Sleep Disorders

Question 1

What is sleep? How is it different from coma?

Answer 1

rapidly reversible state of reduced responsiveness, motor activity & metabolism
different from coma b/c patients in a coma cannot be aroused

Question 2

Identify the amount of sleep required for each of the following age groups: newborns, infants, toddlers, preschoolers, school-aged children, teenagers, young adults, older adults

Answer 2

• newborns - 14-17 hrs
• infants - 12-15 hrs
• toddlers - 11-14 hrs
• preschoolers - 10-13 hrs
• school-aged children - 9-11 hrs
• teenagers - 8-10 hrs
• young adults - 7-9 hrs
• older adults - 7-9 hrs

Question 3

Why is sleep important?

Answer 3

• restoration & cognitive function
• improves immunity
• maintains hormone homeostasis (cortisol levels)
• memory storage
• protein synthesis & repair
• mental health stability
• decrease risk of chronic health problems

Question 4

NREM is what percent of sleep?

Answer 4

75-90%

Question 5

REM is what percentage of all sleep?

Answer 5

10-25%

Question 6

What are the EEG positions in a sleep study?

Answer 6

• mastoid
• occipital
• central
• frontal
• eye
• chin

Question 7

Identify the name of the EEG characteristics indicated on the provided picture:

Answer 7

Question 8

What are the characteristics of stage N1 of sleep?

Percentage of NREM sleep?

EEG characteristics?

Eye movements?

Muscle tone?

Answer 8

• transition wakefulness to sleep
  
  • lightest stage - may not know asleep
• 5-10% NREM
• EEG
  
  • lo amplitude mixed frequencies theta range (4-7 Hz) at least 50%
• Eye movements: slow & rolling
• Muscle tone: present & breathing is regular

Question 9

What are the characteristics of stage N2 of sleep?

Percentage of NREM sleep?

EEG characteristics?

Answer 9

• largest percentage total sleep time
  
  • 45-55% NREM
• EEG:
  
  • theta (4-7 Hz)
  • sleep spindles - short duration 11-16 Hz in central lead
  • K-complexes - well-delineated, negative sharp waves followed by positive component duration >0.5 s in frontal lead

Question 10

Benzodiazepines have what effect on sleep stages?

Answer 10

increase N2 stage & increase spindle activity

decrease REM sleep

Question 11

What are the characteristics of stage N3 of sleep?

Percentage of NREM sleep?

EEG characteristics?

Eye movements?

Muscle tone?

Answer 11

• “deep sleep” or “slow wave sleep”
  
  • occur more in first half of night
  • more difficult to arouse sleepers
  • decreases with age
• 10-20% NREM
• EEG
  
  • low frequency (0.5-2 Hz)
  • high amplitude delta waves (20%)

Question 12

What area parasominas & in what stage are they most likely to occur?

Answer 12

things that happen in sleep- ie. sleep walking & night terrors

N3

Question 13

What are the characteristics of stage R of sleep?

EEG characteristics?

Eye movements?

Muscle tone / breathing?

Breathing?

Answer 13

• associated with dreaming
• EEG
  
  • low voltage, mixed pattern w/ 2-6 Hz sharp wave patterns in sharp bursts (sawtooth)
• Rapid eye movements w/ conjugate, irregular sharply peaked eye movements on EOG
• EMG: atonia, inactivity of all voluntary muscles
  
  • direct inhibition of alpha motor neurons
• breathing more erratic & irregular; HR increased

Question 14

What are the 2 stages of R sleep?

Answer 14

• Phasic
  
  • bursts of rapid eye movement, respiratory variability & brief EMG activity (muscle twitches)
• Tonic
  
  • fewer eye movements & more limited motor activity (atonia more common)

Question 15

What is the most important thing in evaluating a patient or a sleep disorder?

Answer 15

sleep history

Question 16

When taking a sleep history, what types of symptoms should you ask about?

Answer 16

• presenting symptoms
• nocturnal symptoms
• daytime symptoms
• sleep routine
• sleep area
• substances
• other medical problems

Question 17

When seeing a patient for a sleep disorder, what should you include in the physical examination?

Answer 17

neck circumference

mallampati score

retrognathia

septal deviation

obesity abnormal monofilament test

Question 18

Describe the difference classes of Mallampati Score:

Answer 18

1. Class I:
   
   1. complete visualization of soft palate
2. Class II:
   
   1. complete visualization of uvula
3. Class III
   
   1. visualization of only the base of the uvula
4. Class IV:
   
   1. soft palate is not visible at all

Question 19

What diagnostic testing can you perform on a person to work up for a sleep disorder?

Answer 19

• overnight pulse-oximetry
• home sleep study
• polysomnogram
• sleep latency testing

Question 20

What type of disorder is characterized by the inability to fall asleep & stay asleep?

Answer 20

insomnia

Question 21

What type of disorder is characterized by excessive sleepiness?

Answer 21

hypersominas

Question 22

What type of disorder is characterized difficulty breathing during sleep?

Answer 22

sleep related breathing disordrs

Question 23

What type of disorder is characterized by sleeping at non-normal intervals?

Answer 23

circadian rhythm sleep wake disorders

Question 24

What type of disorder is characterized by the abnormal or unwanted events that occur while falling asleep, sleeping or waking up?

Answer 24

parasomnias

Question 25

What type of disorder is characterized by movement prior or during sleep that affect sleep quality?

Answer 25

sleep movement disorders

Question 26

What is the most common sleep complaint in primary care?

Answer 26

Insomnia

Question 27

What are the types of insomnia?

Answer 27

onset insomnia: difficulty falling asleep maintenance insomnia: difficulty staying asleep acute insomnia precipitated by life event - usually \< 3 mo.

Question 28

Insomnia is most commonly seen in what demographics?

Answer 28

women, elderly, substance abuse

Question 29

What is the strategy to manage insomnia?

Answer 29

* manage underlying conditions * sleep hygiene * polysomnography (if other sleep disorder is suspected) * **cognitive behavioral therapy is first line** * Pharmacological therapies * short acting benzodiazepines & antipsychotics are NOT recommended