Term
|
Definition
| a natural, recurring state of relatively suspended sensory and motor activity in animals, characterized by total or partial unconsciousness and the nearly complete inactivity of the voluntary muscles. it is easily reversible, self-regulating, and occurs in all living animals. |
|
|
Term
| what are the proposed theories as to why we need sleep? |
|
Definition
| restoration, memory, immune, energy conservation, circadian homeostasis, and preservation |
|
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Term
| is that brain metabolically active during sleep? |
|
Definition
| yes, during REM sleep, the brain is very metabolically active and an EEG reading would appear similar to an awake pt. |
|
|
Term
| what are the 3 basic levels of activity our brain exists in? |
|
Definition
| wakefulness, non-REM sleep, and REM sleep |
|
|
Term
| how is REM sleep tested for? |
|
Definition
| cornea is electropositive; retina is electronegative - every eye is a dipole, which can be picked up w/an electrode. |
|
|
Term
| what are the stages of non-REM sleep? |
|
Definition
| 1) light sleep [eyes closed, but hear noises]. 2) unaware of environment. 3) deepest level = tissue repair, immune system recharge, slow high voltage EEG. |
|
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Term
| can pts be easily awakened from REM sleep? |
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Definition
|
|
Term
| what is typical sleep staging in a young adult? (*know this*) |
|
Definition
| awake, non-REM:1,2,3,2,1 then REM (**around 90 minutes), then back to non-REM and repeat throughout the night (thought the time spent in each REM cycle increases as the night progresses). infants are the only time in life where it is normal to enter directly into REM sleep. |
|
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Term
| when does dreaming occur? |
|
Definition
| during REM, if the pt wakes up during non-REM sleep - they are less likely to remember their dreams |
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Term
| what characterizes EEG, EMG, eye movement, ANS, nocturnal penile tumescence, and control of respiration during REM sleep? |
|
Definition
| EEG: mixed frequency, fast. EMG: absent. eye movement: rapid. ANS: variable (body does not thermoregulate). nocturnal penile tumescence: present (allows for determination of physiologic/psychologic ED). control of respiration: altered (great impact w/sleep disorders). |
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Term
| what characterizes EEG, EMG, eye movement, ANS, nocturnal penile tumescence, and control of respiration during non-REM sleep? |
|
Definition
| EEG: spindles(more rapid)/k-complexes(the odd slow wave)/delta waves (pattern of slow waves). EMG: present, but low. eye movement: absent. ANS: regular. nocturnal penile tumescence: absent. control of respiration: same as wake. |
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|
Term
| how much sleep is necessary? |
|
Definition
| avg: 7.5 hrs, but according to the individual pt - the amount which permits them to be wide awake, alert and energetic throughout the day. |
|
|
Term
| what characterizes need for sleep according to age? |
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Definition
| infants need the most sleep (lots of REM), children get more non-REM sleep and as pts age, their ability to achieve REM sleep decreases. |
|
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Term
| what are the determinants of sleep? |
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Definition
| homeostasis (the length of time from last sleep increases the pressure on the brain to induce sleep), circadian rhythms, age (gets harder to sleep well as aging occurs), and individual differences |
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|
Term
| what characterizes the cycle of body temperature throughout the day? how does this correlate w/need to sleep? |
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Definition
| body temperature rises in the morning, peaks at mid-day, drops a little after, then drops more at night. each time body temperature drops, this signals the body's need for sleep. taking a nap at midday when the little drop occurs after the peak could allow for more energy later in the day. |
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Term
| what was significant about the 18th century in terms of sleep? |
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Definition
| street lights were developed. before that, humans when to sleep about an hour after sundown for 4 hours, got up to communicate, then slept for another 4 hours until sunrise. w/urbanization and streetlights, people started to go out at night. |
