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Block 5 Week 5 Dani > Sleep HB > Flashcards

Sleep HB Flashcards

1
Q

How we feel and how we perform our daily tasks during our waking hours is greatly influenced by duration and quality of (blank)

A

nighttime sleep

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2
Q

Sleep is affected by what processes?

A

physiological and psychological

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3
Q

(blank) percent of patients present to primary care physicians for sleeping problems

A

50%

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4
Q

What are the 5 determinants of sleep?

A 
duration of prior wakefulness
circadian (biological clock)
aging
drugs
sleep disorders
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5
Q

What is disruption of circadian associated with?

A

tumors and shortens life

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6
Q

What determines circadian rhythm?

A 
wake/sleep
hormonal
temperature
immune
drug metabolism
renal  function
airway function
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7
Q

When is melatonin the highest?

A

in the middle of being asleep

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8
Q

What are the stages of sleep?

A

you have four non-REM stages and REM

12344321REM REM 1235 (cycle)

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9
Q

What are the deepest stages of Sleep?

A

3 and 4 (Slow Wave Sleep)

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10
Q

What is considered normal sleep latency?

A

10 minutes

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11
Q

How long do you spend in each stage (percentage wise)?

A

5% stage 1
50% stage 2
15-25% stages 3 & 4 (slow wave sleep)
25% REM

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12
Q

What is considered Slow wave sleep (SWS)?

A

stage 3 and 4

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13
Q

When do you dream and have inhibition of muscular activity?

A

during REM sleep

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14
Q

When do you have restorative sleep, disinhibition of muscular activity, parasomnias?

A

during stage 3 and 4 (SWS)

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15
Q

The longer you sleep the longer your (blank) cycle.

A

REM

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16
Q

When does SWS typically occur?

A

during the earlier portion of the night and REM sleep last third of night

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17
Q

What are some age-related changes in sleep architecture?

A
  • Increase in light/transitional sleep
  • Reduction in slow-wave sleep
  • Decline in overall sleep time
  • Increased awakenings and arousals
  • Decreased REM sleep
  • Reduced sleep efficiency
    (i. e light sleeping)
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18
Q

REM sleep occurs cyclically throughout the night at intervals of app. (blank) minutes in all age groups

A

90

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19
Q

(blank) sleep decrease slightly in elderely, whereas (blank) sleep decreases progressively with age, so that little, if any, is present in the elderly.

A

REM

Stage 4

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20
Q 
What are these:
Tiredness, fatigue, sleepiness
Trouble sleeping
Poor sleep quality
Inadequate sleep quantity
Abnormal behavior during sleep
Loud snoring
A

Chief complaints and symptoms in sleep medicine.

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21
Q

What kind of history should you take and why?

A

sleep history because a lot of people suffer from sleep disorders

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22
Q

What four questions should you ask to assess sleep disoders?

A

Is your sleep at night satisfactory?
Do you tend to fall asleep or struggle to stay alert during the day?
Are you bothered by fatigue, tiredness, lack of energy most of the time?
Do you have unusual behaviors which arise from the sleep period?

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23
Q

What kind of problem is linked to sleep disorders?

A

car accidents

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24
Q

Which is more closesly associated with car accidents, insomnia or sleep apnea?

A

insomnia

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25
Q

What is this:
Difficulty initiating, maintaining, or non - restorative sleep
Most common sleep disorder

A

insomnia

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26
Q

What kind of insomnia is this:
Difficulty falling asleep
Longer time to sleep onset

A

sleep onset insomnia

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27
Q

What kind of insomnia is this:
difficulty staying asleep
frequent nocturnal awakenings

A

sleep maintenance insomnia

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28
Q

What kind of insomnia is this:

waking too early in the morning

A

sleep offset or late insomnia

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29
Q

What kind of insomnia is this:

fatigue despite adequate sleep duration

A

nonrestorative sleep

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30
Q

What kind of insomnia can these cause:

acute illness, jet lag, shift change

A

transient insomnia: episodic

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31
Q

What kind of insomnia can these cause:
major life event
substance abuse

A

short-term insomnia: few days to 3 weeks

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32
Q

What kind of insomnia can these cause:
chronic illness
psychiatric illness

A

Chronic insomina: longer than 3 weeks

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33
Q

How long does short-term insomnia last?

A

few days to 3 weeks

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34
Q

How long does chronic insomnia last?

