RPSGT

Central Alveolar Hypoventilation Syndrome

Impaired ventilatory control, characterized by low arterial oxygen levels and hypoventilation without apnea or hypopnea. Hypoventilation periods may persist for several minutes with sustained arterial oxygen desaturation and increased levels of carbon dioxide.

Circadian Rhythm Sleep Disorder

Altered functioning of the circadian sleep-wake system or imposed mismatch between the Pt.'s natural sleep-wake system and required sleep-wake system. (Common in Shift Workers)

atEMGs

Anterior Tibialis Electromyograms

AI

Apnea Index

AHI

Apnea-Hypopnea Index

Central Sleep Apnea

Apneic and hypopneic episodes without obstruction and usually results from cardiac or neurological disorders that cause impairment of ventilation.

Sedative/Hypnotic Chronic Use/Withdrawal - Mixed Insomnia and Hypersomnia

As the Pt. develops a tolerance for the drug, sedative effects decrease, and insomnia occurs. If the Pt. increases the dose of medication to compensate, then hypersomnia recurs. Withdrawal often results in insomnia with a decrease in sleep duration and an increased disruption of sleep and stage R sleep rebound as well as anxiety, tremors, and ataxia.

Maintenance of Wakefulness Test (MWT)

Assesses sleepiness and effectiveness of treatment, determines the Pt.'s ability to stay awake in the daytime. The MWT may be done with the multiple sleep latency test (MSLT)

Spinal Cord Injury

Bilateral diaphragmatic paralysis

Psychiatric Disorders

Bipolar Disorder, depression, PTSD & schizophrenia

Blockers - Insomnia

Blockers decrease sleep, increase disruption of sleep, and increase nightmares.

Respiratory Disorders

COPD, cystic fibrosis, restrictive lung diseases & asthma.

Hypersomnia

Characterized by increased sleepiness, prolonged nocturnal sleep (8-12 hours) and daytime sleepiness with intentional or unintentional napping on a daily basis for at least 1 month with difficulty awakening, resulting in social , occupational, and other impairment, and related to psychiatric & mental disorders. Can be caused by medical disorders or substance abuse

Secondary Enuresis

Child has had long periods (6-12 months) without any instances of nocturnal incontinence

Primary Enuresis

Child has never been dry at night, and incontinence is associated with delay in maturation and small functional bladder rather than stress or psychiatric disorders.

Sleep-Wake Activity Inventory

Comprehensive instrument that includes subscales the measure a number of different aspects of sleep disorders: EDS, nocturnal sleep, relaxing ability, energy, social desireability, and psychological distress.

CAP

Cyclic Alternating Pattern

Diuretics - Insomnia

Decreasing potassuim levels may cause leg cramps that interfere with sleeping, and the increase in urinary output may cause nocturnia, interrupting sleep.

ECGs

Electrocardiogram

EEGs

Electroencephalogram

EOG

Electrooculogram

Kidney/Urinary Disorders

End-Stage renal disease & Urinary Frequency

Epworth Sleepiness Scale

Evaluates how likely a person is to fall asleep during a number of different activities.

EPAP

Expiratory Positive Airway Pressure

Fatal Familial insomnia

Fatal neurologic disorder in which the Pt. has difficulty falling asleep, progressing to the inability to sleep. A desynchronized EEG and an absence of slow-wave sleep characterize this disorder.

Gastrointestinal Disorders

GERD & functional bowel disorders

Fatigue

General feeling of tiredness, weakness, or lack of energy and may be related to physical or emotional problems.

Alcohol Withdrawal - Insomnia

Gross disturbance of sleep with an increase in the amount of stage R sleep, often with vivid dreams. After withdrawal, insomnia with a light restless sleep may persist for weeks to years with a deficit in slow-wave sleep.

Infectious Diseases

HIV/AIDS, Lyme Disease & Human African Trypanosomiasis

Cardiovascular Disorders

Heart Block, dysrhythmias, congestive heart failure, coronary artery disease & atrial fibrillation

Bronchodiators (theophylline) - Insomnia

High doses of some bronchodilators may cause nervousness, muscle cramping, twitching, and sleep disruption.

Thyroid Hormone (Synthroid) - Insomnia

High doses of thyroid hormone may cause nervousness, tremors, heart palpitations, and disruption of sleep.

Endocrine Disorders

Hypothyroidism, acromegaly, Cushing's syndrome, Addison's disease, diabetes mellitus & diabetes insipidus.

