8-22 SLEEP

Question 1

Sleep is the ____state between _____and _____

Answer 1

Sleep is the INTERMITTENT state between WAKEFULNESS and DEATH

Question 2

List and describe the 3 states of Being

Answer 2

1. Wake
2. NREM sleep=Active body/physical restoration/Stages N1, N2, N3
3. REM sleep=Active Brain/Mental Restoration

Question 3

1) All species have _____ sleep in EARLY LIFE that will ___[INC/DEC] with age
2) All mammals have _____sleep

Answer 3

1) All SpeCies have REM Sleep in early life but this DEC as general species age
2) All MAMMALS have NREM/REM Sleep

Question 4

Sleep depends on ____, _____, ______ and _______

Answer 4

Human Sleep depends on AGE, DRUGS/DISORDERS, COURSE OF WAKE/SLEEP CYCLE AND COURSE OF NREM/REM

Question 5

What is the NREM:REM sleep ratio FOR INFANTS?

Answer 5

Infants NREM:REM= 50%NREM: 50%REM

Question 6

What is the NREM:REM sleep ratio FOR ADULTSSS?

Answer 6

ADULTS NREM:REM= 75-80%NREM : 20-25%REM

“WE SPEND MORE TIME IN PHYSICAL/BODY RESTORATION DURING SLEEP!”

Question 7

NREM sleep occurs mostly in the ___half of sleep and is linked to ________

Answer 7

NREM sleep occurs mostly in the FIRST half of sleep and is linked to PRIOR LEVEL OF WAKEFULLNESS

Question 8

REM sleep occurs mostly in the ____half of sleep and is linked ______

Answer 8

REM sleep occurs mostly in the SECOND half of sleep and is linked to CIRCADIAN RHYTHM

Question 9

What happens to a Childs sleeping patterns as it grows up?

Answer 9

Children sleeping[wake/sleep pattern] gradually becomes RESTRICTED TO THE NIGHT as they get older

Question 10

Describe Normal Sleep in Children [2]

Answer 10

• No Sleep Onset REM Periods (SOREMs) until 3 mo. old

* NREM stages 3-6 months

Question 11

Describe Normal Sleep in ADULTS [2]

Answer 11

1) Adult sleep is entered through NREM stage first

2) REM cycles every 90-120 minutes

Question 12

Circadian Rhythm

2)Physiologically where does this come from?

Answer 12

Intrinsically NATURAL RHYTHMS of sleep even w/out environmental cues like the sun. Not exactly but approximately a 24 hour rhythm
2)Comes from the circadian pacemaker in the hypothalamus’ suprachiasmatic nuclei(biological clock)

Question 13

Entrainment [2]

Answer 13

Stimuli (Zeitgebers) signal the time of day and can shift circadian clocks systemically–> enables Circadian Rhythms to synchronize w/ the environment.
2)Can be either photic or non-photi

Question 14

In the two-process model of sleep Process S=______ and Process C = ______

Answer 14

Process S= homeoStatic INC in sleep pressure w/INC time awake
**Process C=Circadian nadir occurring early in the morning

Question 15

What is the Sleep debt “payback” ratio?

Answer 15

For ever 2.5 hours you miss in sleep(debt) you will have to payback 1 hour to make up for it! 2.5:1 ratio

Question 16

What are some Known effects of Sleep Deprivation

Answer 16

• INC car crashes
• Major industrial accidents (cheronobyl, 3 mile island)
• INC risk of blood-borne pathogen exposure accidents in EM residents (sticking self with needle)

Question 17

Describe the Epworth Sleepiness Scale

Answer 17

0=no chance of dozing off
1= Slight chance of dozing off
2= Moderate chance of dozing
3=HIGH chance of dozing off

Question 18

What are the 4 Diagnostic Test used for sleep?

