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behavioral med Q2 > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

(53 cards)

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1
Q

how many stages of sleep

A

4 measurable ones

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2
Q

REM stage

A

rapid eye movements

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3
Q

how many stages of REM/NREM per night?

A

3-4

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4
Q

the first REM period is about __min and then each successive cycle increases in ___

A

first one about 5-10 min
then increases in frequency and length

density of REM sleep increases over the night

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5
Q

stage 0

A

wakefulness with eye closed just before sleep onset

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6
Q

stage 1

A

presleep drowsiness, NREM

small wave 4-7 hz on EEG

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7
Q

stage 2

A

asleep, NREM

EEG has theta waves but hz increase leading to E burst on EEG = sleep spindle

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8
Q

what percentage of sleep is spent in each stage?

A

1: 5%
2: 45-55%
3: 15-20%

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9
Q

stage 3

A

delta waves, 1-4 hz, less sleep spindles, NREM sleep

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10
Q

REM sleep

A

aka paradoxical sleep
fast desynchronized EEG
body paralyzed - dreaming
20-25% of sleep

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11
Q

after reaching REM what happens?

A

go back to stage 2, then go back to REM and repeat ever 90 min 4-5 x/night

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12
Q

when relazed and sleepy brain activity is more__

A

synchronized

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13
Q

wakefulness

A

desynchronous beta waves predominate

low in amplitude but high in frequency

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14
Q

closing eyes triggers

A

alpha waves to dominate

slower frequency an higher amplitude

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15
Q

what 4 areas of brain regulates sleep

A

brainstem, thalamus, hypothalamus, basal forebrain

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16
Q

what is multiple sleep latency test for

A

excessive sleepiness that occurs during normal period of wakefulness

q2 hrs pt is placed in dark room to sleep for 20 min

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17
Q

what result of MSLT signifies dx excessive daytime sleepiness

A

an average sleep latency less than 5 min

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18
Q

insomnia dx

A

must be difficulty with sleep initiation, maintaining, or early awakening

at least 3 days/ wk for 3 mo

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19
Q

what populations is insomnia more common in?

A 
elderly 
women 
chornic medical problems 
lower income 
less education
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20
Q

hypnotics should be used for ___insomnia

A

transient/ short term

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21
Q

are bzd and antihistamines good for insomnia?

A

can tx but tolerance can form

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22
Q

ramelteon

Study These Flashcards
A

insomnia tx option

melatonin receptor agonist for MT1 and MT2

23
Q

zolpidem
esozopiclone
and belsomra
are…

Study These Flashcards
A

targeted insomnia meds
with less daytime sleepiness
less tolerance and less potential for abuse

24
Q

hypersomnolence disorder

Study These Flashcards
A

excessive daytime sleepiness
prolonged nocturnal sleep and continual daytime drowsy

1-2 long naps (1hr) 3 times per wk for 3 mo

25
what will hypersomnolence disorder show on EEG
diminished delta sleep (stage 3) | and short latency to REM sleep (MSLT)
26
tx for hypersomnolence disorder
tx is symptomatic: sleep hygiene and therapy
27
what stimulants can be used for hypersomnolence disorder?
dextroamphetamine methylphenidate multiple doses per day
28
modafinil is for
narcolepsy single dose in morning unknown MOA stimulant can be used for hypersomnolence disorder
29
narcolepsy
recurrent episodes of irrepressible need to sleep sleep attacks
30
narcolepsy sleep attacks occur with 1+ of these factors
1. cataplexy 2. CSF hypocretin deficiency (under 1/3 of normal) 3. nocturnal polysomnography with REM latency under 15min or MSLT sleep latency under 8min
31
Tx for narcolepsy
1. stim: dextramphetamine or methylphenidate 2. modafinil 3. Na oxybate for cataplexy 4. supportive tx
32
what is cataplexy
when strong emotion / laughter causes individual to collapse
33
what are 3 breathing sleep disorders
1. obstructive sleep apnea hypopnea 2. central sleep apnea 3. sleep related hypoventilation
34
central sleep apnea disorder cause
problem with CNS control | ex: Cheyne Stokes, Opioid Variants
35
TX central sleep apnea disorder
CPAP: continuous positive airway pressure ASV: adaptive servo ventilation
36
sleep related hypoventilation disorder
decreased response to high Co2 | pts with lung dz, neuromuscular disorder, chest wall disorder
37
sx of sleep related hypoventilation
wake up with headaches, insomnia, daytime sleepiness
38
persistant sleep related hypoventilation complications
pulmonary HTN, polycythemia, Right HF
39
tx sleep related hypoventilation
supplemental oxygen | mechanical ventilation if severe
40
__ regulates our light and dark information
suprachaismatic nucleus
41
-- gland secretes melatonin in response to increasing darkness
pineal gland
42
circadian rhythm sleep wake disorder
sleep disturbance from altered sleep wake cycle | work: night shift etc
43
TX circadian disorder
quit that shift | or take Nuvigil (armodafinil)
44
3 parasomnia disorders
1. NREM sleep arousal disorder 2. Nightmare disorder 3. REM sleep behavior disorder
45
NREM sleep arousal disorders
sleep walking, sleep terrors | complex motor behavior w/o consciousness
46
TX NREM sleep arousal disorder
BZD will promote stage 3 sleep keep them safe avoid caffeine / alcohol
47
nightmare disorder
vivid terrifying dreams well remembered after waking during REM sleep
48
TX nightmare disorder
treat underlying mental illness if there is one | judicious use sedatives / hypnotics
49
REM sleep behavior disorder
arousal during sleep associated with vocalizations +/- complex motor mvmt
50
REM sleep behavior disorder dreams associated with
dream of being attacked or escaping can recall dream associated with PD, lewy body dementia, and multiple system atrophy 50% will dev these
51
DOC for REM sleep behavior disorder
clonazepam
52
what meds could cause REM sleep behavior disorder
TCA, SSRI, BB
53
TX restless leg syndrome
dopamine agonist Ropinirole Pramipexole

behavioral med Q2 (5 decks)

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