Sleep-state Misperception

PSG shows normal sleep, but the Pt. reports reduced or no sleep and often does not believe contrary lab results.

Rheumatologic Disorders

Pain syndromes & Fibromyalgia

Nicotine Patches - Insomnia

Patches may interfere with falling asleep and duration of sleep and cause vivid dreams or nightmares.

PRC

Phase Response Curve

Amphetamines/Related Drugs: Withdrawal - Hypersomnia

Prolonged sleeping during the night. REM and slow-wave sleep may increase above baseline. MSLT shows increased sleepiness during the daytime as well.

Hypnotic dependent sleep disorder

Pt is unable to sleep w/o sleep medication - resulting in a tolerance requiring ever increasing doses; withdrawal results in insomnia, nervousness, and agitation.

Sleep-related Eating

Pt. eats during the night and has no recollection of doing so. This is distinct from night eating syndrome.

Night Eating Syndrome

Pt. is aware of eating, but is unable to go back to sleep without eating.

Jet Lag

Pt.'s travel to different time zones and cannot adapt their sleep-wake cycle resulting in fatigue, disorientation, and lack of adequate sleep with a degree of symptoms related to the number of time zones.

RBD

REM Behavior Disorder

Electrocardiograms

Record and show a graphic display of the electrical activity of the heart through a number of different waveforms, complexes, and intervals.

Nightmare Disorder

Repeated nightmares (sometimes associate with PTSD) that cause the Pt. to awaken fully alert, interrupting the normal sleep cycle. -Nightmares occur during REM sleep and tend to occur in the second half of the night when these periods are longer. The Pt. may suffer from fatigue from lack of sleep caused by frequent awakening or may avoid sleeping because of fear of the nightmares.

Narcolepsy

Repeated periods of falling asleep during waking hours daily for at least 3 months.

Enuresis

Repeated, involuntary, urinary incontinence in children old enough to have bladder control, usually about 5-6 years old. Most common in the first third of the night with the child awakening after urinating.

U Wave

Represents repolarization (return to resting state)of the Purkinje fibers.

P Wave

Represents the beginning of the electrical impulses which spread through the atria (this is the atrial depolarization/muscle contraction)

QRS complex

Represents the ventricular muscle depolarization (contraction) and atrial repolarization (return to resting state)

T Wave

Represents ventricular muscle repolarization (resting state) as cells regain negative charge.

RDI

Respiratory Disturbance Index

Alcohol Intoxication - Insomnia

Sedation occurs during acute intoxications with increased sleeping and decreased wakefulness for 3-4 hours with increased stage N3 sleep and reduced stage R sleep. After this period, the Pt. experiences decreased stage N3 sleep, increased wakefulness, and increased stage R sleep with restlessness and sometimes vivid dreams.

SPT

Short Period Time

SWS

Short- Wave Sleep

SE

Sleep Efficiency

SOL

Sleep Onset Latency

Cocaine Withdrawal - Hypersomnia

Sleep is markedly prolonged

Opioid Withdrawal - Hypersomnia

Sleep is prolonged.

Cocaine Intoxication - Insomnia

Sleep is severely compromised, and the Pt. may sleep only for short, disrupted periods.

SWAI

Sleep-Wake Activity Inventory

Antihistamines (diphenhydramine, Benadryl) - Hypersomnia

Some drugs may produce a sedative effect, causing increased sleeping during the night and increased sleepiness during the daytime.

Selective serotonin reuptake inhibitors (SSRIs) - Insomnia

Some individuals experience sleep disruption and sleepiness during waking hours when taking SSRIs.

Corticosteriods - Insomnia

Steroids may markedly decrease sleep time and increase time needed to fall asleep as well as cause fatigue and jitters during the day.

Sleep Paralysis

The Pt. can see and breathe but is not able to move for periods of seconds to minutes - occurs during onset of sleep (hypnagogic) or upon on waking (hypnopompic).

Antiarrhythmics (quinidine procainamide) - Insomnia

These drugs may cause disruption of sleep during the night and increased sleepiness in the waking hours.

TSP

Total Sleep Period

TST

Total Sleep Time

TWT

Total Wake Time

Amphetamines Related Drugs: Intoxication - Insomnia

Total sleep is reduced with increased sleep latency and sleep disturbance. EMG shows increased muscular activity. Stage R sleep and slow-wave sleep decrease.

Caffeine Withdrawal - Hypersomnia

Increased sleeping and daytime sleepiness are common.