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|
Term
| what is the pacemaker to the circadian rhythm? |
|
Definition
| the suprachiasmatic nucleus (SCN), which is located beneath the hypothalamus. the SCN is profoundly affected by light via the retino-hypothalamic tract and changes in light will have systemic changes in the timing of sleep/wake function. |
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Term
| who complains the most about sleep? |
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Definition
| elderly pts: problems w/continuity, restfulness of sleep. as pts age, the level of delta sleep (deep non-REM sleep) decreases even more than REM sleep. |
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|
Term
| does the need for sleep change w/age? (*know this*) |
|
Definition
| no. the *ability to sleep decreases, not the need for sleep - since daytime sleepiness increases |
|
|
Term
| what ultimately governs the existence of the changing daily and seasonal environmental conditions to which the internal human SCN regulates a response to? |
|
Definition
|
|
Term
|
Definition
| the scientific study of the timing of biological functions: ultradian (rhythms occurring inside a day - cardiac, sleep cycles, etc), circadian (24 hr cycle), and infradian rhythms (rhythms occurring over a longer period of time - menstruation). |
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|
Term
| what processes are affected by biological rhythms? |
|
Definition
| alertness, psychomotor performance, REM sleep propensity, cognitive performance, urinary potassium secretion, core body temperature, and cortisol release. |
|
|
Term
|
Definition
| the process by which external time cues influence the timing/periodicity of biological rhythms. free-running rhythms are processes which escape this paradigm and only respond to internal stimuli -> much more disorganized. |
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|
Term
| who was nathaniel kleitman? |
|
Definition
| the first US sleep researcher who did experiments on himself in a cave, determining the importance of external cues. |
|
|
Term
| what is desynchronization? |
|
Definition
| when processes that usually work together lose their common cues and no longer work in sync |
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|
Term
| what characterizes photic cues? |
|
Definition
| the effect of light reaching the SCN via the RHT and regulating rhythmic patterns. |
|
|
Term
|
Definition
| external time cues other than photic cues (light/dark cycle) such as food, personal relationships, exercise programs, serotonin release (melatonin pre-cursor), and body temperature. |
|
|
Term
| what is the structure of the suprachiasmatic nucleus? |
|
Definition
| bilaterally paired neuronal clusters in the anterior hypothalamus above the optic chiasm. the RHT (retinohypothalamic tract) is a projection of retinal ganglion cells which goes directly into the SCN and surrounding hypothalamic areas. |
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|
Term
| what is extraocular circadian phototransduction? |
|
Definition
| light exposure doesn't necessarily have to be through the eyes, exposure to the skin can have the same effect. one area of great photoreceptor concentration is the backs of the knees - but this pathway is based on NO vs the RHT. |
|
|
Term
| where does melatonin come from? |
|
Definition
| the pineal gland, which is stimulated by both the RHT and SCN |
|
|
Term
| when is GH released in highest levels (pulsed)? |
|
Definition
| delta wave non-REM sleep - which children have the most of |
|
|
Term
| what characterizes cortisol secretion? |
|
Definition
| cortisol is pulsed throughout the night and peaks in the early morning hours. not linked to sleep-wake cycle as much as just the circadian rhythm. |
|
|
Term
| what characterizes melatonin? |
|
Definition
| this is the hormone most associated w/the circadian rhythm, secreted in darkness (regulated by RHT). the SCN holds a high density of high affinity melatonin receptors. |
|
|
Term
| what characterizes prolactin? |
|
Definition
| only produced during sleep |
|
|
Term
| what other body functions are affected by circadian control? |
|
Definition
| airway function, CV, DNA synthesis, drug metabolism, endocrine systems, GI, hematology, immune system, neoplastic cells, renal function, and thermoregulation. |
|
|
Term
| what characterizes the association between mood and circadian rhythm? |
|
Definition
| in endogenous depression, mood is commonly poor in the morning - but gradually improves as the day continues. |
|
|
Term
| what is the correlation between performance and circadian rhythm? |
