20 Sleep respiration

Question 0

Sleep architecture

Answer 0

Usually 2 cycles to stage 4, then 1 to stage 3, then a few stage 2

Question 1

Sleep waveforms

Answer 1

Stage 1- relatively disordered- some theta waves (2-8%)
Stage 2- sleep spindles(quick oscillation) and K complexes (large waves) (45-55%)
Stage 3,4- Synchronus wave pattern (13-23%)
REM- Disorganized with areas of saw tooth waves (20-25%)

Question 2

Sleep control

Answer 2

Process H/S- buildup of need for sleep

Process C- Alertness signaling that increases until sleep (circadian)

Question 3

Circadian clock

Answer 3

Located in SCN

Reset with photoperiod

Question 4

Sleep promoting factors

Answer 4

Cytokines (flu)
Prostaglandin D2
Adenosine
Serotonin
ACH

Question 5

Wake promoting factors

Answer 5

Epi
NE
Histamine
Serotonin

Question 6

NREM vs. REM sleep CNS activation and blood flow

Answer 6

NREM

• Low discharge rate
• Glucose utilization decreased

Rem

• Increase in mean discharge of neurons
• Glucose utilization increased- resembles waking
• cerebral blood flow increased

Question 7

REM vs. NREM somatic activity

Answer 7

NREM-
- repositioning and light motor events

REM

• Paralysis (postsynaptic inhibition through hyperpolarization)
• Phasic eye movements and muscle twitches

Question 8

Brreathing in sleep

Answer 8

• Periodic breathing in stages 1 and 2
• Regular breathing stage 3-4
• REM Irregular breathing - paradoxical

Question 9

Additional sleep tidbits

Answer 9

GH increases 90 inutes after sleep onset- slp. deprav. dec. GH
Parathyroid increased during sleep
ACTH deccreases n sleep onset (dec cortisol) increases before wakening.
BODY TEMP- set point lower with NREM, and unregulated in REM

Question 10

Sleep diaries

Answer 10

Make a patient do one of these before bringing them into the lab

Record sleep times
naps
waking
work
etc.

Question 11

Actinography

Answer 11

Movement sensor (though not reliable in insomnia as patients tend to lie very quietly

Question 12

Multiple sleep latency test

Answer 12

• 20 minute opportunities to nap every two hours (5 sessions)
• measure time from lights out to sleep
• Pathological sleep is less than 8 min (normal >10)
• More than one REM is abnormal

Question 13

Obstructive sleep apnea affect on heart and BP

Answer 13

• Obstruction causes negative intrathoracic pressure- overfill RV, underfill LV (CO can drop by as much as 25%)
• Decreased CO increases sympathetic tone, and spikes BP after opening of airways

Question 14

Cheyne Stokes respiration

Answer 14

Apnea followed by crescendo-decrescendo effort and breathing

• blunted pCO2 response secondary to low perfusion
• increased response of lung receptors causes overshoot and hypercapnea

Treat heart failure regamin and then CPAP- CPAP decreases lung overshoot and helps remiss the cheyne stokes

Question 15

Sleep latency

Answer 15

10-12 Normal
Below 8 - resident or Sleep apnea
below 6- idiopathic hypersomnia
below 4- narcolepsy

Question 16

Narcolepsy

Answer 16

Environmental and Genetic
Maybe trauma, antigen binding, sleep depravation
*Hypocretin cell loss
Basically screws up hypothalamic sleep control ( cant stay away or stay asleep)
*REM intrusion into wakefulness- paralysis/cataplexy and dreaming while awake

Question 17

Periodic movement disorder

Answer 17

Withdraw reflex overactive- hyperactive limb movements causing sleep disturbances.

• RLS
• Neuropathy
• Medications/ withdrawl

Question 18

Non 24 hour sleep disorder

Answer 18

• Retnally blind at risk

* treat with melatonin

Question 19

REM behavior disorder

Answer 19

No paralysis in REM sleep

Question 20

Night terror

Answer 20

Abnormal arousal from slow wave sleep- related to sleep walking

• Only partially awake
• little or no dream recall
• frequently goes back to sleep
• racing heart, thrashing, screaming.

Question 21

NREM parasomnias

Answer 21

Sleep walking
Sleep talking
Sleep eating
Confusional arousal
Night terrors

Question 22

REM

Answer 22

Nightmares
Sleep paralyss
REM behavior disorder