A

longer than 3 weeks

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35
Q

What are some main category causes of insomnia?

A 
medical conditions (COPD, asthma)
psycological disorders (anxiety)
sleep disorders (apnea)
pharmacological agents (nicotine, alcohol)
environmental factors (temp, light)
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36
Q

What is the economic impact of insomnia?

A

30-107 billion dollars

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37
Q

What are direct costs of insomnia?

A

drugs-> 1.7 billion

services -> 11.96 billion

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38
Q

What are some indirect costs of insomnia?

A

decreased productivity
higher accident rate
increased absenteeism
inreased comorbidity

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39
Q

What is the most common treatment approach to insomnia? Are meds used in chronic insomnia?

A

meds

NO, used only for short term insomnia (couple of weeks)

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40
Q

What are some adverse responses to sleep meds?

A

tolerance and dependency can develop

withdrawal, rebound, relapse may occur

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41
Q

What cauess chronic insomnia?

A

circadian dysreg
hyeractive arousal system
sleep-incompatible conditioning (wake->sleep transiont, sleep fragmentations)

42
Q

What is the first step to getting sleep organized?

A

anchor the body clock (wake up at same time)

43
Q

What are the nonpharm treatments of sleep insomnia?

A 
sleep hygience
stimulus control
sleep restriction
relaxation training
cognitive therapy
cognitive behavior therapy
44
Q

What technique should you use to promote habits that help sleep?

A

sleep hygiene

45
Q

What technique should you use to strengthen bed and bedroom as sleep stimulus?

A

stimulus control

46
Q

What technique should you useto retrict time in bed to consolidate sleep and improve depth of sleep?

A

sleep restriction

47
Q

What technique should you use to reduce arousal and decrease anxiety?

A

relaxation training

48
Q

What technique should you use to address thoughts and beliefs that interfere with sleep?

A

cognitive therapy

49
Q

What technique should you use to tackle all problems of insomnia?

A

behavioral therapy

50
Q

How can you get better sleep hygiene?

A

reduce arousal and regulate sleep homeostatic and circadian system.

51
Q

How do you reduce arousal?

A 
elimintate stimulants (caffeine, tobacco)
exercise
sleep conducive environment
relax
avoid clock watching
52
Q

How do you regulate sleep homesotatic and circadan system?

A

regular sleep-wake schedule
avoid nap
avoid excessive amount of time awake in bed
minimize alcohol use

53
Q

What are some relaxation techniques?

A

progressive muscle relaxations (PMR) -> tense release exercises
passive muscle relaxation (body scan)
imagery
meditation (mindfulness)
biofeedback
diaphragmatic breathing (slow, deep breathing)

54
Q

How do you reduce arousal?

A 
wind down
closure
review to do list and set plans for tomorrow
schedule worry time
stress managament
55
Q

What should you do if you think of “to dos” in the middle of the night?

A

jot them down and move on

56
Q

What are ways you can get stimulus control?

A 
wake up at the same time 
go to bed only when sleepy
use bed only for sleep and sex
get out of bed when unable to fall asleep
avoid daytime napping
57
Q

What are some indicators of cicadiat dysregulation?

A 
sleep disturbance
GI distress
daytime fatiue or waves of sleepiness
tired muscles
headached
reduced cognitive skills
poor psychomotor coord.
moodiness
general malaise
58
Q

What can these result in or indicate:
erratic or variable schedule, lack of consitent time cue anchors (get up time, meal times, routine), sedentary, shiftwork, presence of “jet lag” symptoms?

A

circadian dysregulation

59
Q

What is this:
pattern of delayed sleep onset and awakening times with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time.

A

delayed sleep phase

60
Q

What is this:
pattern of advance sleep onset and awakening times with an inability to remain awake or sleep until the desired or conventionally acceptable later sleep or wake time.
Who is this more common in?

A

advanced sleep phase

older adults

61
Q

Jet lag results from rapid changes in time zone.

Travelin which way results in worse jet lag?

A

westbound travel is less disruptive than east bound travel

62
Q

How can shift work become a persistent disorder?

A

with continual shift changes

63
Q

What is the purpose of circadian rhythm shifting?

A

to shift underlying core body temperature rhythm to desired sleep-wake schedule

64
Q

What is light therapy for?

A

to improve ease of falling asleep and getting alert quicker in the morning.

65
Q

When would you use evening light exposure?