|
Definition
| performance efficiency has an objective, measurable circadian rhythm. athletes who train/compete during their peak performance times may perform better and different athletes have different times of peak performance (9 am vs 3 pm) |
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|
Term
| what is the pattern of alertness? |
|
Definition
| avg peaks of alertness have been recorded in the late morning and late afternoon (approx 8-10 hours after awakening). alertness and body temperature have a direct correlation. |
|
|
Term
|
Definition
| a circadian rhythm disorder consisting of desynchronization due to travel across time zones (west -> east is worse). melatonin can help adjust pts who recently travel to different time zones (.5 mg and 5 mg appear to have the same effect, except sleep onset is faster w/5 mg). |
|
|
Term
| what characterizes the effect of shift work? |
|
Definition
| this can lead to a circadian rhythm disorder where pts perform in occupations that demands critical skill, being alert, making critical decisions have difficulty doing so b/c humans are not nocturnal creatures. |
|
|
Term
| what is delayed sleep phase syndrome (DSPS)? |
|
Definition
| a circadian disorder where pts (commonly adolescents) cannot fall asleep at night and shifts the sleep cycle to ~ 3-10 am. this is a difficult pattern to tx, but melatonin can be helpful if given at dinner time (not at bedtime). chronotherapy: more strict tx of DSPS, where the time pts are allowed to go to bed is advanced progressively until you hit the right time for them to adjust to |
|
|
Term
| what is advanced sleep phase disorder? |
|
Definition
| pts fall asleep at 6 pm and then are wide awake and ready to go at 2 am. this is more common in older people and tx consists of high intensity light at 5 pm to kick the clock back a little (this tx also can be used in the morning for DSPS). |
|
|
Term
| what characterizes the irregular sleep-wake pattern? |
|
Definition
| a common disorder marked by complete loss of the circadian rhythm, leading to a very irregular sleep pattern. this is seen in pts w/psychiatric disorders. |
|
|
Term
| what is the non 24-hr sleep-wake syndrome (hypernycthermal syndrome)? |
|
Definition
| this describes a disorder consisting of a constantly changing sleep cycle, often one which keeps advancing around the clock. this occurs mostly in young adults, blind individuals or pts w/schizoid personalities. the pattern is usually present for many years and symptoms include: sleep onset insomnia, fatigue, cognitive disturbance and daytime sleepiness. |
|
|
Term
| what are the different kinds of circadian therapy? |
|
Definition
| chronotherapy, light therapy, chronopharmacology, and melatonin |
|
|
Term
| what are medical problems affected by circadian control? |
|
Definition
| increased severity in the morning: allergic rhinitis, arthritis, asthma, MI, stroke, and PUP. increased severity in the evening: bronchial asthma (cortisol levels are lower at this time). |
|
|
Term
| what is the correlation between CV disease and circadian rhythm? |
|
Definition
| the highest incidence of CV incidents occurs after 9 am (cortisol levels drop) and then a slightly lower peak late at night |
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|
Term
|
Definition
| a neurological condition characterized excessive sleepiness (and sleep attacks) that is typically associated w/cataplexy (sudden loss of muscle tone) and other REM sleep phenomena (such as sleep paralysis and hypnagogic hallucinations). this is pathologic not only b/c sleep intrudes on wakefulness but b/c REM sleep intrudes on wakefulness (not supposed to start for 90 min). peak age: adolescence. |
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|
Term
| what are the main symptoms of narcolepsy? |
|
Definition
| excessive sleepiness, cataplexy (sudden muscle atonia), sleep paralysis (aware are sleeping and as well as inability to move), and hypnagogic hallucinations |
|
|
Term
| what are the manifestations of excessive sleepiness? |
|
Definition
| tendency to fall asleep easily, sleep attacks, frequent daytime napping, amnesic episodes w/automatic behavior (nod off and do something you don't remember doing), memory disturbances w/impaired concentration and visual disturbances. |
|
|
Term
| what characterizes cataplexy? |
|
Definition
| this can be triggered by any emotion, most commonly laughter (also commonly fear). most are unreported b/c they are subtle and may be unappreciated by the pt - but can also be very embarrassing if prominent. |
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|
Term
| what characterizes sleep paralysis? |
|
Definition
