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Diagnosis_Management 1 > sleep/wake disorders > Flashcards

sleep/wake disorders Flashcards

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1
Q

clinical presentation of insomnia disorder

A

difficulty falling asleep, staying asleep, or early morning awakening with inability to return to sleep sufficient enough to impair function

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2
Q

clinical presentation of hypersomnolence disorder

A

excessive sleeping/sleepiness not d/t disrupted circadian rhythm problems

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3
Q

clinical presentation of narcolepsy

A

overwhelming desire to fall asleep (may do so spontaneously) when inappropriate. May experience cataplexy

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4
Q

definition of cataplexy

A

sudden loss of muscle tone while conscious ranging from transient weakness to complete paralysis that is often precipitated by laughter or strong emotions

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5
Q

what is psychophysiologic insomnia

A

conditioned to remain awake when thinking of sleeping

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6
Q

what is idiopathic insomnia

A

lifelong difficulty obtaining adequate sleep

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7
Q

what is paradoxical insomnia

A

person thinks they are awake and having insomnia but EEG shows healthy sleep

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8
Q

definition of klein-levin syndrome

A

recurrent periods of prolonged sleep with intermittent periods of healthy sleep and alert waking

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9
Q

classic presentation of klein-levin syndrome

A

18-20 hour sleep period with waking time characterized by voracious eating, hypersexuality, and disinhibition

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10
Q

what deficit is highly associated with narcolepsy

A

hypocretin

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11
Q

what are the types of central sleep apnea

A

idiopathic
cheyne-stokes breathing
comorbid with opioids
high altitude periodic breathing
d/t medical disorder
d/t substance
primary sleep apnea of infancy

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12
Q

types of circadian rhythm sleep wake disorders

A

delayed sleep phase type
advanced sleep phase type
irregular sleep-wake type
non-24-hour sleep-wake type
shift work type
jet lag type
unspecified type

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13
Q

difference between irregular sleep-wake type and non-24-hour sleep-wake type

A

irregular is unpredictable w/ no discernable circadian rhythm and non-24-hour circadian cycle is longer or shorter than 24 hours so sleep phases drift

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14
Q

types of parasomnias

A

NREM-related parasomnias
REM-related parasomnias

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15
Q

types of NREM-related parasomnias

A

sleepwalking
sleep terrors
confusional arousals
sleep-related eating disorder

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16
Q

what sleep phase does sleepwalking occur in

A

slow-wave sleep

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17
Q

another term for sleepwalking

A

somnambulism

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18
Q

sleep phase that sleep terrrors occur in

A

slow-wave sleep

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19
Q

REM related parasomnias

A

nightmare disorder
REM sleep behavior disorder
recurrent isolated sleep paralysis

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20
Q

when does sleep paralysis become a parasomnia

A

when it occurs at sleep onset or arousal

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21
Q

what are the other, less common parasomnias

A

exploding head syndrome
sleep-related hallucinations
sleep enuresis
d/t substance
d/t medical condition

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22
Q

what do yo always check in RLS

A

ferritin level

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23
Q

definition of periodic limb movement disorder

A

brief stereotypic repetitive movements of limbs usually in NREM approximately every 20-40 seconds and frequently associated with brief arousals and involves extension of big toe

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24
Q

which conditions can cause periodic limb movement disorder

A

folate deficiency
renal disease
anemia
antidepressant use

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25
what is sleep-related bruxism?
grinding teeth in sleep
26
definition of sleep-related rhythmic movement disorder
repetitive movements typically involving head/neck occurring during transition from wakefulness to sleep or in light sleep
27
clinical tests for sleep disorders
polysomnography home sleep test multiple sleep latency test maintenance of wakefulness test actigraphy
28
what clinical test is needed for dx of narcolepsy
multiple sleep latency test
29
what confirms dx of narcolepsy
REM sleep on 2+ nap occasions
30
what is a multiple sleep latency test
provided opportunity for 20 minute nap every 2 hours without resisting sleep to determine sleep stage and sleep latency
31
what is a maintenance of wakefulness test
40 minutes sessions every 2 hours where patient sits in a dark room in a comfortable chair with a pillow and sleep latency is measured
32
what is actigraphy
device worn on wrist that measures and records movement
33
treatment options for insomnia
meds CBT universal sleep hygeine stimulus control therapy sleep restriction therapy cognitive therapy paradoxical intention
34
First-line pharmacologic treatment for insomnia
benzodiazepine receptor agonists (Z drugs)
35
pharmacologic treatments for insomnia other than Z drugs
benzodiazepines low-dose antihistamine (doxepin) melatonin ramelteon suvorexant
36
what is sleep restriction therapy
decreasing time spent awake in bed and avoid naps
37
what is stimulus control therapy
rules for sleep routines that must be followed consistently
38
types of relaxation therapy techniques
self-hypnosis progressive muscle relaxation guided imagery breathing exercises
39
what is used to treat hypersomnolence disorder
usually stimulants
40
what are the wake-promoting agents utilized for narcolepsy
pitolisant solriamfetol
41
REM sleep-repressing drugs used for narcolepsy
imipramine protriptyline sodium oxybate
42
therapeutic approaches to treating narcolepsy
scheduled naps lifestyle adjustments counseling drug holidays
43
treatment options for obstructive sleep apnea
CPAP BiPAP oral appliance position therapy surgery weight loss
44
treatment options for circadian rhythm sleep-wake disorders
light therapy medication chronotherapy
45
medication to treat nightmares
prazosin
46
behavioral techniques for nightmare disorder
desensitization and exposure therapy image rehearsal therapy lucid dream therapy cognitive therapy
47
medication for sleep enuresis
desmopressin
48
first line medications for RLS
pramipexole rotigotine ropinirole (dopaminergic agonists)
49
second-line meds for RLS
levodopa (dopamine precursor) benzodiazepines opiates antiepileptics
50
benzodiazepines used to treat insomnia
flurazepam temazepam quazepam estazolam triazolam
51
nonbenzodiazepine agonists used to treat insomnia
zolpidem (Ambien) zaleplon (Sonata) eszopiclone (Lunesta)
52
zolpidem peak concentration and half-life
peak in 1.5h half-life 2.6h
53
peak concentration and half-life of zaleplon
peak: 1h half-life: 1h
54
peak concentration and half-life of eszopiclone
peak: 1h half-life 6h
55
what is given for benzodiazepine OD that can also reveres ambien and sonata
flumazenil
56
does tolerance develop to ambien/sonata
no
57
dosage and clinical guidelines for Zaleplon
start 10mg (elderly and hepatic impairment 5mg) need 4 hours of sleep max dose 20mg
58
dosage and clinical guidelines for eszopiclone
2-3mg startin dose NTE 1mg w/ hepatic impairment or if taking CYP3A4 inhibitors
59
dosage and clinical guidelines for zolpidem
5mg for females, elderly, and frail 5-10mg for males impairs for 7-8 hours
60
melatonin agonists used for insomnia
melatonin ramelteon
61
peak concentration and half-life of ramelteon
peak: 45 minutes half-life: 1-2.6 hours
62
dosage and clinical guidelines of ramelteon
8mg within 30min of bedtime do not take w/ high-fat meals
63
peak concentration and half-life of prazosin
peak: 3 hours half-life: 2-3 hours
64
dosage and clinical guidelines for prazosin
6-15mg in divided doses (higher than 20mg not more effective) reduce to 1-2mg TID if on diuretic or antihypertensive

Diagnosis_Management 1 (16 decks)

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