A

for advanced sleep phase (i.e to improve ability to stay up later and sleep continutation in the 2nd half of the night)

66
Q

What is this:

recurrent periods of irrepressible need to sleep, lapsing into sleep or napping occurring within the same day.

A

narcolepsy

67
Q

Wht are the four symptoms of narcolepsy?

A

excessive daytime sleepiness
cataplexy- sudden loss of muscle tone often triggered by strong emotions
sleep paralysis- inability to move at sleep onset or upon awakening
hyponagogic hallucinations- REM sleep occuring during wakefulness

68
Q

Can you have narcolepsy without cataplexy?

A

yes

69
Q

How can you diagnose narcolepsy?

A

polysomnography (PSG) and multiple sleep latency (MSLT)

70
Q

How do you treat narcolepsy?

A

with stimulant meds, timed naps, and good sleep hygience

71
Q

What are 2 things that will tell you if a person has narcolepsy?

A

2 sleep onset REM periods (REM sleep within 15 minutes)

Average sleep latency of 6 minutes or less

72
Q

Unlike people with insomnia, OSA is a (blank) problem with physiological consequences

A

structural

73
Q

How do you treat obstructive sleep apnea?

A

CPAP/Bi-level, oral appliance or surgery

74
Q

What all improves with treatment of OSA?

A

sleep maintenance insomnia, parsomnias (such as sleep walking)

75
Q

What does a high epworth score indicate/

A

need for a referral to a sleep physician

76
Q

What are the four levels of the epworth sleepiness scale?

A

0 would never doze
1 slight chance of dozing
2 moderate chance of dozing
3 high chance of dozing

77
Q

on an epworth sleepiness scale, there is a range between 0-24, what happens if you are at 10? what about over 12?

A

borderline

abnormal

78
Q

Which is more common, central or obstructive sleep apnea?

A

obstructive

79
Q

What is this:

patient has recurrent obstruction of upper airway durin sleep produces apnea

A

obstructive sleep apnea

80
Q

What are risk factors for obstructive sleep apnea?

A

middle aged men and post-menopausal women, neck circumference (larger the worse) and structural abnormalities

81
Q

What is this:

symptoms include insomnia, mild or absent snoring, no obstruction, but absence of venilatory effort=cessation of airflow

A

central sleep apnea

82
Q

What should you ask to assess for sleep apnea?

A

whether they snore loudly or if someone has noticed that they snore loudly

83
Q

What is this:
Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions

A

parasomnias

84
Q

Do parasomnias cause insomnia or escessive sleepiness?

A

no (they are like sleep walkin)

85
Q

When do nightmares occur?

A

during REM

86
Q

When do nightmares typically occur, during the 1st half or the 2nd half of the night?

A

2nd half closer to the morning

87
Q

Who are nightmares most common in?

A

children, and decrease with age

88
Q

What is this:

confused arousals, person may cry out

A

night terrors

89
Q

When do night terrors occur?

A

during slow wave sleep, more often in irst half of the night.

90
Q

Do you remember night terrors?

A

no

91
Q

When are night terrors most common?

A

in children under 10 years old, often disappear with age

92
Q

(blank) is one of the most common complaints of patients with mood disorders

A

disturbed sleep

93
Q

(blank) is a diagnostic criteria of mood disorders and anxiety disorders.

A

Seep disturbance

94
Q

Fatigue is a diagnostic criteria for (blank)

A

sleep and affective disorders

95
Q 
What are these subjective complaints of:
difficulty falling asleep
frequent nocturnal awakenings
early morning awakenings
non-restorative sleep
decreased total sleep time
disturbing dreams
A

sleep and major depression

96
Q

narcolepsy diagnosis requires (blank) and (Blank)

A

PSG and MSLT

97
Q

when should you refer a sleep disorder to a specialist?

A

if they are suspected of having sleep apnea or narcolepsy

98
Q

Sleep apnea diagnosis requires (blank)

A

PSG

99
Q

Insomnia, sleep deprivation, medication effects are usually diagnosed (blank)

A

clinically

100
Q

You should refer a patient for non-medication treatment of (blank) where (Blank) can be used for treatment

A

insomnia

cognitive behavioral therapy (CBT)

101
Q

What is an on-going assessment technique that can be used for sleep disorders?

A

sleep diary

Block 5 Week 5 Dani (9 decks)

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