| this occurs normally when dreaming. sleep paralysis consists of an inability to perform voluntary movements which occur at sleep onset (hypnagogic) or at awakenings (hypnopompic) in association w/either nighttime sleep or w/naps |
|
|
Term
| what is the neurochemistry of narcolepsy? |
|
Definition
| there is known to be a deficit in hypocretin or orexin - which is made in the anterior hypothalamus by the tuberomammillary bodies to *inhibit sleepiness normally. there are also problems with monoaminergic and cholinergic mechanisms are mainly responsible for the sleepiness and other symptoms of narcolepsy. there is also evidence that DA and noradrenergic receptors may be altered in narcoleptic pts and there is a loss of hypocretin in pts w/cataplexy. |
|
|
Term
| what is the genetic association of narcolepsy? |
|
Definition
| pts w/first degree relatives w/narcolepsy have a greater risk of getting the disorder (or some similar symptoms) than those in the general population. |
|
|
Term
| what are psychiatric features associated w/narcolepsy? what are the effects of this? |
|
Definition
| social introversion, adjustment disorders, major depression, anxiety, alcohol/chemical dependence and personality disorders. this can lead to impaired interpersonal marital, work and social relationships. education, recreation, motor vehicle driving (have to report to DMV), housework, employment, earning capacity, and promotion can be affected by this disorder. |
|
|
Term
| what is behavioral tx for narcolepsy? |
|
Definition
| structured sleep schedules (regular naps), dietary factors (regular and healthy), and physical activity |
|
|
Term
| what characterizes the main tx for narcolepsy? |
|
Definition
| somnolytics (DA/NE stimulants like ritalin, amphetamines. adenosine antagonists: caffeine. hypocretin agonists: modafinil, armodafinil), anticataplectic agents (catecholamine re-uptake blockers, serotonin re-uptake blockers, and centrally-acting cholinergic antagonists), hypnotics (sodium oxybutate - causes immediate delta sleep, "date rape" drug - very tightly controlled), and REM suppressants (same as anticataplectics/antidepressants) |
|
|
Term
| can any antidepressant be used to tx narcolepsy w/cataplexy? |
|
Definition
|
|
Term
| what is the psychosocial aspect to narcolepsy tx? |
|
Definition
| pt education, self-help support groups, professional agencies and counseling |
|
|
Term
| what is obstructive sleep apnea? |
|
Definition
| during sleep the upper airway obstructs, leaving pts unable to inhale/exhale - resulting in alterations of blood-oxygen levels. this is often associated w/snoring, fragmented sleep, and daytime somnolence. this occurs more often in adults, but can occur in children. overweight male pts are at the highest risk. incidence: mild sleep apnea – 2% female, 4% male populations, more severe sleep apnea - 9% female, 24% male populations. |
|
|
Term
| what are the symptoms of obstructive sleep apnea? |
|
Definition
| snoring, apneic episodes, gasping, more frequent nocturia (during an apneic episode, intrathoracic pressure increases, the pulmonary effects of which = R heart strain and dilatation of the atrium, which tells your body there is too much fluid in the system -> releases natriuretic peptide which increases kidney GFR), paradoxical breathing (chest expands but abdomen contracts -> also causes bladder pressure) and tiredness upon awakening. |
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|
Term
| what does the excessive sleepiness due to obstructive sleep apnea often lead to? |
|
Definition
| MVAs, work-related accidents, impaired school/work performance, social embarrassment, marital problems, memory/concentration difficulties, depression and impaired quality of life (anhedonia). |
|
|
Term
| what characterizes the features of obstructive sleep apnea in children? |
|
Definition
| hyperactivity or excessive sleepiness, noisy breathing during sleep, irregular body positions during sleep, rib cage retractions, and flaring of the ribs. children suffering from this are often misdiagnosed - child shows impaired functioning at school, fidgeting, irritability, inability to pay attention … often mis-diagnosed as ADD. overall growth is often impaired (not adequate GH) and the culprit is usually the adenoids/tonsils. |
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|
Term
| what are predisposing features towards obstructive sleep apnea? |
|
Definition
| age (40-60 yrs), obesity, gender (m:f::2:1), anatomical abnormalities (upper airway obstruction, craniofacial abnormalities), medications, alcohol (has has a strong affinity for motor nuclei of CN9), smoking, and fam hx. |
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|
Term
