1: Sleep - physiology, hypersomnolence, parasomnias

Question 1

What is sleep?

Answer 1

Recurring, reversible state where you lose ability to respond to environment

Question 2

Are you conscious or unconscious when asleep?

Answer 2

Both

Question 3

What are the two main types of sleep?

Answer 3

REM sleep

Non-R.E.M. Sleep

Question 4

When does

a) R.E.M. sleep
b) Non-R.E.M. sleep occur?

Answer 4

a) End of the night, short period
b) Start and most of the night

Question 5

What happens to the body during non R.E.M. sleep?

Answer 5

Relaxation of muscles

Decreased HR and BP

Reduced respiration

Protein synthesis, cell division and growth

Question 6

What happens to your

a) muscles
b) blood flow

during R.E.M. sleep?

Answer 6

a) complete relaxation (atonic, to stop you from jumping out of bed)
b) increases

Question 7

What is the most important type of sleep?

Answer 7

Non-R.E.M. sleep

makes up the majority

Question 8

What is the homeostatic process of sleep?

Answer 8

If you’re in a ‘sleep debt’, your body will try to sleep

Question 9

Being awake and being asleep are partly controlled by your body’s ___ rhythm.

Answer 9

Circadian

Question 10

What stimulus ‘resets’ your body clock?

Answer 10

Light

via ‘non-rod, non-cone cells’

Question 11

What is the name for a stimulus which acts as a cue for your body’s circadian rhythm?

Answer 11

Zeitgeber

Question 12

Sleep ___ has profound effects on your behaviour and cognition.

Answer 12

Sleep deprivation

Question 13

What happens when you sleep?

Answer 13

Growth and repair

Protein synthesis and cell division

Question 14

What is the only time which the cortex rests?

Answer 14

During sleep

Question 15

What are some of the effects of sleep deprivation?

Answer 15

Loss of concentration

Visual hallucinations

Irritable behaviour

Question 16

Which behaviours aren’t affected by sleep deprivation?

Answer 16

Strongly reinforced habits e.g protocols

Question 17

Does sleep deprivation itself kill people?

Answer 17

Probably

Question 18

People who are sleep deprived are more likely to die in ___.

Answer 18

accidents

Question 19

At which times does your circadian rhythm make you the most tired?

Answer 19

2pm

4am

Question 20

How long should you sleep at night?

Answer 20

7 - 8 hours

Question 21

How long should you nap for in the afternoon?

Answer 21

15 minutes

equivalent to 90 minutes of overnight sleep

Question 22

Confusion all arousal / Non R.E.M. parasomnia

Question 23

Why do patients behave primally during confused arousal?

Answer 23

Primitive brain ‘wakes up’ first

Question 24

What is a parasomnia?

Answer 24

Abnormal transitions from sleeping to wakefulness

e.g sleepwalking, talking, night terrors, paralysis, bruxism

Question 25

What is a R.E.M. Parasomnia?

Answer 25

Simple behaviours e.g kicking occurring during the last third of the night

Question 26

R.E.M. parasomnias are strongly associated with which neurodegenerative disease?

Answer 26

Parkinson's disease

Question 27

In which disease do patients frequently fall asleep involuntarily?

Answer 27

Narcolepsy

Question 28

What is the presentation of narcolepsy?

Answer 28

Daytime sleepiness - impossible to resist Cataplexy - hypotonia in response to strong emotions Hallucinations - at sleep onset Sleep paralysis REM parasomnias

Question 29

What are the investigations for narcolepsy?

Answer 29

**Overnight polysomnography** - EEG strapped to head, sleep waves analysed ## Footnote **Multiple sleep latency test**

Question 30

How does a multiple sleep latency test work? What does it find in narcolepsy?

Answer 30

**Patient timed getting to sleep up to four times** **REM sleep occurs much faster than in normal people**

Question 31

Do narcolepsy patients lose consciousness during a cataplectic attack?

Answer 31

No so it's terrifying

Question 32

Narcolepsy is a hugely ____ disease.

Answer 32

disabling

Question 33

What is insomnia?

Answer 33

Inability to sleep

Question 34

What is psychophysiological insomnia?

Answer 34

Loss of association between bed and sleep