Sleep_EO Flashcards
(35 cards)
What’s to know about NREM?
75% of night
Slowed autonomic system (low BP, low T, low HR)
When Beta waves?
Awake
When alpha waves?
Drowsy but awake with eyes closed
When theta waves?
N1 507hz 5% of the night Hall hypnagogiques «Rolling eyes»
When k complexes and spindles?
N2 45% of night Also theta waves 12-14hz No eye mvt
When slow wave sleep?
N3
12-13% of night (most of it during first 1/3 of night)
0.5-4Hz
Delta waves
What’s to know about REM sleep?
25% of the night
Autonomic activity increased (BP, HR, T)
Fast, low voltage with sawtooth waves
Theta and beta
Penile erection
Paralysis
Dreams are abstract and weird (vs NREM dreams are lucid)
Majority of rem happens in the last third of the night
Q90 mins ; first REM is short (10min) and increases during the night ad 45min
No REM during naps
Elderly and changes in sleep
1- need stays the same
2- total sleep same
3- more fractionnated sleep
4- reduced N3 (SWS) but increased N1 and N2
5- sleep latency increased
6- reduced tot REM sleep (more frequent but shorter)
7-advances circadian cycle
what’s the purpose of the suprachiasmatic nucleus in sleep?
Circadien rythm
Site of action of melatonie
Which neurotransmitters are pro-REM and anti-REM?
Pre: Ach
Anti: NE and 5HT
Which neurotransmitters favor sleep and favor awake?
Sleep: Ach
Awake: NE, orexin (hypocretin), hist, dopamine, glutamate
Anatomic site of REM?
Reticular formation
Pons
What is the tx of narcolepsy?
Planned naps during the day
Modafinil for sleep attacks
SSRI/SNRI/TCA for sleep paralysis, cataplexie and hall
Sodium oxybate for all above
What can happen clinically in narcolepsy (4)?
1-sleep attacks (2-6 times per day)
2- cataplexie: sudden loss of tonus, preserved sensorium, precipitated by strong emotions
3-hypnopomp/hypnagog hall : REM sleep starts when almost awake, usually visual and vivid
4-sleep paralysis
DSM criteria for narcolepsy?
A. Sleep attacks at least 3x per week for at least 3 months
B. One of the following:
1-cataplexie several times per months
2-hypocretine deficiency in LCR
3-PSMG, REM latency < 15min OR sleep latency <8 min with >2 sleep-onset REM au MSLT (multiple sleep latency test)
What are the indications of polysomnography?
Hypersomnolence Narcolepsy Breathing related sleep disorders Violent behavior in sleep Uncertain dx Pt non-responding to tx
What’s measured in PSG?
EEG EOG *eye mvt EMG Airflow (oral and nasal) Oxiometry Respiratory effort (abdo thoraciq movement) EKG Capnography
Name the breathing related sleep disorders DSM diagnosis
What’s to know about breathing related sleep disorders?
1-Obstructive sleep apnea
2-central sleep apnea
3-sleep related hypoventilation
Risk factors for OSA: male, middle age, obesity, micrognatie, retrognatia, hypot4, acromegalia
Most frequent complaint is daily somnolence
20 % prevalence
tx: lose weight, sleep on back, CPAP, sx, stop etoh and sedatives
In central sleep apnea, there is no respiratory effort during apnea (*vs effort in OSA). Often secondary to carida and neurological issues. More often in elderly. No snoring.
What is the most important risk factor of insomnia?
Past episode of primary insomnia
What are the DSM criteria for insmonia disorder?
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one of:
- Diff initiating sleep
- Frequent awakenings
- Early-morning awakenings
B. Sleep disturbance cause significant distress/impairment
C. At least 3 nights per week
D. For at least 3 months
E. The sleep diff occurs despite adequate opportunity to sleep
F. The insomnia is not better explained by another sleep-wake do, substance or GMC
Specifyers: With non-sleep disorder mental comorbidity including SUD With other medical comorb With other sleep do Episodic (at least 1 mo less 3 mo) persistent (3 mo or longer) or recurrent (2 or more in 1 yr)
Treatent of insomnia do?
CTBi first line
- psychoed on sleep hygene and stimuli control (wake up same hour, use bed only for sleep, no nap)
- restriction of sleep (reduce time spent in bed to increase sleep efficacy. When 85% is reach, increae time in bed 15 min at a time)
Cogitive therapy is second line (decrease importance and consequence of lack of sleep, reduce rx, relaxation techniques)
Rx only temporary (<4 weeks), low dose, intermittent use, short-half life, no recommended for chronic insomnia
What is hypersomnolence disorder?
A. Self reported excessive sleepiness despite a main sleep period lasting at least 7hrs, with at least one:
- recurrent periods of sleep or lapses into leep within the same day
- 9 hours of sleep per day that is nonrestorative
- difficulty being fully awake after abrupt awakening
B. At least 3 timers per wekk for at least 3 months
Usually starts 15-25 yo and tends to become chronic
What are the main types of circadian rythm sleep-wake disorders?
1) Delayed sleep phase type: most common, normal sleep once initiated, endogenous rythm affected (T, melatonin)
2) Advance sleep phase type: tx: luminothx in evening
3) Irregular sleep-wake type: associated with neurodegenerative do
4) Non-24 hours sleep-wake type: in 50% of blind, tx: melatonine HS
5) Shift work type: in 5-10% of night shift workers, tx: naps before work, minimise sun before going to bed (wear sunglasses)
6) Unspecified
7) jet-lag: atteinte proportionnelle au nombre de fuseaux horaire traversés (worse if 8 or more in less than 24hrs). Travel toward east is worse. Tx: melatonin
What are the criteria of circadian rythm sleep-wake do?
A. A persistent patter of sleep disruption that is due to an alteration of the circadian system (misalignement between the endogenous circadian rythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B. The sleep disruption leads to excessive sleepiness or insomnia or both
C. Cause distress impairment
