1.
___ has essentially a 100% improvement in OSA, however compliance (influenced by tolerance) is only about 80%.: CPAP
2.
___ is a term coined by Gelineau in 1880 that describes the tetrad of (1) daytime sleepiness, (2) cataplexy (sudden and transient episode of loss of muscle tone, especially triggered by an emotional event), (3) hypnogenic hallucinations, and (4) sleep paralysis.: Narcolepsy
3.
___ is a unique condition to humans because we have a non-bony (fibrocartilagenous) pharynx.: Obstructive sleep apnea (OSA)
4.
___ is also knwn as desynchronized sleep or paradoxical sleep.: REM sleep
5.
___ is an melatonin agonist that acts on melatonin receptors in the SCN. It is good for help with initiating sleep, has a short half-life, low abuse potential, and minimal side effects.: Ramelteon (Rozerem)
6.
___ is Dx when one has (1) difficulty initiating or maintaining, waking up too early, or sleep that is chronically nonrestorative or poor in quality despite (2) adequate opportunity and circumstances for sleep which (3) results in deficits in daytime function.: Insomnia
7.
___ is volitional sleep loss. Persons exhibiting this typically fall asleep rapidly, given the opportunity.: Sleep deprivation
8.
___ occurs when a person believes they are not sleeping adequately, but they are. Despite its name, it is not actually a form of insomnia.: Paradoxical insomnia
9.
___ sleep is known as slow-wave or synchronized sleep and has 3 stages.: NREM
10.
____ are made by dentists to help move the tongue forward to prevent physicial obstruction of the airway. It is effective about 40-50% of the time in Pts c mild to moderate OSA.: Mandibular advancement devices/splint
11.
____ occur in REM sleep and create fear. The details of these dreams can usually be recounted by those who experience them.: Nightmares
12.
____ occurs after a > 3 months of acute insomnia when anxiety about sleep deprivation itself causes insomnia.: Psychophysiological insomnia
13.
~20% of people are ____, who are able to sleep only ≤4 hours a day without daytime impairment.: short sleepers
14.
10% of people are ___, who require 9-10 hours of sleep a day to avoid daytime impairment.: long sleepers
15.
A ___ is a REM period that occurs within 15 minutes of falling asleep, rather than the typical 90 minute delay.: SOREM (Sleep-onset REM)
16.
A surgery performed in adults c OSA to open the airway is ___.: Uvulopalatopharygeoplasty (UPPP, or UP3)
17.
Benzodiazepines, including temazepam (Restoril), lorazepam (Ativan), and estazolam (ProSom), are ___ therapy for insomnia, because of the risk of dependence.: 2nd line
18.
Benzos increase duration of sleep an average of 30-60 minutes and reduce latency by ___.: 10 minutes
19.
Between birth and puberty, total sleep and proportion of REM dramatically decrease from ___.: 16 → 8h, 50 → 20%
20.
For narcolepsy to be Dx, episodes must occur almost daily for ≥ ___. Then sleep studies are done, observing the patient with a nocturnal polysomnogram for ≥6 h, then multiple sleep latency test (MSLT).: 3 mo
21.
Ideally, one sleeps ___ hours in a day, week, month, and year.: 8, 56, 224, 2688
22.
In ___ sleep, RR and HR are increased and irregular, O2 consumption is increased, and muscle tone (except the diaphragm) are decreased. Rapid eye movements, inner ear muscle twitching, and miosis are also seen. This type of sleep is associated with dreams.: REM
23.
In ___ sleep, RR, HR, O2 consumption, and muscle tone are all decreased.: NREM
24.
In ___ sleep, the EEG shows desynchronized, fast activity of low amplitude.: REM
25.
In ___ sleep, the EEG shows slow, synchronized activity of high amplitude.: NREM
26.
In ___, OSA is caused by closure of the upper airway, it is most commonly seen in the obese. It is characterized by continued corresponding thoracic and abd muscle activity.: upper airway apnea
27.
In ___, Pts awakened during slow wave, NREM sleep might experience fear, but not be able to recount any details or memories of a frightening dream.: night terrors
28.
In ___, the diaphragm does not contract due to a CNS abnl. It is characterized by an absence of corresponding thoracic and abd muscle activity.: central apnea
29.
In ___, upper airway apnea usually follows central apnea.: mixed apnea
30.
