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36 Cards in this Set
- Front
- Back
what stage of sleep is light sleep with slow irreguglar brain waves, you have occasional twitching
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Stage 1
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what stage of sleep is described by
Still easy to awaken – may require shaking Sleep Spindles: 25 sec bursts of 12-14 cps waves K complexes: 2 sec rise & fall Largest percentage of total sleep time (45-55%) Slight decrease in body temperature |
sleep stage 2
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this is the stage where sleep walking, eating, and night terrors occur
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3/4
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what stage of sleep is restorative sleep?
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3/4
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“Active” or “paradoxical” sleep
Associated with dreaming ? |
REM
Makes up 20 – 25% of total sleep time Absence of skeletal muscle movement (EMG = silent) Rapid eye movements occur Pulse, respiration, BP increased but less regular Nightmares and REM Sleep Behavior Disorder may occur |
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difference in sleep for old ppl
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less delta sleep
less REM more awakenings |
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which occurs earlier in sleep, delta or REM?
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delta
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ID: 65 year old female
CC: difficulty falling asleep HPI: Problem for 10-15 years Goes to bed at 9pm, reads or watches TV for 1 hour, does not fall asleep until midnight, wakes 4-5 times, gets up at 5am Has some excessive daytime sleepiness Has tried numerous sleep aids PMH: hypertension, coronary artery disease, asthma and depression Medications: metoprolol, aspirin, albuterol, singulair and prozac PE: anxious appearing female otherwise unremarkable pt has? |
Insomnia
A repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment |
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A repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment
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insomnia
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treatment success = in insomnia?
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*treatment success = improved sleep latency by 30 minutes (patient needs to have realistic expectations)
** treatment is chronic, often symptoms wax and wane |
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which is better for tx of insomnia, drugs or Cognitive behavioral therapy
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Cognitive behavioral therapy
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ID: 54 year old male
CC: snoring and witnessed apnea HPI: Snoring for 10-15 years Wife will not sleep in same room Excessive daytime sleepiness, occasionally falls asleep at the wheel PMH: atrial fibrillation (failed cardioversion), hypertension Medications: coumadin, metoprolol, aspirin FH: +CAD, +CVA PE: BMI-35 obese B/P – 145/90 Heart – irregularly, irregular pt has? |
Obstructive Sleep Apnea
Disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns |
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Disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns
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Obstructive Sleep Apnea
pt is still trying to breathe but cant |
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Excessive daytime sleepiness
Difficulty concentrating bed wetting ADHD associated with? |
Obstructive Sleep Apnea in kids
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Obstructive Sleep Apnea has higher incidence of...
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death
MI stroke aka its real bad |
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tx for Obstructive Sleep Apnea
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Positive pressure ventilation (CPAP or BiPAP)
Oral appliances Weight reduction (10%) |
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what is a curative tx of Obstructive Sleep Apnea for kids?
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Surgery (Tonsillectomy and adenoidectomy in children)
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ID: 18 year old male
HPI: 2 year history of excessive daytime sleepiness, causing problems staying awake at school Reports feeling weak in the knees whenever he laughs or is embarrassed, but has never actually fallen Reports rare episodes when he can’t move for a few minutes when he wakes up in the morning |
narcolepsy
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excessive daytime sleepiness=??
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Narcolepsy
Sleepiness not relieved by adequate sleep Usually most bothersome symptom Disturbed Nocturnal Sleep Fragmented sleep Frequent unexplained arousals |
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Sleep Paralysis
Hypnogogic Hallucinations and Cataplexy are seen in? |
Narcolepsy
Cataplexy (inappropriate intrusion of REM sleep physiology into wakefulness) Sudden loss of postural tone brought on by emotion, especially laughter (legs, knees, jaw, slurred speech) If present, essentially diagnostic for narcolepsy Seen in 60 – 80% of patients and may be very subtle |
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Pathophysiology of narcolepsy?
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Lack of hypocretin neurons of the lateral hypothalamus
Low CSF hypocretin levels |
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tx for Cataplexy in Narcolepsy?
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Sodium Oxybate (aka GHB
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56 yr old 72”, 200 lb male
Chief complaint: Snoring and restless sleep (wife complains she can’t sleep with him) Sleeps 7-8 hours per night Complains of excessive daytime sleepiness and some difficulty at work |
Restless Leg Syndrome (RLS):
Clinical diagnosis made primarily on subjective report of the patient note: Periodic Limb Movements (PLMs): An objective polysomnographic finding |
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4 sx of RLS?
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RLS – Core Symptoms…”URGE”
Urge to move limbs accompanied by an uncomfortable, unpleasant feeling in the limbs Rest or inactivity precipitates symptoms Getting up and moving improves symptoms Evening or nighttime is associated with worsening of symptoms (circadian fluctuation) |
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common finding in RLS?
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iron deficiency
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Pharmacologic Management of PLM
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Dopamine agonists
Ropinirole (Requip) Pramipexole (Mirapex) Levodopa Clonazepam Clonidine (children) |
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ID: 4 yo M
HPI: Past 1 month waking up screaming, kicking Agitated, unconsolable Events occur between 10:30 and midnight Goes to bed at 9:00pm, wakes at 7:00am Occasional naps FH: dad OSA PMH, ROS, PE: unremarkable pt has? tx? |
sleep terrors
Reassurance, usually no treatment necessary Environment may need to be secured |
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Episodic physiologic and behavioral, usually undesirable behaviors that involve autonomic or skeletal muscle disturbances, and/or disorientation
Occur exclusively during or exacerbated by sleep= |
Parasomnias
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mom comes in and said before going to bed her kid bangs his head on the crib...she asks you what to do...
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this is a normal parasomnia
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Inability to fall asleep or remain asleep
Most common sleep disorder (10-15%) Hyperarousal and conditioned sleep disturbance Treatment: identify cause or confounding factors, cognitive behavioral therapy……. pharmacologic therapy *treatment is difficult and chronic *** |
Insomnia
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18 million Americans have it
Symptoms: excessive daytime sleepiness, snoring, memory impairments… Complications: hypertension, arrythmias, congestive heart failure, pulmonary hypertension, stroke, death… Treatment: positive pressure ventilation, oral devices, surgery |
Obstructive Sleep Apnea
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a child who snores......
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should be evaluated for obstructive sleep apnea
snoring in kids is never normal |
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Excessive daytime sleepiness, cataplexy, hypnogogic hallucinations, sleep paralysis…AND disrupted sleep
Diagnostic testing: ANP and MSLT Shortened REM latency, short mean sleep latency, sleep onset REM episodes Treatment EDS: Stimulants, Modafinil Cataplexy: TCA, SSRI, Sodium Oxybate |
Narcolepsy
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which is subjective/objective considering RLS and PLM
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RLS – subjective, PLM – objective
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tx for RLS and PLM
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RLS – dopamine agonist
PLM – dopamine agonist, clonazepam, clonidine |
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Most episodic, stereotyped behaviors at night are benign
Take a good history, sleep diary or home videotaping Rule out concomittant primary sleep disorders (OSA, RLS/PLMS) Consider PSG or nocturnal video EEG for unusual presentation |
Parasomnias
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