| what are the examination findings for pts w/obstructive sleep apnea? |
|
Definition
| often obese, short/fat neck (men w/ neck size >18 inches; women w/ neck size >15), macrognathia/retrognathia and leg edema (inefficiency of R heart function). |
|
|
Term
| what are the physiologic consequences of obstructive sleep apnea? |
|
Definition
| *asphyxia (hypoxemia, hypercapnia, acidosis) = cardiac dysrhythmias (chronic sympathetic activation as well as inflammation/endothelial dysfunction/increased endothelin/hypercoagulability/RAS stimulation), HTN (systemic/pulmonary artery), hypotension (older pts), intravascular inflammation, and metabolic disturbances. *excessive daytime sleepiness. |
|
|
Term
| what are the hemodynamic consequences of obstructive sleep apnea? |
|
Definition
| blood pressure (cyclical variations in systemic/pulmonary BP), cardiac output (cyclical reductions due to bradycardia and negative intrathoracic pressure), and cor pulmonale (can occur in the presence of hypoxemia during wakefulness) |
|
|
Term
| what are the cardiovascular consequences of obstructive sleep apnea? |
|
Definition
| systemic HTN, pulmonary hypertension, cor pulmonale, brady-tachycardia, sinus arrest, atrial fibrillation, ventricular arrhythmias, myocardial infarction, sudden death and atherosclerosis |
|
|
Term
| where are common areas of obstruction for obstructive sleep apnea? |
|
Definition
| turbinate enlargement, adenoid enlargement, and a long soft palate. |
|
|
Term
| what is tx for obstructive sleep apnea? |
|
Definition
| behavioral control (wt loss, sleep on side, avoid sedatives, elevate head of bed, avoid smoking/large meals), medical tx (*CPAP [keeps airway open], oral appliances [keeps jaw out of the way]), sx tx (setaplasticy, turbinectomy, tonsillo-adenoidectomy, clear excess tissue from the oropharynx, remove enlarged uvula, and tracheotomy if life-threatening) |
|
|
Term
|
Definition
| disorders of arousal, partial arousal, and sleep stage transition. |
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|
Term
| what are the disorders of arousal parasomnias (associated w/non-REM sleep)? |
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Definition
| confusional arousals: sleepwalking, sex-somnia, sleep terrors and sleep drunkenness. these feature mental confusion and disorientation, automatic behavior, relative non-reactivity to external stimuli, poor response to efforts to provoke behavioral wakefulness, retrograde amnesia for many intercurrent events, and only fragmentary or no recall of dream mentation. |
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|
Term
| what characterizes sleep terrors? |
|
Definition
| these arise out of the delta wave stage 3 non-REM sleep, of which infants and babies have the most. if these pts are partially aroused (brain sends signals toward wakefulness, but doesn't quite reach threshold) it can result in the pt hyperventilating, experiencing tachycardia and fighting any help w/out ever totally waking up (pt has no recall). tx: reassure parents that the child is not having a bad dream/not disturbed and that they will outgrow it. this is occasionally seen in adults and can be violent. |
|
|
Term
| what characterizes sleep walking (somnambulism)? |
|
Definition
| pts may get up out of bed and go through complex behavior without recall. |
|
|
Term
| what characterizes sleep drunkenness? |
|
Definition
| confusion following arousal from sleep, disoriented in time/space, slow in speech/mentation, and slow response to questioning |
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|
Term
| what is tx for confusional arousals? (*know this*) |
|
Definition
| rarely is tx needed, sometimes the environment may need to be secured (door locked etc), and in exceptional cases - BZDs may be required (**clonazepam: 1st line rx for sleep terrors**). for sleep terrors, antidepressants such as trazadone and paroxetine may also be helpful. hypnosis may also be useful for sleep walking (and other parasomnias). |
|
|
Term
| what are the REM associated parasomnias? |
|
Definition
| REM sleep behavior disorder, recurrent isolated sleep paralysis, and nightmare disorder. these disorders have a common underlying pathophysiological mechanism related to REM sleep: muscle atonia (paralysis). |
|
|
Term
| what is REM sleep behavior disorder? |
|
Definition
| intermittent loss of REM sleep muscle atonia and the appearance of elaborate motor activity associated w/dream mentation (can physically react to the dream). with these pts, REM sleep occurs earlier than normal (in ~ 30 min). |
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|
Term
| what is tx for REM sleep behavior disorder? |
|
Definition
