsy:

Abnormalities in sleep architecture
-_____ sleep latency
-____ REM latency:  less than 10 minutes

-___ REM overall 

Decreased

Decreased

Less

22

What neuro factor is different in narcolepsy

hypocretin (orexin) deficiency 

Epidemiologic factors
- Usually diagnosed in adolescence - Significant genetic component 

23

Tx options for narcolepsy

- Scheduled daytime naps

- Psychostimulants: methylphenidate (Ritalin) modafinil (Provigil) 

24

What is circadian ryhthm sleep disorder

Features
- Inability to sleep at appropriate or desired times -

Two types: Delayed or Advanced -

Causes: Intrinsic or Extrinsic (e.g. shift work, jet lag) 

25

What are the tx recommendations for circadian sleep rythm disorder:

both delayed and advanced

( Shift work: Modafinil 100-200 mg or caffeine for alertness; Melatonin or other hypnotic at bedtime) 

26

- Uncomfortable sensation in the legs

- Repetitive limb jerking
- Frequent night-time awakenings 

Restless Legs Syndrome: dyssomnias

27

Who gets RLS and what's the treatement?

Epidemiologic factors: Usually occurs in older adults

Treatment: Antiparkinsonian agents, levodopa, carbidopa/levodopa (Sinemet) ropinirole (Requip) 

28

- Cessation of breathing
- Carbon dioxide increases
- Frequent awakenings
- Increase rate of sudden death 

Sleep Apnea (dyssomnia)

29

what in the hypothalamus transmits information to pineal gland to increase produciton of melaotnin which aids in sleep

Suprachiasmiatic nucleus

30

Pt comes in saying she has recurrent headaches and feels very drowsy during the day. Her husband has moved to the other room to sleep because of her snoring. She is overweight. What is a possible dx? What would you expect to see on her labs?

Sleep apnea (likley obstructive from weight)

lab would show respiratory acidosis

31

Cauased by decreased respiratory effort; usually in older adults. A type of dyssomnia

Central Sleep apnea

32

Seen in pts with NORMAL respiratory effort and obstructed airway; seen in middle aged adults, more common in men and associated with obesity

Obstructive sleep apnea

33

What are some tx options for Sleep Apnea

- Weight loss (if obesity present)
- Continuous positive airway pressure (CPAP)

- Medroxyprogesterone acetate
- Uvulopalatoplasty /Tracheostomy 

34

Pt comes in stating he's been having issues fallling asleep. It has been going on for the past two weeks about 3-4 days a week. He feels tired and groggy all the time. Whats going on?

May be developing Insomnia, need to wait a MONTH to make dx,but needs 3/4 s a week

seen in 30% poputlation

35

Pt was recently dx with insomnia, what may be some possible etiologies

seen in pts with cognitive impairement and in accidents

36

Recommended tx for insomnia

- Avoid caffeine, especially in evenings

- AM exercise
- Develop sleep routine
- Relaxation techniques
- Hypnotic medication: May, however, decreased REM and delta sleep. 

37

When does Bruxism occur and what is a tx option?

Stage 2 sleep; wear appliance

38

Child comes in with mother. Mom states he's been screaming at about 2-3 in the morning the past several weeks on and off. He is difficult to rouse and has no memory of the dream when he wakes. What stage of sleep is thi slikley during?

Night Terrors: likely stage 3-4

39

What stage does sleepwalking occur

Occurs in Stage 3 and 4 sleep (usually the first half of the night)

no memory, create safe envirnoment

40

- Motor activity while dreaming
- Eyes closed
- Awakens fully alert and able to recount their dream 

REM Sleep Bhavior Disorder (occurs during REM in second half of night)

41

What pts are prone to REM Sleep Behavior disorder and what can we tx pts with?

Associated with Parkinson disease and Lewy Body Dementia Treatment:

- Environmental manipulation: Safety
- Melatonin or low-dose benzodiazepines