Sleep Disorders

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Author:
jknell
ID:
196200
Filename:
Sleep Disorders
Updated:
2013-01-28 21:00:01
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MBB II
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MBB II
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  1. Stages of Sleep
    • REM:
    • -20-25% of sleep
    • -dreams
    • -rapid eye movements
    • -atonia/paralysis
    • -later in sleep

    • N1:
    • -5% of sleep
    • -transition from wake to sleep

    • N2:
    • -50% of sleep
    • -EEG shows spindles and K complexes

    • N3/N4:
    • -20% of sleep
    • -slow wave sleep
    • -occurs earlier in sleep
  2. Sleep Latency
    amount of time required to fall asleep

    • -decreased in anxiety
    • -ok in MDD
  3. Sleep Continuity
    overall balance of sleep and wakefulness during a night of sleep

    -decreased in MDD
  4. Sleep Efficiency
    percentage of time in bed that is spent asleep
  5. Polysomnography
    • -measures night time sleep
    • -EEG, EMG, EKG, air flow, breathing effort, leg movements
  6. Multiple Sleep Latency Test (MSLT)
    • -daytime test
    • -how quickly patient falls asleep during series of short naps
    • -determines stage of sleep

    -used to diagnose narcolepsy
  7. Actigraph
    -records movement while patient is asleep
  8. Primary sleep disorders
    • Dysomnias:
    • -disorders of initiating or maintaining sleep OR of excessive sleepiness
    • 1. Primary insomnia
    • 2. Primary hypersomnia

    • Parasomnias:
    • -abnormal behavioral or psychological events in association with sleep
    • 1. Nightmare disorder
    • 2. Sleepwalking disorder
    • 3. Sleep terror disorder
    • 4. REM sleep behaviour disorder
  9. Primary Insomnia
    -greater than 1 months of difficulty falling asleep, difficulty staying asleep or nonrestorative sleep

    • Epidemiology:
    • -35% of adult population
    • -10% meet criteria
    • -25 of elderly meet criteria

    • Impairments:
    • -decreased cognitive function, increased pain or psych sx, increased accidents

    • Course:
    • -light sleeper prior
    • -onset may occur with stress
    • -(conditioned response)
    • -increased sleep latency
    • -decreased sleep efficiency
    • -increased N1, decreased N3
    • -increased muscle tension

    • Assessment:
    • -history
    • -sleep log
  10. Primary Insomnia Treatment
    • Non-Pharmacologic:
    • -sleep hygiene
    • -stimulus control
    • -relaxation and biofeedback
    • -CBT

    • Pharmacologic:
    • -Antihistamines: rapid tolerance, constipation, morning hangover, delirium (esp elderly)
    • -Melatonin
    • -Ramelteon (melatonin agonist)
    • -Sedative hypnotics (Zolpidem --> Ambien)
  11. Primary Hypersomnia
    -excessive sleepiness for at least one month
  12. Secondary Insomnia
    -due to substance

    • -alcohol
    • -caffeine
    • -nicotine
    • -antidepressants
    • -steroids
    • -decongestants
    • -beta agonists
    • -statins
    • -stimulants
    • -DA agonists
  13. Narcolepsy
    -irresistible attacks of refreshing sleep that occur daily over at least 3 months

    • Presentation:
    • -cataplexy
    • -recurrent intrusions of REM sleep
    • -hallucinations (hypnopompic or hypnagogic)

    • Epidemiology:
    • -0.1%
    • -men=women

    • Pathophysiology:
    • -reduction of hypocretin-containing neurons

    • Treatment:
    • -modafinil
    • -armodafinil
    • -methylphenidate
    • -sodium oxybate
  14. Sleep apnea syndromes
    Apnea for longer than 5 seconds

    • 1. Obstructive sleep apnea syndrome
    • 2. central sleep apnea syndrome
    • 3. central alveolar hypoventilation syndrome

    • Epidemiology:
    • -increased in elderly and obese
    • -hx of snoring

    • Course:
    • -chronic and progressive
    • -increased risk of death from cardiac causes

    • Treatment:
    • -weight loss
    • -don't sleep on back
    • -stop alcohol and drugs
    • -positive airway pressure (CPAP, CiPAP)
    • -surgery
  15. Circadian Rhythm Sleep Disorder
    -mismatch between sleep-wake cycle and schedule required by environment

    • 1. Jet leg type
    • 2. Shift work type

    • Treatment:
    • -light therapy
    • -melatonin
    • -sedative hypnotic drugs
  16. Restless Leg Syndrome
    • -uncomfortable sensation in the limbs (crawly, electrical, worms, pain)
    • -relieved by movement
    • -worse in evening or night

    • Course:
    • -usually life long (may wax or wane)
    • -80% have periodic movements of sleep)

    **rarely associated with iron deficiency

    • Treatment:
    • -DA agonists (ropinirole)
    • -Carbidopa/levodopa
    • -Benzos
    • -Opiates
    • -Gabapentin
  17. Periodic Limb Movements of Sleep
    • -repetitive movements of feet and legs (every 20-90s for hour)
    • -may disturb sleep partner
    • -daytime sleepiness

    • Course:
    • -typically lifelong (may wax and wane)

    • Treatment:
    • -dopaminergic or benzo drugs
  18. Nightmare Disorder
    • -repeated awakenings with good recall of frightening dreams
    • -rapidly become oriented and alert

    • Epidemiology:
    • -5% of children
    • -male > female
    • -3-6 years
  19. Sleepwalking Disorder
    • -repeat episodes of rising from bed during sleep and walking about
    • -blank stare
    • -unresponsive
    • -difficult to awaken
    • -amnesic for episode

    • Epidemiology:
    • -3% of children
    • -4-12
    • -during first 1/3 of sleep

    • Treatment:
    • -make environment safe
    • -Benzos (suppress slow wave sleep)
  20. Sleep Terror Disorder
    • -recurrent episodes of abrupt awakening from sleep
    • -panicky scream
    • -increased autonomic arousal
    • -unresponsive to comforting
    • -don't recall dream
    • -amnesic for episode

    • Epidemiology:
    • -3% of children
    • -males > females
    • -4-12 years

    • Treatment:
    • -Benzos (suppress slow wave sleep)
  21. REM Sleep Behaviour Disorder
    • -"act out dreams"
    • -amount and degree of movement varies
    • -rapidly fully awake

    • Epidemiology:
    • -most often in older patients

    • Pathophysiology:
    • -loss of activity of system that paralyzes muscles during REM sleep

    ***early sx of a neurodegenerative disorder that usually includes Parkinsonsm

    • Treatment:
    • -Benzos (suppress REM sleep)
    • -high does melatonin

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