| secure the environment, pharmacologically: clonazepam (most effective), melatonin, L-tryptophan, carbamazepine, clonidine (good for kids if you don't want to start BZDs), and gabapentin. donepezil has also been effective. |
|
|
Term
| what is recurrent isolated sleep paralysis? |
|
Definition
| this is usually normal, but can be abnormal depending on how intrusive it is/how often it occurs. pts report involuntary immobility occurring in transitions between sleeping/waking, awareness of surroundings while paralyzed + the ability to report events taking place during that paralysis, attempts to make sounds, and some frightening hypnagogic hallucinoid experiences. tx: TCAs, SSRIs, venlafaxine (similar to cataplexy) - also pts can try sleeping on their sides. |
|
|
Term
| what is nightmare disorder? |
|
Definition
| recurrent awakenings from sleep w/recall of intensely disturbing dream mentation: fear, anxiety, anger, sadness, disgust, and other dysphoric emotions. tx: *TCAs, SSRIs (suppress REM sleep), and systemic desensitization such as imagery rehearsal tx (IRT). |
|
|
Term
| what are the "other" parasomnias? |
|
Definition
| sleep related dissociative disorders, sleep enuresis, sleep-related groaning, exploding head syndrome (severe h/a), sleep related hallucinations, and sleep related eating disorder. |
|
|
Term
| what is sleep related dissociative disorder? |
|
Definition
| pts come out of sleep w/a totally different identity. (rare) |
|
|
Term
| what characterizes sleep enuresis? |
|
Definition
| usually occurs w/children normally until age 6. secondary enuresis may also occur, where pts start wetting the bed again. there is no specific pathophysiology and medication which controls bladder activity/desensitizes often is adequate. |
|
|
Term
| what characterizes sleep-related groaning/exploding head syndrome? |
|
Definition
| these can be disruptive and hard to predict. b/c they are parasominas, arousal needs to be blocked therefore BZDs and clonidine are useful. |
|
|
Term
| what characterizes sleep-related hallucinations? |
|
Definition
| this is an arousal phenomenon (so tx arousal), but this will also respond to antidepressants (SSRIs), antiseizure meds (topiramate), and anti-parkinson medication (L-dopa). |
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|
Term
| what characterizes sleep-related eating disorders? |
|
Definition
| pts sleep walk (also related to obstructive sleep apnea and medication abuse) to kitchen and eat lots of food they don't remember eating (usually high calorie or abnormal food - not etoh). generally these pts do not have eating disorders or OCD consciously. this is an arousal phenomenon (so tx arousal), but this wil also respond to antidepressants (SSRIs), antiseizure meds (topiramate), and anti-parkinson medication (L-dopa). |
|
|
Term
| what are sleep related movement disorders? are they parasomnias? |
|
Definition
| periodic limb movement disorder, restless legs syndrome, sleep related leg cramps, sleep related bruxism, and rhythmic movement disorder. **these are not parasomnias, but are included in the ddx of parasomnias. |
|
|
Term
| what is restless leg syndrome? |
|
Definition
| this occurs just before sleep, and the pt has uncomfortable sensations (dysesthesias) in their legs - which is only relieved by movement. this is a common cause of insomnia complaints and usually occurs in pts who don't have other sleep problems. this can run in families (autosomal trait) and is generally seen as due to a DA-deficiency (2/2 to lack of iron, which is required for synthesis), but can be secondary to renal disease, peripheral neuropathy or pregnancy. primary tx: L-dopa, pramipexole, or ropinirole (anti-parkinsonian, increase DA). also iron supplements can be used, but it has to be a fairly high dose and given w/vit C (can cause GI discomfort). |
|
|
Term
| what is periodic limb movement disorder? |
|
Definition
| a disorder which is comorbid w/80% of restless led syndrome pts. it is characterized by episodes of periodic and highly stereotyped limb movements that occur during sleep - resulting in either insomnia or excessive sleepiness. the limb movements mainly occur in the legs (anterior tibialis), but can affect the arms and they last .5 - 5 sec at intervals of 20-40 sec. episodes are most common in stage 2 sleep (sometimes in 1, never in 3 or REM) and the pt is usually not aware of the movements which are typically noted by a bed partner. tx: dopaminergic agents such as L-dopa, pramipexole, or ropinirole. BZDs or a narcotic can also help w/associated symptoms. gabapentin has also been used. |
|
|
Term
| what are sleep related leg cramps? |
|
Definition