Answer 18

1. PSG!/Polysomnography :Scoring & Staging(EEG, EMG, Airflow, Respiratory Effect, EKG)(3 stages Wake vs. NREM vs. REM)
2. Multiple Sleep Latency Test [MSLT]
3. Maintenance of Wakefulness Test
4. Actigraphy

Question 19

Describe the Multiple Sleep Latency Test

Answer 19

Used to Diagnose sleep disorder=preceded by an all-night in lab PSG the well-cntrolled MSLT uses (5) 20-min naps to test tendency of falling asleep during usual wake hours (i.e. Narcolepsy)

Question 20

What are the Parameters measured in MSLT?

Answer 20

MSLT (multiple sleep latency test) measures

1. average latency[eyes close but not sleep] to sleep onset
2. Appearance of REM sleep

Question 21

What are the NORMS for sleep latency: [4]

Answer 21

latency: Lying in bed w/eyes closed but not yet sleep
* 0-5 min of latency=severe hypersomnia=narcoleptic=pt goes to sleep VERY FAST

• 5-10 min of latency=borderline narcoleptic
• 10-20 min latency=NORMAL :-)

*2 or more naps with REM periods=Abnormal

Question 22

Describe the “Maintenance of Wakefulness Test”

Answer 22

Will test pt ability to STAY AWAKE–> by requiring them to sit up in dimly lit room and stay awake for 40 minutes. Repeats this 4 times throughout the day.

Question 23

Describe Actigraphy

Answer 23

Minimally invasive cheap at-home method, worn as a watch and used to capture all types of sleep score information that can be interpreted later!

Question 24

1) Psychological Insomnia

2) Treatment?

Answer 24

PI=Present for at least 1 month and described as heightened arousal in bed and/or evidenced sleep difficulty
2)TRMNT: Cognitive Stimulus control, Sleep restriction, Rx

Question 25

1) Obstructive Sleep Apnea! [6]
2) How do you diagnose this?
3) What is treatment for OSA?

Answer 25

1)Obstctive= narrowing/occlusion of upper airway during sleep–>Loud snoring, morning sore throat/HA, Elevated BMI, crowded oropharynx and HTN

2) Dx with PSG/POLYSOMNOGRAPHY
3) TRMNT OSAS: Oral Appliance mouthpiece (moderate severity) or CPAP (SEVERE OSA) while sleep

Question 26

1)Restless Legs Syndrome

Answer 26

1)Pt has Restless Legs if they have the U-R-G-E!!
U=unpleasant limb sensations w/urge to Move
R=Rest helps alleviate Sx
G=getting up/mvmnt helps alleviate Sx
E=Evening or Night exacerbates Sx

Question 27

1) Narcolepsy
2) When does this typically onset?
3) What is Secondary Narcolepsy?
4) What are the MSLT findings for Narcolepsy? [2]

Answer 27

1) Sleepiness and sx caused by abnormal regulation of REM/2nd half sleep
2) Narcolepsy onsets during adolescence usually
3) Sec Narc= Head trauma (stroke, MS, CNS infection) causes sx similar to regular Narcolepsy

4)MSLT=Sleep latency is 0-5 min
AND
pt has 2 or more REM periods in 5 out of 20 naps

Question 28

Parasomnias

Answer 28

• Disorders that disrupt sleep but don’t originate from problems w/the wake-and-sleep state itself.
• Are PHYSICAL EVENTS OR EXPERIENCES(movements, dreams, behaviors, perceptions) that INTERRUPTS sleep

Question 29

Sleepwalking!

Answer 29

Complex Automatic motor activity during deep sleep associated w/amnesia of the event!

Question 30

1) Sleep Terrors :-(

2) What is this also known as…?

Answer 30

1) MOST COMMON IN MALE KIDS-involves sudden extreme autonomic arousal from deep sleep w/terror &confusion on wake
2) Sleep Terrors are AKA “Pavor nocturnus”

Question 31

REM Sleep Behavior Disorders are characterized by what…

Answer 31

Dream enactment behavior w/loss of muscle control in REM
1-Verbalizations/Singing
2-Violent/agitated bed behavior {hitting partner}
3-Walking/running

Question 32

Sleep-Related Eating Disorder [4]

Answer 32

Prepares food and sometimes non-edible objects to eat w/amnesia of the event

2) subcategory of sleep walking
3) MORE COMMON IN WOMEN
4) Arises from NREM(SWS) sleep