7. Sleep Disorders

Question 1

Why is sleep important?

Answer 1

• sleep deprivation can be fatal
• lack of sleep or too much sleep can lead to comorbidities
• flushes out toxins

Question 2

Causes of sleeplessness include:

Answer 2

• caffeine (coffee/tea, soft drinks)
• alcohol
• medication
• stress
• noise/ distracting surroundings
• phones, TVs, technology

Question 3

T/F everybody needs the same amount of sleep

Answer 3

FALSE. The required amount of sleep varies with age. Typically, more sleep is needed when younger.

Question 4

Stage 1 (sleep cycle)

Answer 4

• drowsiness, light sleep
• slow eye movement
• sawtooth pattern
• alpha waves

Question 5

Stage 2 (sleep cycle)

Answer 5

• asleep
• slow eye movement
• body temperature decreases and HR begins to slow
• first stage of NREM
• sleep spindles and K complexes
• theta waves

Question 6

Stage 3 and 4 (sleep cycle)

Answer 6

• deepest sleep
• difficult to wake
• most restorative stage of sleep
• mostly slow waves
• delta waves
• NREM

Question 7

REM (sleep cycle)

Answer 7

• paradoxical sleep
• dreaming
• body effectively paralyzed, muscle atonia
• rapid eye movement

Question 8

Common consequences of lack of sleep:

Answer 8

• decreases productivity
• comorbidities
• might need stimulants like caffeine to stay awake
• difficult to function (i.e. driving sleep deprived is just as dangerous as driving intoxicated)

Question 9

Consequences of lack of sleep on the GI system & causes

Answer 9

• peptic ulcers, constipation, diarrhea

- eating at unusual times, poor diet, increased consumption of caffeinated beverages and/or alcohol

Question 10

Consequences of lack of sleep on the cardiovascular system & causes

Answer 10

• myocardial infarction, heart failure, total and cardiovascular mortality
• change in hormone secretions regulating metabolism, change in sympathetic and parasympathetic cardiac regulation, increased tobacco use, reduced physical activity

Question 11

Consequences of lack of sleep on the endocrine system & causes

Answer 11

• diabetes, metabolic syndrome, increased cholesterol and triglycerides
• disruptions in hormone secretions involved in appetite regulation and glycemic control, poor diet, lack of exercise

Question 12

Consequences of lack of sleep on the reproductive system & causes

Answer 12

• decreased fertility, problems with pregnancy, menstrual irregularities
• disruption of hormone secretions, elevated stress, lack of needed nutrients in diet

Question 13

Consequences of lack of sleep on the neuro/psych system & causes

Answer 13

• impaired memory and/or cognition, anxiety, depression

- lack of exposure to sunlight, lack of social interaction, increased potential for alcohol use

Question 14

Consequences of lack of sleep in general:

Answer 14

• breast cancer, colorectal cancer, prostate cancer
• possible alterations in cancer-related pathways, changes in hormone production connected to specific cancers, immune system function impairment

Question 15

T/F: The glymphatic system is activated during sleep.

Answer 15

True

Question 16

What two tests did we discuss for studying sleep?

Answer 16

EEG-electroencephalogram

MSLT-multiple sleep latency test

Question 17

EEG

Answer 17

tracks and records brain wave patterns to find problems related to electrical activity of the brain

Question 18

MSLT

Answer 18

• sleep disorder diagnostic tool that usually takes a full day
• commonly used for to test for narcolepsy
• 5 schedules naps separated by breaks
• measures how long it takes to fall asleep, also includes light in testing (light on=awake, light off=time)
• based on the idea that you will fall asleep faster the more tired you are

Question 19

World view of sleep (map based on survey)

Answer 19

US: most likely to take a drug or use sleep aid
Brazil: least time between eating last meal and bedtime
UK: most impacted by SO sleep habits
France: larger bedroom
Germany: least distracted by TV/technology
S. Korea: most likely to sleep on floor, most stressed

Question 20

Sleep Quality World Comparison (Best and Worst)

Answer 20

Best: Switzerland
Worst: USA

Question 21

Nocturnal Sleep Problems by Gender in Africa and Asia (women)

Answer 21

highest: Bangladesh
lowest: Indonesia

Question 22

Nocturnal Sleep Problems by Gender in Africa and Asia (men)

Answer 22

highest: Vietnam
lowest: Kenya and Indonesia (tie)

Question 23

What are the sleep/wake disorders?

