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Sleep Disorders Flashcards

(63 cards)

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1
Q

What is sleep onset latency?

A

Time it takes to transition from wakefulness to sleep

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2
Q

What is sleep maintenance?

A

The ability to stay asleep

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3
Q

What is sleep efficiency?

A

Amount of sleep in relation to the amount of time in bed

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4
Q

What is sleep architecture?

A

Structure and pattern of sleep (including sleep cycle, duration spent asleep during 24 hour period etc)

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5
Q

Where does the circadian rhythm originate from?

A

Superchiasmatic nucleus in the hypothalamus

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6
Q

What does the circadian rhythm control?

A

Physiologic functions, hormone secretions, body temperature, and sleep wake cycle

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7
Q

Why do we care about sleep in the elderly?

A

50% of community-dwelling older adults complain of some form of sleep difficulty

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8
Q

How is sleep affected in older adults?

A

Takes longer to fall asleep
Wake more often
Lower sleep efficacy

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9
Q

What are the etiologies of sleep disorders?

A

Primary sleep disorders
Endogenous changes in circadian clock
Medical and psychiatric illnesses
Medications

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10
Q

What psychiatric illnesses can lead to sleep disorders?

A

Depression
Dementia
Anxiety

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11
Q

What happens to the superchiastmatic nucleus with age?

A

Degenerates

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12
Q

What hormone secretion is decreased at night with age?

A

Endogenous melatonin

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13
Q

With age, do we become more or less sensitive to exposure to external signals?

A

Less sensitive

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14
Q

How does the sleep-wake cycle shift in the elderly?

A

Earlier shift

Older people may get sleepy earlier in the evening and wake earlier in the morning

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15
Q

Are there required treatments for changes in sleep with aging?

A

No, nonpharmacologic treatment is preferred if patient wants to change habits

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16
Q

What are nonpharmacologic treatments for adjusting sleep habits?

A

Sleep-wake cycle retraining

Bright light therapy

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17
Q

What are the types of sleep disorders?

A

Circadian rhythm sleep disorder
Periodic limb movement in sleep(PLMS) /restless leg syndrome (RLS)
REM behavior disorder
Insomnia

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18
Q

What is PLMS?

A

Jerking movement of extremities every 20-40 seconds during the night

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19
Q

What is RLS?

A

Dysesthesia of the legs (“creeping, crawling sensation” or “pins and needles”)

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20
Q

What is the hypothesis for the cause of PLMS/RLS?

A

Dysfunction of DA system - treat with DA agonists

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21
Q

How do PLMS/RLS affect sleep?

A

Arouses patient out of sleep, or prevents them from falling asleep

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22
Q

What is a primary presenting sign of PLMS/RLS?

A

Insomnia

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23
Q

What is REM behavior disorder?

A

Complex motor behaviors while in a sleeping state

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24
Q

What actions occur in REM behavior disorder?

A

Walking, talking, eating, etc

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25
What part of sleep does REM behavior disorder occur?
During a lack of skeletal muscle tone during REM stage sleep
26
What is the usual treatment of REM behavior disorder?
Clonazepam which decreases motor movements partially or completely
27
Is it more common for RLS to have PLMS or PLMS to have RLS?
90% of patients with RLS have PLMS | 20% of patients with PLMS have RLS
28
What is insomnia?
Low quantity and/or poor quality of sleep resulting in nonrestorative sleep
29
What may insomnia result from?
Problems with sleep onset, sleep maintenance, or early morning awakening with inability to return to sleep
30
What are sedating agents?
Hypnotics Antihistamines Antipsychotis Antidepressants
31
What are activating agents?
``` Nicotine CNS stimulants Thyroid hormones Bronchodilators Corticosteroids ```
32
What are non-pharm approaches for sleeping?
Avoid caffeine, alcohol, and cigarettes after lunch Limit liquids in the evening Keep a regular bedtime-waketime schedule Avoid naps (no longer than 20 minutes) Spend times outdoows, particularly in later afternoon or early evening Exercise, but avoid in the evening
33
What can many sedating medications cause?
Falls, fractures, and cognitive slowing
34
What % of community dwelling older adults complain of some form of sleep difficulty?
50%
35
If a patient has difficulty falling asleep, what type of agent should be used?
Shorter half-lives
36
If a patient has difficulty maintaining sleep, what type of agent should be used?
Intermediate half-lives
37
What is the MOA of benzo receptor agonists?
Enhances activity of GABA (inhibitory neurotransmitter) at various receptor sites leading to sedative and hypnotic effects resulting from decreased neuronal excitability
38
What are benzo receptor agonists?
Non-benzo/non-barbiturate Ambien Lunesta Zaleplon
39
How do benzo receptor agonists compare to benzos?
Lower tolerance effects Rebound insomnia Residual daytime sleepiness
40
What is Ambien effective for?
Sleep onset (ER can help with sleep maintenance as well)
41
Where does ambien work?
Benzodiazepine-1 receptor
42
What is Lunesta effective for?
Sleep onset and maintenance
43
Where does Lunesta work?
GABA-receptor complex domain
44
What is zaleplon effective for?
Sleep onset
45
Where does zaleplon work?
Omega-1 receptor GABA-A
46
What are common SEs for benzodiazepine receptor agonists?
HA Dizziness Somnolence
47
Which benzo receptor agonist leaves a found taste in the mouth?
Lunesta
48
What is melatonin's MOA?
Binds to melatonin receptor at the suprachiasmatic nucleus of the hypothalamus, which plays a key role in circadian rhythms and synchronization of sleep-wake cycle. MT1 receptor responsible for inducing sleepiness, MT2 receptor responsible for circadian rhythms
49
Which type of patients is melatonin most beneficial for?
Melatonin deficient
50
What are common SEs of melatonin agonists?
``` Similar to placebo HA Dizziness Nausea Drowsiness ```
51
What are the melatonin agonists?
Melatonin | Ramelteon (Rozerem)
52
What is ramelteon effective for?
Sleep onset
53
What is Ramelteon more selective for?
MT1 > MT2
54
Does melatonin or ramelteon have a higher affinity for MT1?
Ramelteon
55
What is ramelteon more effective for?
Primary insomnia (w/o melatonin deficiency)
56
What are the antidepressants that can be used for insomnia?
Trazodone Mirtazapine Doxepin
57
Which patients receive Trazodone?
With concomitant depression
58
What are SE of trazodone?
``` Nausea Dry mouth Dizziness HA Somnolence Blurred vision Nervousness Fatigue Priapism ```
59
Who receives mirtazapine?
With concomitant depression and/or decreased appetite/weight
60
What type of mirtazapine doses are sedating?
Lower
61
What are the SE for Mirtazapine?
``` Increased appetite Increased TG Constipation Dry mouth Somnolence ```
62
What does the insomnia dose of doxepin do?
Selectively antagonizes H1 receptors
63
What other medications may be used for depression but are on the Beers list?
Antihistamines Antipsychotics Benzos

Geriatrics (15 decks)

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