| pts awaken w/cramps in foot/calf - often from dehydration or electrolyte deficiency - more common in older pts. |
|
|
Term
|
Definition
| a stereotyped movement disorder characterized by grinding/clenching of teeth during sleep. this can lead to dental injury/TMJ discomfort and disturb sleep. usually a mouth guard is used. antidepressants may aggravate this condition. |
|
|
Term
| what is rhythmic movement disorder? |
|
Definition
| stereotyped, repetitive movements involving the large muscles (head+neck) which usually occur immediately prior to onset and are maintained into light sleep. usually related to "rocking to sleep" habit, but may be disturbing to bed partner and need to protect children from banging head on crib. tx: cushioning on crib, coach children on sleeping techniques when old enough and use BZDs if severe. |
|
|
Term
|
Definition
| sleep talking/utterances, not associated w/a pathological cause - ensure bed partner of this. more common in males and may run in families. |
|
|
Term
|
Definition
| sleep talking/utterances, not associated w/a pathological cause - ensure bed partner of this. |
|
|
Term
|
Definition
| also called predormital myoclonus, this is a solitary generalized contraction which usually occurs spontaneously and involves most of the body - but particularly the lower limbs. the pt awakens w/a sensation of falling, visual flash or hallucination. this can be a cause of sleep-onset insomnia. tx: reassurance (keep regular sleep schedule, this is not harmful, allow body to relax, "worry time" etc.) but if severe: clonazepam. |
|
|
Term
| what characterizes sex-somina? |
|
Definition
| may consist of: violent masturbation, sexual assaults, and continuous/loud sexual vocalizations. often associated w/feelings of guilt/shame/depression and morning amnesia is typical. may be associated w/partial complex seizures, sleep-disordered breathing, 3-4 REM sleep parasomnias, and REM sleep behavior disorder. this can be controlled by counseling and tx of the sleep disorders (clonazepam may be necessary). |
|
|
Term
| how do sleep disorders in children often manifest? |
|
Definition
| overactive and inattentive - leads to misdx. |
|
|
Term
| when do babies first develop stages of sleep similar to that in adults? |
|
Definition
| 6 mos - before that they go directly to REM sleep (only time this is physiologic) for 60 min (by adolescents then 90 minute cycle). |
|
|
Term
| what are the stages of sleep in infants <6 mos? |
|
Definition
| active and quiet sleep. active is like REM and quiet sleep is like non-REM (see the typical EEG pattern). |
|
|
Term
| when do children not need to nap any more? |
|
Definition
|
|
Term
| when do humans first start having "adult sleep"? |
|
Definition
|
|
Term
| what is the only condition kids get which adults don't? |
|
Definition
| SIDS (sudden infant death syndrome) which seems to be decreasing. it is thought to be related to serotonin (related to cardio-respiratory function) and children affected by it have abnormalities disallowing thermoregulation/normal respiration - which is worsened during REM sleep due to less ANS control. possible tx: home monitoring of the baby w/apnea machine (monitors chest wall activity and ox-hemoglobin saturation) - only recommended if child has ALTE. best tx: sleep on firm mattress on back |
|
|
Term
|
Definition
| an apparent life threatening event - where the child looks as if they have sleep apnea and are acyanotic, then they choke/gasp and recover. |
|
|
Term
| what characterizes obstructive sleep apnea in children? |
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Definition
| this generally occurs in children due to tonsil/adenoid problems = obligate mouth breathers w/developing palate abnormalities (hard palate becomes "U" shaped w/high arch and no room for tongue) which occludes the airway. this can lead to pickwickian syndrome: snoring, obesity, sleepiness and “dropsy” (right-sided heart failure). |
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Term
| what sleep syndrome is often misdiagnosed as psychiatric? |
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Definition
| narcolepsy w/cataplexy - struggle to stay awake, may be seen as lazy/dumb/hyperactive - not core problem. |
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Term
| what characterizes the 2 kinds of behavioral insomnia? |
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Definition
| 1) sleep onset association disorder: a child gets used to sleeping in a certain place or with certain objects in the bed and then it changes = child may have difficulty sleeping. 2) limit-setting disorder: sleep problems resulting from lack of routine before bed. |
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