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Elaina: IGEP Final > Sleep Problems > Flashcards

Sleep Problems Flashcards

1
Q

do elderly people have an increased or decreased sleep latency?

A

increased

latency=time to fall asleep

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2
Q

when should we consider polysomnography in an elderly patient? (5)

A

if primary sleep disorder is suspected:

1) sleep apnea
2) narcolepsy
3) periodic limb movement disorder
4) violent or unusual behaviors during sleep
5) other sleep sx that don’t respond to tx

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3
Q

what can be used in the home to screen for sleep apnea?

A

in-home portable monitoring

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4
Q

what can we give our patient to use that provides an estimate for sleep vs. wakefulness throughout the night?

A

wrist-activity monitor

helpful in nursing home setting to identify circadian rhythm disorders

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5
Q

what are the 3 diagnostic criteria for insomnia?

A

1) difficulty falling asleep, staying asleep, waking too early, or sleep that is non-restorative or poor in quality
2) adequate opportunity and circumstances for sleeping
3) daytime impairment related to the sleep complaint, such as fatigue, poor attention, mood disturbance, daytime sleepiness

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6
Q

______ is a common cause of sleep problems

A

depression

treating depression may improve sleep abnormalities

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7
Q

what are a few common medical problems that can contribute to sleep difficulties?

A

1) pain from arthritis
2) paresthesias
3) cough
4) dyspnea (cardiac, pulm dz)
5) GERD

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8
Q

_____ can lead to sleep difficulties because of increased frequency of urinatino

A

diuretics

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9
Q

what are 3 drug classes that can induce nightmares and impair sleep in the elderly?

A

1) antidepressants
2) antiparkinson agents
3) anti-HTN (propranolol)

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10
Q

what is alcohol abuse’s effect on sleep?

A

lighter sleep of shorter duration

can worsen sleep apnea

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11
Q

what is the term for the sleep disorder with episodes of cessation of breathing without associated respiratory effort?

A

central sleep apnea

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12
Q

the ______ pattern of sleep apnea has a crescendo-decrescendo pattern of breathing

A

cheynes-stokes

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13
Q

what are common causes of central sleep apnea? what should initial treatment focus on?

A

opioid use, stroke, heart failure, or other conditions

initial TX should focus on management of heart failure, if present

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14
Q

______ sleep apnea is characterized by a complete or partial (hyponea) upper airway obstruction during sleep, with evidence of respiratory effort during the events

A

obstructive sleep apnea

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15
Q

what will your OSA patient complain of throughout the day?

A 
daytime sleepiness
morning headache
personality change
poor memory, confusion
irritability
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16
Q

what might the person with OSA’s bed partner report in their partner during the night?

A

loud snoring ,cessation of breathing, choking during sleep

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17
Q

what are 2 important predictors of OSA?

A

high BMI and large neck circumference

others: alcoholism, male gender, dementia

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18
Q

what should we do to confirm DX if we suspect OSA? what is the main treatment?

A

sleep lab for evaluation

main tx = positive airway pressure

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19
Q

repetitive, stereotypic leg movements that occur during sleep is known as what?

A

restless leg syndrome

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20
Q

does restless leg syndrome occur during REM sleep or non-REM sleep?

A

non-REM sleep

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21
Q

diagnosis of periodic limb movement disorder requires what?

A

polysomnography

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22
Q

what is the name of the disorder characterized by an urge to move the legs, usually accompanied by an unpleasant sensation in the legs that occurs with inactivity?

A

restless leg syndrome

23
Q

when are symptoms worst for restless leg syndrome? when are they best?

A 
worst = night
best = with movement
24
Q

can restless leg syndrome involve the arms?

A

yes

25
Q

how do we diagnose restless leg syndrome?

A

clinically

does not require polysomnography

26
Q

what disorder do most patients with restless leg syndrome also have?

A

periodic limb movement syndrome

27
Q

how do we treat restless leg syndrome?

A

dopaminergic agent is initial agent of choice

28
Q

what is the difference between a delayed sleep phase and an advanced sleep phase?

