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Flashcards in Sleep-wake d/o Deck (23):
1

where is the "biological clock"

the suprachiasmatic nucleus

2

REM vs NREM

REM characateristics


NMRE

REM -- Pulse, BP, RR higher;
sexual arousal; skeletal paralysis, abstract dreams; last third of the night (deep)
Majority of infants sleep
25% of adult sleep

NREM-
Decreased RR, Pulse, BP
Less sexual arousal
Skeletal muscles active
Dreams can be lucid and purposeful (acting out dreams)
50% of adult sleep

3

NTs involved in sleep

5HT, DA, ACH, NE

4

Name a few sleep-wake d/o

Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing-Related Sleep Disorders


Circadian Rhythm Sleep-Wake Disorders
NREM Sleep Arousal Disorders
Nightmare Disorder
REM Sleep Behavior Disorder
Restless Legs Syndrome
Substance/Medication-Induced Sleep Disorder

5

Criteria for ALL sleep wake d/o

linically significant distress or impairment in functioning

not attributable to the physiological effects of a substance

Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint


6

Insomnia
Criteria

Dissatisfaction with sleep quantity or quality, plus ≥ 1 sxs:

- can't initiate sleep; can't maintain sleep; early morning awakening

- 3nights/week x 3 months at least

7

what is the most preveleant Sleep wake d/o

Insomnia

8

Treatment for insomina

sleep hygeine
CBT
Benadryl, Melatonin

Rozerem -- melatonin agonist

Short term -- BZDs (never for longer than 1 month --risk of withdrawal; amnesia)
NEVER ALPRAZOLAM (short acting)
Reduce slow wave sleep




9

Z drug treatment

dose/course
side effects

Z Drugs -- GABA-a agonists; preserve slow wave
take EVERY OTHER NIGHT

amnesia
halluciations
parasomnias

10

Hypersomnolence Disorder

criteria

Treatment

excessive sleepiness
3x/week x 3 months



: Stimulants, or non-sedating SSRIs (buproprion)

11

Narcolepsy

criteria --
other characteristics

REM sleep attacks which occur 2-6 times per day and last 10 to 20 minutes each


Hypocretin deficiency


hypnagogic and hypnopompic hallucinations, cataplexy (50%), and sleep paralysis

12

Narcolepsy treatment

Modafinil (Provigil) reduces sleep attacks and improves psychomotor performance by stimulating α1-adrenergic receptors, with fewer side effects than traditional stimulants

Amphetamines

TCAs or SSRIs for cataplexy

13


Obstructive Sleep Apnea Hypopnea

criteria --

five obstructive apneas or hypopneas per hour of sleep

+ sleep symptoms (snoring, snorting/gasping, or breathing pauses during sleep.
Daytime sleepiness, fatigue, or unrefreshing sleep)

14

Obstructive Sleep Apnea Hypopnea

treatment

CPAP, weight loss, nasal surgery

SSRIs and TCAs may reduce amount of time in REM, (reduce REM apneic episodes)

Avoid sedatives, including alcohol

15

Circadian Rhythm Sleep Disorder

Misalignment between desired and actual sleep periods

16

NREM Sleep Arousal Disorders

name 2

general characteristics

Sleepwalking

Sleep terrors --


Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode

usually cannot remember the dreams or the episodes themselves

17

NREM Sleep Arousal Disorder: Sleepwalking


treatment:

perform perseverative motor tasks

Usually return to sleep without any recollection of the event



Enact measures to ensure safety and prevent injury (hide the car keys, block stairs). Medications which suppress NREM slow-wave sleep.

18

NREM Sleep Arousal Disorder: sleep terrors

if these begin later in life, what could it be a sign of

Scream or cry + behavioral manifestations resembling panic


Temporal lobe epilepsy

19

REM Sleep DIsorder: Nightmare Disorder

Criteria


Treatment

Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams

On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.


Treat: No specific treatment is available. Agents that suppress REM sleep (TCAs, SSRIs

20

REM Sleep Behavior Disorder


what disease might be associated?

Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.

REM sleep without atonia on polysomnographic recording.

Motor activity, often violent in nature


., Parkinson’s disease, MSA

21

Restless Legs Syndrome



criteria --

usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs: urge to move legs;
3x/week x 3 months

22

Treatment of RLS

***

23

sleep changes in MDD

Reduced slow-wave sleep (SWS)

Sleep-onset REM