Caffeine Use - Insomnia

Increased wakefulness and decreased sleep are does dependent. Polysomnography shows increased sleep latency and wakefulness and decreased slow-wave sleep.

Excessive Daytime Sleepiness

Increasing societal problem related to lack of adequate sleep, causes the Pt. to feel sleepy during waking hours to the point at which the person may fall asleep or feel the need to nap.

Sedative/Hypnotic Intoxication - Hypersomnia

Initial sedative effects result in an increase in sleepiness, decreased wakefulness, and a decrease in stage R sleep with an increase in sleep-spindle activity.

IPAP

Inspiratory Positive Airway Pressure

IEA

Interictal Epileptiform Activity

Substance-induced sleep disorder

Intoxication and withdrawal from alcohol as well as many other different drugs.

Neuromuscular Diseases

MS, amyotrophic lateral sclerosis, myasthenia gravis, poliomyelitis & myotonic dystrophy.

Electroencephalograms

Measure the electrical activity within the brain through scalp electrodes to rule out seizure disorders and to determine the characteristics of the sleep-wake state.

Multiple Sleep Latency Test (MSLT)

Measures sleepiness during waking hours and then tendency of a person to fall asleep. (May diagnose narcolepsy and idiopathic hypersomnia and determine the effectiveness of therapy)

Anterior Tibialis Electromyograms

Monitor the electrical activity in the leg muscles, allowing for monitoring of periodic leg movement during the polysomnogram because electrical activity is absent when the muscle is relaxed and increases with movement.

Sleep Walking Disorder

Motor activity during sleep including sitting up, picking at bedding, talking, walking, running, operating machinery, and eating. Pt. may respond verbally to others, but speech may not be clear because of reduced alertness. The Pt.'s eyes are usually open. Typically, the Pt. does not awaken easily and is confused if awakened and has little or no memory of the episode.

Sleep Disorders

OSA, CSA, narcolepsy, circadian rhythm disorders, RLS , PLMs, parasomnias & insomnia.

Sleep-related groaning

Occurs during exhalation, primarily during REM. The respirations become slow, and the groaning exhalation may persist for 30 - 40 seconds, usually concluding with a grunting or sighing sound.

Periodic Leg Movements

Occurs during sleep and are often associated with RLS (occuring in about 80% of patients with RLS) with five or more PLMS usually within the first half of the night.

Berlin Questionnaire

Often used for screening those at risk for obstructive sleep apnea, but it is also occationally used to determine progress after the onset of treatment with positive airway pressure.

Exploding Head Syndrome

Upon awakening, the Pt. perceives a sudden (imaginary) noise or explosion, sometimes accompanied by a flash of light, jerking and fright.

Stanford Sleepiness Scale

Used to determine if people have excessive daytime sleepiness.

Sleep-related Hallucinations

Visual, auditory, or tactile hallucinations occur during onset of sleep (hypnagogic) or on waking (hypnopompic) sometimes associated with sleep paralysis. Images tend to be stationary and disappear if the light is switched on.

Opioid Use (Chronic) - Insomnia

While acute use of opioids may result in increased sleepiness with reduced stage R sleep, chronic use may cause insomnia with increased wakefulness and decreased sleep time.

Unspecified/advanced delay:

a circadian rhythm disorder: increasing of sleep onset latency resulting in changes in sleeping patterns over time with sleep onset occuring at increasingly later hours.

Chronic Insomnia

difficulty initiating & maintaining sleep over prolonged periods of time - has several forms: psychological, sleep-state misperception, hypnotic dependent sleep disorder & fatal familial insomnia.

Primary Insomnia

difficulty initiating and/or maintaining sleep, or having non-refreshing sleep for at least 1 month with onset usually after a stressful episode resulting in impairment of work, study, and social activities.

Cataplexy

sudden and uncontrollable muscle weakness or paralysis that is triggered by a strong emotion such as excitement or laughter; associated with narcolepsy - person is awake and aware of what is happeniing, but cannot move; episodes last up to 2 min: occurs because of the inability to regulate sleep & awake states

Shift Work

work requirements force person to sleep outside the their normal sleep cycle, often resulting in shorter periods of sleep and chronic fatigue.

Alpha

8-13 Hz - Pt is awake w/ eyes closed

Delta

<0.5-4 Hz - NREM 3

Theta

>4-7 Hz - NREM 2

Cheyne - Stokes

10-60 seconds of hyperventilation followed by another period of apnea

Beta

13-30 Hz - Pt is awake w/ eyes open