A

delayed = fall asleep late, awaken late

advanced = fall asleep early, awaken early (common in old people)

29
Q

problems with delays or advanced sleep phases may respond to what?

A

appropriately timed bright light

30
Q

what is the name of the disorder characterized by excessive motor activities during sleep and a pathologic absence of the normal muscle atonia during REM sleep?

A

REM sleep behavior disorder

31
Q

what underlying disorder is REM sleep behavior disorder often linked with?

A

neurodegenerative disorders

32
Q

what are presenting symptoms of REM sleep behavior disorder?

A

vigorous sleep behaviors associated with vivid dreams

might result in injury to patient or bed partner

33
Q

what is the first step when working up REM sleep behavior disorder?

A

review meds!

TCA, MAOIs, fluoxetine, venlafaxine, cholinesterase inhibitors may be at fault

34
Q

what is needed to confirm DX of REM sleep behavior disorder?

A

polysomnography

35
Q

what are the 4 treatment option for REM sleep behavior disorder?

A

1) if drug induced – discontinue
2) clonazepam – adverse effects a concern in older patients
3) melatonin
4) environmental safety interventions

36
Q

people with dementia are more likely to have a higher percentage of sleep in stage ____ and decreases in stage ___ and ____

A

more sleep in stage 1

less sleep in stage 3 and 4

37
Q

true or false, people with dementia are more likely to sleep during the day and have nighttime wakefulness?

A

true

38
Q

what minor fix can help improve sleep quality in a patient with dementia?

A

give their cholinesterase inhibitors IN THE MORNING (they exacerbate insomnia and cause vivid dreams)

39
Q

should we use sedatives or hypnotics in our patients with dementia?

A

no; they have not been adequately tested in this population

40
Q

what non-pharmacologic treatment can we use for dementia patient’s with sleep difficulties?

A

bright light therapy

41
Q

patient just moved into a nursing home and can’t stand the sleep-disruptive environment. what are some non-pharm treatments we can give her?

A

1) daytime bright light exposure
2) change medication times; allow patient to sleep in
3) back rub, warm drink, relaxation tape

42
Q

which drug class should we use when treating a patient’s sleep difficulties, benzodiazepines or antihistamines (like diphenhydramine)?

A

use benzos

do NOT use antihistamines

43
Q

patients in the hospital on ______ are at high risk for sleep-related breathing disorders

A

opioids

44
Q

if your patients history and PE do not suggest a serious underlying cause of their sleeplessness, where should you start?

A

improved sleep hygiene

45
Q

what is the first line treatment for chronic insomnia?

A

cognitive behavioral therapy

combine with sleep restriction, stimulus control and cognitive therapy, +/- relaxation techniques

46
Q

generally, we want to try our best to avoid sleep medications. why?

A

increased risk of falls

47
Q

are short or intermediate acting agents used for problems INITIATING sleep? what is the main side effect with these?

A

short acting agents for initiating sleep

more rebound and withdrawal syndromes after discontinuation

48
Q

are short or intermediate acting agents used for problems MAINTAINING sleep? what is the main side effect with these?

A

intermediate acting

more daytime carry over

49
Q

studies have shown that chronic ______ use increases morbidity and mortality

A

benzodiazepines

50
Q

does chronic use of benzodiazepines exacerbate sleep problems?

A

yes

51
Q

how can we help eliminate the need for benzos in our patient who requires more intense therapy for their insomnia?

A

1) decrease dose by half for 2 weeks prior to full withdrawal; may need to taper more slowly
2) add replacement tablet (tylenol PM or melatonin) after tapering off benzo
3) refer to CBT

52
Q

there is evidence for usefulness of _______ in circadian rhythm disturbances

A

melatonin

53
Q

what 3 non-prescription sleep products are not generally recommended for sleep?

A

1) sedating antihistamines (like benadryl – anticholinergic SE)
2) alcohol (messes up sleep later in night)
3) valerian (herbal, little effectiveness)

Elaina: IGEP Final (5 decks)

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