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Flashcards in Sleep disorders Deck (39)
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1

How much time do we spend in Rapid Eye Movement (REM)

20-25%

2

How much time do we spend in Non-Rapid Eye Movement (NREM)

50-60%
N1 and N2

3

What is characteristic of REM sleep?

Brainstem mediated muscle atonia=ABSENT EMG activity in nearly all skeletal muscle=Body paralysis

4

List the 3 stages of NREM. Which one is the most difficult to arouse you from?

1. N1
2. N2
3. N3-Most difficult to arouse

5

What sleep stage do you observe decreased BP, HR and RR

NREM-Especially N3

6

What hormone do men secrete during sleep?

GH

7

What hormone do women secrete during sleep?

Prolactin

8

What hormones are inhibited during sleep?

1. TSH
2. ACTH-Cortisol axis

9

What is considered the "regenerative" stage of sleep

N3

10

How much sleep does the average adult need?

7.5-8 hrs

11

How much sleep do teenagers need?

9+ hrs

12

What does Multiple Sleep Latency Test (MSLT) measure?

Propensity to sleep during the day

13

What does Maintenance of Wakefulness Test measure?

Ability to sustain wakefulness during daytime

14

Diagnostic criteria for insomnia

1. Symptoms at least 3 x/wk
2. Sleep initiation OR maintenance problem
3. Opportunity to sleep
4. Daytime consequences

15

Short term insomnia

<3 months

16

Chronic insomnia

>3 months

17

What medication would you prescribe for a patient who has a short, acute episode of insomnia due to stress from a death in the family

Benzodiazepines

18

What is nonbenzodiazepine sedative that you could consider in insomnia?

Zolpidem (Ambien)

19

What is actually considered first line tx for insomnia, but patients have a low tolerance for?

Melatonin Agonist

20

What causes obstructive sleep apnea?

Repetitive collapse of upper airway during sleep

21

When can you diagnose sleep apnea with just 5+ events (compared to 15)

1. Excessive sleepiness, fatigue, and/or insomnia
2. Waking with gasping/choking
3. Habitual snoring or breathing interrruptions
4. HTN, CAD, stroke, A-fib, HF, DM
5. Mood disorder, cognitive dysfunction

22

Highest prevalence of sleep apnea

1. Men
2. African Americans

23

Sleep apnea risk factors

1. Obesity
2. Male
3. Advanced age
4. Craniofacial morphology or upper airway soft tissue abnormality (tonsillar/adenoid hypertrophy)

24

Sleep apnea PEx findings

1. Obesity
2. Elevated BP
3. Pulmonary HTN
4. Crowded/narrow orophargneal

25

How do you diagnose sleep apnea?

Polysomnography

26

Sleep apnea Treatment

1. Positive airway pressure (CPAP)= initial therapy
2. Behavioral: Wt. loss/exercise, sleep position, avoid alcohol

27

What is the estimated percentage of sleep apnea patients who DO NOT use their CPAP device?

20-40%

28

What is the average nightly use of CPAP?

4 hrs

29

Narcolepsy etiology

-Loss of hypothalamic neurons that produce orexin neuropeptides
-Orexins promote long episodes of wakefulness and suppress REM sleep

30

List the two types of narcolepsy

1. Type 1- With Cataplexy
2. Type 2- WithOUT Cataplexy

31

Define cataplexy

-Sudden muscle weakness without LOC
-Usually triggered by strain emotions (laughing, crying)

32

Define Hypnagogic hallucinations

Dream-like hallucinations at sleep onset or upon awakening (hypnopompic)

33

What is a typical Epworth sleepiness scale score in narcolepsy?

>15

34

Polysomnogram findings in narcolepsy

REM sleep within 15 minutes of sleep onset at night

35

Multiple sleep latency (MSLT) findings in narcolepsy

sleep latency < 8 minutes & REM episodes in at least 2 of the naps

36

What is first line pharmacologic treatment for narcolepsy?

Modafinil: Wake-promoting

37

What can you prescribe to treat cataplexy?

Antidepressants that increase noradrenergic or serotonergic tone=suppress REM sleep and cataplexy

38

List the NREM related parasomnias

Disorders of arousal:
1. Confusional arousal
2. Sleepwalking
3. Sleep Terrors: Autonomic activation (tachypnea, tachycardia, mydriasis)
4. Sleep-Related eating disorders

39

List the REM related parasomnias

Intrusion of features of REM sleep into wakefulness:
1. Sleep paralysis
2. Nightmare disorder