Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychopath 2 > sleep disorders > Flashcards

sleep disorders Flashcards

1
Q

Stage 0 sleep characteristics

A

Wakefulness w eyes closed just before sleep onset
EEG: alpha waves over occiput, decreases w inc drowsiness
Increase mm tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stage 1 sleep characteristics

A

Sleep-onset or drowsiness, transition from wake to sleep
EEG: less than 50% alpha waves, mixed beta and theta waves
5% total sleep period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stage 2 sleep characteristics

A

EEG: theta waves, sleep spindles, and K complexes
K complex may represent CNS response to internal stimuli
Increased mm tone, no eye mvmts
45-55% total sleep time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stage 3 sleep characteristics

A

Slow wave or deep sleep
EEG: high-voltage delta waves
Increased mm tone, no eye mvmts
15-20% total sleep time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

REM sleep characteristics

A

EEG: similar to stage 1 (a waves)
Bursts of rapid conjugate eye movements, reduced mm tone, resp and cardiac rate fluctuations, penile or clitoral engorgement
20-25% total sleep time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

REM latency

A

Waking through NREM sleep, preceding REM sleep

Usually about 90 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neurophysiological control of sleep

A

Pontine nuclei regulate REM sleep
Perilocus ceruleus inhibits motor activity
Inc ACh promotes REM
Dec DA, NE, 5HT a/w REM sleep
NREM sleep a/w dec ACh and adrenergic NTs, controlled by ventral arterial preoptic area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Insomnia disorder criteria

A 
1- dissatisfaction w sleep or sleep quality a/w 1+ of: difficulty initiating sleep, maintaining sleep, or early morning awakening (can't go back to sleep)
2- causes distress or impairment
3/4- at least 3 nights/w for 3 months
5- occurs despite opportunity for sleep
6/7/8- not d/t another d/o or substance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx for insomnia d/o

A

Sleep hygiene- consistent schedule, avoid bed when not sleeping, don’t nap, exercise 3-4x/w, reduce EtOH, caffeine, nicotine, anxiolytics, and sedative hypnotics
Pharm: temporary use of sedative hypnotics, BZDs, z-drugs, chloral hydrate, antihistamines, trazodone, doxepin (TCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypersomnolence disorder criteria

A

1- self-reported excessive sleepiness despite sleeping 7+ hours with 1+ of: recurrent periods of sleep w/i same day, unrestorative sleep 9+ h/day, difficulty feeling awake w abrupt awakening
2- at least 3x/w for 3 months
3- distress or impairment
4/5/6- not better explained by other condition or substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sleep drunkenness

A

Excessive grogginess on awakening that may last several hours, experienced by up to 50% of hypersomnolence d/o patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

EEG findings of hypersomnolence

A

Reduced REM latency, decreased delta sleep, increased # awakenings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tx of hypersomnolence d/o

A

Sleep hygiene, naps

Stimulant rx: dextroamphetamine, methylphenidate, modafinil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

narcolepsy criteria

A

1- recurrent periods of irrepressible need to sleep, falling asleep, or napping in same day for 3x/w for 3 mos
2- 1+ of: cataplexy (brief loss of mm tone after laughter/joking or spontaneous grimaces or jaw-opening episodes w tongue thrusting and global hypotonia w no emotional triggers), hypocretin deficiency (less than 1/3 normal), or REM sleep latency less than or = 15 min or MSLT shows mean sleep latency less/= 8 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

narcolepsy epidemiology

A

1/2000 people, M=F

may be hereditary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

biology of narcolepsy

A

loss of hypothalamic hypocretin-producing cells -> CSF hypocretin-1 deficiency
*hypocretin regulates arousal, wakefulness, appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

tx for narcolepsy

A

stimulants- methylphenidate, dextroamphetamine, modafinil (minimal CV effects)
for cataplexy: sodium oxybate (CNS depressant, careful w EtOH), TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

obstructive sleep apnea hypopnea cause

A

airway muscles relax and airway narrows, lowering blood oxygen, low O2 sensed by brain causes brief arousal from sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

obstructive sleep apnea hypopnea criteria

A

either:
1- evidence by polysomnography of 5+ obstructive apnea/hypopnea per hour of sleep and either nocturnal breathing disturbance (snoring, gasping, pause in breathing) or daytime sleepiness/fatigue not explained by other d/o
OR
2- evidence by polysomnography of 15+ obstructive apneas/hypopneas per hour of sleep regardless of other sx

20
Q

obstructive sleep apnea hypopnea clinical

A

middle aged-older adults, overweight people
sx: excessive daytime sleepiness, loud snoring, observed episodes of breathing cessation during sleep, abrupt awakening w shortness of breath, sore throat or dry mouth on waking, morning headache, difficulty staying asleep, difficult-to-control HTN

21
Q

tx for obstructive sleep apnea hypopnea

A

weight loss, avoid sedative-hypnotics, sleep position training (don’t sleep supine), oral appliances to keep airway opening
CPAP (continuous + airway pressure)
uvulopalatopharyngeoplasty if redundant oropharyngeal tissue
life-threatening or unresponsive: tracheostomy

22
Q

apnea and hypopnea definitions

A

apnea: pause in breathing
hypopnea: decrease in airflow during breathing

23
Q

central sleep apnea criteria

A

1- evidence by polysomnography of 5+ central apneas/hour of sleep
2- not better explained by another sleep disorder

24
Q

cause of central sleep apnea

A

idiopathic

medical: heart failure, stroke, renal failure - Cheyne-Stokes breathing (crescendo-decrescendo tidal volume variation)
* can also be d/t substance, like chronic opioid use