Answer 23

Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing-related sleep Disorder
Circadian Rhythm Sleep-Wake Disorder
Non-REM Sleep Arousal Disorders
Nightmare Disorder
REM Sleep Behavior Disorder
Restless Leg Syndrome
Substance/Medication-Induced Sleep Disorder

Question 24

Insomnia Disorder is characterized by complaint of dissatisfaction w/ sleep quality plus one or more of:

Answer 24

• difficulty initiating sleep
• difficulty maintaining sleep
• early morning awakening w/ inability to return to sleep
• Remember 3x3 criteria

Question 25

_____ _____ causes clinically significant distress or impairment in social, educational, academic, behavioral, or other important areas of functioning.

Answer 25

Sleep disturbance

Question 26

T/F time is important for an insomnia diagnosis.

Answer 26

TRUE. Remember the 3x3 criteria.

Question 27

3x3 criteria

Answer 27

-must occur for at least 3 nights per week and be present for at least 3 months

Question 28

Sleep disturbance from insomnia:

Answer 28

- occurs despite adequate opportunity for sleep - is not better explained by another sleep disorder - not attributable to the psychological effects of substance abuse

Question 29

Hypersomnolence Disorder

Answer 29

excessive sleepiness after 7+ hrs of sleep w/ 1 of : - 9+ hrs nonrestorative sleep - recurrent sleep periods or lapses into sleep on the same day - trouble being fully awake after abrupt awakening

Question 30

Restless Leg Syndrome (symptoms)

Answer 30

- sharp pulling, tingling, drawing, bubbling pain beneath the skin in calf area - irresistible urge to move legs - periodic involuntary limb movement - severe insomnia, anxiety, depression - lack of social activity

Question 31

Narcolepsy

Answer 31

- recurrent periods of an irrepressible need to sleep or napping occurring w/in the same day - 3x3 criteria

Question 32

Narcolepsy includes at least 1 of the 3 following:

Answer 32

- cataplexy - hypocretin deficiency - REM sleep latency = 15 minutes by nocturnal sleep PSG or MSLT = 8 minutes and 2+ onset REM periods

Question 33

Circadian Rhythm

Answer 33

- Approximately a 24-hour cycle, also known as the sleep/wake cycle that is modulated by sunlight and body temperature - works best with regular sleep

Question 34

SCN

Answer 34

- suprachiasmatic nucleus | - aka biological clock

Question 35

What is the impact of light on the circadian rhythm?

Answer 35

Light stimulates the hypothalamus to send "tired" signals that stimulate the release of melatonin from the pineal gland

Question 36

How is the "tired" signal transmitted?

Answer 36

1. Light/darkness is detected by the eye 2. Signal travels along eye-pineal neuron to SCN (suprachiasmatic nucleus) 3. Signal from SCN to PVN (paraventricular nucleus) 4. PVN to spinal cord 5. Spinal cord to SCG (superior cervical ganglion) 6. SCG to pineal gland where melatonin production is stimulated

Question 37

Circadian Rhythm Cycle

Answer 37

- not absolute, can fluctuate - biggest dips are usually early in the morning when most are sleeping (2-4 am) and lunchtime (1-3 pm) - ideally aligns with sunlight/nightfall

Question 38

Circadian Rhythm Disorders: Non-24 (blind)

Answer 38

- sleep times out of alignment, doesn't follow normal night sleep times - sleep shifts a little later each day - don't have 24-hour reset due to lack of light, wake up later and later - often don't sleep until morning (sun up)

Question 39

Circadian Rhythm Disorders: Shift work

Answer 39

- difficult to adjust to work schedule - only characterized as a disorder if unable to adjust after several weeks of working - typically sleepy at work, and alert when they have time to sleep (producing melatonin when working)

Question 40

Circadian Rhythm Disorders: Time Zone Change/Jet Lag

Answer 40

- difficulty adjusting after traveling across multiple time zones (@ least 2) - usually takes one day per time zone to adjust - Does it meet 3x3 criteria?