In 04AD, ___ defined sleep as the absence of wakefulness.: Lucretius
31.
In 1830, ___ described sleep as the suspension of sensorial power in which the voluntary functions are absent, but the involuntary functions, such as circulation, respiration and other functions controlled by the autonomic nervous system, remains intact.: Macnish
32.
In 1929, the ___ was invented and REM sleep was first discovered in 1953.: EEG
33.
In a normal young adult, ___ of sleep is spent in REM.: 20-25%
34.
In a normal young adult, about 5% of sleep is spent in NREM 1. ___ is spent in NREM 2.: 50-60%
35.
In a normal young adult, only ___ of sleep is spent in NREM 3.: 15-20%
36.
In aging, the duration of stage ___ sleep declines exponentially, which correlates with the increased frequency of awakenings seen in older people.: NREM 3
37.
In MSLT, the Pt is asked to nap ___ times with a 2 hour interval between each attempt. This allows measurement of the time it takes for the patient to fall asleep. An average ≤ 8 minutes and two sleep-onset REM periods is considered diagnostic for narcolepsy. Normal is 12-16 minutes.: 5
38.
Light, physical activity, and melatonin are the ___ which synchronize sleep-wake cycles. The strongest of these is light.: zeitgebers ("time-givers")
39.
Most cases of insomnia (70-85% of cases) are associated with ___.: psychologic problem (e.g. depression, anxiety, stress)
40.
MSLT < 8 minutes s SOREMx2 is called ___.: idiopathic hypersomnia
41.
Narcolepsy occurs in about 25-50/100k and is equally common in men and women. The episodes of sleep paralysis usually last ___.: 1-2 minutes
42.
Narcoleptics are treated with stimulants (e.g. (Ar)modafinil, pemoline, amphetamines, e.g. Adderall) during the day, and REM suppressors (TCAs, SSRIs, SNRIs) for ___.: cataplexy
43.
Non-benzodiazepine's have risen to prominence in the Tx of insomnia in the last 10-15 years. They act on ___ receptors, but are not benzodiazepines, so have a lower risk of dependency. Examples include Zolpidem (Ambien), Eszopiclone (Lunesta), and Zleplon (Sonata).: GABA
44.
Obesity, male, old age, EtOH, craniofacial skeletal abnormalities, and family history are risk factors for OSA. In children and young adults ___ is an additional risk factor.: adenotonsillar hypertrophy
45.
Older persons, women (by ___), and lower SES persons are more likely to suffer from insomnia.: 2.5x
46.
OSA is defined as repeated interruptions in breathing (>10s in an adult, 2x longer than normal in a child) over the course of an hour, totaling ___ episodes. The usual complaint is excessive daytime sleepiness or snoring, reported by a family member, usually after 10 or more years.: ≥5
47.
Practically all sleep apnea sufferers snore heavily. They are commonly obese. It occurs in men ___ more often than women. Daytime sleepiness can lead to development of psychiatric or CV d/o, possibly due to chronic lack of O2.: 2x
48.
REM sleep is most similar to NREM __ or the waking state.: 1
49.
Sleep is not a static brain state, as is demonstrated by EEG, O2 consumption, metabolism, some sensory processing and reflex activity. It is a reversible state with decreased responsiveness to the environment and motor activity, defined by physiological and behavioral criteria. It occurs in recurring cycles, largely maintained by the ___, which is also the pacemaker for temp, melatonin, and cortisol cycles.: suprachiasmatic nucleus
50.
Stage ___ sleep is defined by the presence of >20% δ (3-4Hz) activity in a 30 second EEG.: 3
51.
Stage 2 is characterized by presence of ___ on EEG.: K complex followed by sleep spindle
52.
The ENT surg performed for children c OSA is ___. It is effective about 40-50% of the time in Pts c mild to moderate OSA.: Adenotonsillectomy
53.
The main concerns in OSA are inadequate ventilation, reduced O2 sat, and ___.: sleep disruption
54.
The SCN projects to the forebrain and thalamus (which projects to other areas like the VLPO and locus coeruleus). It recognizes light from the environment via the ___.: Retinal-hypothalamic tract
55.
The suprachiasmatic nucleus (SCN) regulates synth and secretion of ___, whose levels begin to rise ~2h before habitual sleep and whose production is suppressed by exposure to the bright light.: melatonin
56.
Tx options for OSA include:: CPAP, mandibular advancement devices or surgery