25
Q

central sleep apnea tx

A

similar to obstructive sleep apnea tx

also meds: acetozolamide, theophylline may be prescribed to stimulate breathing

26
Q

sleep-related hypoventilation cause

A

decreased response to CO2 during sleep, characterized by frequent episodes of shallow breathing lasting longer than 10 sec
a/w lung disease or neuromuscular or chest wall disorders

27
Q

sleep-related hypoventilation criteria

A

1- polysomnography shows dec respiration a/w inc CO2 levels (or persistently low levels of O2 sats)
2- not better explained by another sleep d/o

28
Q

congenital central alveolar hypoventilation

A

rare congenital d/o in which individual presents in perinatal period w shallow breathing or cyanosis and apnea during sleep

29
Q

sleep-related hypoventilation sx

A

insomnia or excessive sleepiness, orthopnea, headaches on awakening
may have consequences of ventilatory insufficiency: pulm HTN, cor pulmonale (RHF), polycythemia, neurocognitive dysfunction
w progression, blood gas abnormalities may persist in wakefulness

30
Q

tx of sleep-related hypoventilation

A

correct underlying d/o
theophylline (stimulate respiratory center and diaphragm contractility)
avoid respiratory depressants (EtOH, BZDs)
weight loss, including bariatric surgery if indicated
some pts need ventilatory assistance

31
Q

circadian rhythm sleep-wake d/o criteria

A

1- persistent/recurrent pattern of sleep disruption d/t altered circadian system or misalignment w sleep-wake cycle required by environment or professional schedule
2- leading to excessive sleepiness, insomnia, or both
3- causes distress or impairment of functioning

32
Q

types of circadian rhythm sleep-wake disorders

A 
delayed sleep type: "night owl"
advanced sleep type: "morning people"
irregular sleep-wake type: variable cycles
non-24-hour sleep-wake type
shift-work type
33
Q

tx for circadian rhythm sleep-wake d/o

A

delayed sleep type: delay sleep time by 30m-3h on successive nights, delay for almost 24 hours to induce sleep at acceptable time
shift work: stop shift work or armodafinil (stimulant)

34
Q

non-rapid eye movement sleep arousal disorder criteria

A

1- recurrent episodes of incomplete waking from sleep during first 1/3 of major sleep episode, accompanied by sleepwalking or sleep terrors
2- no/little dream imagery recalled
3- amnesia for episodes
4- distress/impairment
5/6- not d/t substance or other condition

35
Q

sleepwalking

A

repeated episodes of rising from bed and walking about with blank, staring face; unresponsive to efforts by others to communicate or rouse from sleep
occurs in stage 3 NREM sleep
*onset in adults = search for specific etiology like breathing-related sleep d/o, nocturnal seizures, or med effect

36
Q

sleep terrors

A

recurrent episodes of abrupt arousal from sleep, usually w panicky scream, intense fear and signs of arousal (sweating, rapid breathing, tachycardia, mydriasis); relative unresponsiveness to attempts to comfort individual
*usually no recall of event upon awakening

37
Q

tx for NREM sleep arousal d/o

A

BZDs - suppress stage 3 sleep, dec sleepwalking and sleep terrors
TCAs, SSRIs, melatonin
better sleep hygiene
*protect from injury by installing alarms, staying on first floor, latching windows, removing breakables from room

38
Q

nightmare d/o criteria

A

1- repeated episodes dysphoric and well-remembered dreams involving threat to security, survival, or physical integrity usually occurring during second 1/2 major sleep episode
2- rapidly oriented and alert on awakening
3- distress or impairment
4/5- not d/t substance or other condition

39
Q

causes of nightmares

A 
febrile illness and delirium in elderly and chronically ill
drug withdrawal (esp BZDs; barbs or EtOH d/t inc REM; SSRIs)
40
Q

tx nightmare d/o

A

treat underlying mental illness if present

counseling or short-term use sedative hypnotics if d/t psychologically traumatic events (MVA, sexual assault)

41
Q

REM sleep behavior d/o criteria

A

1- repeated episodes of arousal during sleep w vocalization or motor behaviors
2- occurs during REM sleep (after 90 m sleep onset), more frequent later in sleep, not common in daytime naps
3- upon awakening, not confused or disoriented; alert and completely awake
4- either REM sleep w/o atonia or established synucleinopathy dx (PD, multiple system atrophy) w consistent hx
5- distress/impairment
6/7- not d/t substance or other condition

42
Q

causes of REM sleep behavior d/o

A

relationship w neurodegenerative d/o (PD, Lewy body dementia, multiple system atrophy)
also w TCAs, SSRIs, SNRIs, BBs - these may just unmask underlying condition and not be a true cause

43
Q

tx REM sleep behavior d/o

A

clonazepam may be effective

protect dreamer and bed partner by sleeping in separate rooms

44
Q

restless leg syndrome criteria

A

1- urge to move legs d/t unpleasant sensations: worse at periods of rest, partially/totally relieved by mvmt, and worse in evening/night or only occurs at evening/night
2- 3x/w for 3 months
3- distress or impairment
4/5- not d/t substance or other condition

45
Q

mimics of restless leg syndrome

A

cramps, positional discomfort, arthralgia, arthritis, myalgia, positional ischemia, leg edema, peripheral neuropathy, radiculopathy, habitual foot tapping

46
Q

tx restless leg syndrome

A

DA agonists: pramipexole, ropinirole

47
Q

possible causes of restless leg syndrome

A

1- low Fe w/o anemia, low ferritin (less than 50 ng/mL)
2- pregnancy
3- neuro lesion - SC or peripheral nerve lesion, degenerative disk disease
4- uremia
5- drug-induced

Psychopath 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions