[8.42/43] Sleep

Question 1

Describe sleep

Answer 1

naturally periodically recurring state of inactivity, characterised by a loss of consciousness and a lack of response to external stimuli

Question 2

What does inadequate sleep result in?

Answer 2

Reduction of:
- performance
- concentration
- reaction time
- consolidation of information learning

Increase in:
- memory lapses
- accidents and injuries
- behaviour / mood problems

Question 3

Describe ECGs in sleep

(this is like not rly impt lol)

Answer 3

lower frequencies of ECG; linked to EEG in slow-wave sleep
- heart beat acting as a neural stimulus which evokes a down-state (slow oscillation of ECG evoked potential) - generally weaker and noisier

Question 4

split into organ (3) + physiological (4)

Parameters of polysomnography and their use?

Answer 4

sleep study tool;
organ functions:
- EMG (electromyogram) - muscle activity
- EEG (electroencephalogram) - brain activity
- EOG (electrooculogram) - eye movement (distinguishes REM and NREM sleep)

physiological functions:
- breathing monitoring
- video and sound monitoring
- BP
- temperature

Question 5

gashnod

Which NTs are involved in wakefulness?

Answer 5

• Glutamate
• Ach
• Serotonin
• Histamine
• NA
• Orexins
• Dopamine

Question 6

3

Which NTs are involved in sleep?

Answer 6

• Gaba
• Adenosine (acting as an inhibitor)
• Melatonin

Question 7

what happens to thalamic relay during sleep?

Answer 7

thalamo-cortico-thalamic circuit:
during sleep: blocked response: receives signal from external stimuli but thalamus to cortex is blocked

Question 8

Characteristics of REM sleep

Answer 8

• muscle atonia
• rapid ocular movement (EOG desynchronisation)

Question 9

describe narcolepsy + its side effects

Answer 9

tendency to fall asleep inappropriately during the daytime, despite having sufficient sleep

s/e:
- cataplexy (sudden brief spells of muscle weakness eg. eyes sagging, head drooping, knees buckling)
- hypnogogic/hypnopompic hallucinations (upon falling asleep or waking)
- sleep paralysis
- disrupted night-time sleeping (insomnia)

Question 10

what is insomnia?
what are the types of insomnia (3) and what are they classified based on?

Answer 10

inability to initiate, maintain sufficient/proper sleep or waking up too early

types:
1. transient (<4 weeks triggered by excitement or stress)
2. short-term (4 weeks - 6 months)
3. chronic (>6 months)

Question 11

Treatments: Insomnia

Answer 11

• benzodiazepines
• Z drugs (zolpidem; zaleplon)
• antidepressants
• melatonin therapy
• CBT

Question 12

Describe hypnopompic / hypnagogic hallucination

Answer 12

• hypnagogia –> from waking to sleep
• hypnopompic –> from dreaming to waking
• experiencing narrative or frightening dreams + auditory hallucinations

Question 13

Treatments: Narcolepsy

Answer 13

• amphetamine derivatives
• antidepressants
• benzodiazepines
• modafinil (CNS stimulant)

Question 14

what are parasomnias?

Answer 14

unpleasant / undesirable behavioural phenomena which occur during sleep
- including nightmares,
- night terrors,
- sleep walking
- confusional arousals

Question 15

causes of night terrors

Answer 15

• genetic factors
• sleep breathing disorder
• acute triggers: alcohol, drugs, PTSD

Question 16

Treatments: parasomnias

Answer 16

• TCAs (eg. imipramine)
• benzodiazepines (eg. diazepam)

Question 17

types of parasomnias

incl age-range, causes of each, degree of severity

Answer 17

• REM sleep (arousal): REM sleep behaviour disorder (RBD) - lack of somatic muscle atonia, permitting acting out of dream mentation, often with violent or injurious results
• non-REM sleep (partial arousal): common in childhood (sleepwalking), decrease in freq with increasing age; occurs during first third of sleep cycle
• night terrors: partial waking from sleep with episodes of intense screaming, crying, thrashing or fear
• sleepwalking
• sleep terrors (usually no medication for these but some antidepressants benzodiazepines if these episodes lead to risky effects)

Question 18

okay there’s alot so just a few can alr

causes of insomnia?

Answer 18

depression, restless leg syndrome, hyperthyroidism, arthritis, chronic pain benign prostatic hypertrophy, headaches, periodic leg movement, sleep breathing disorder, bruxism, cramps

caffeine, nicotine, alcohol, exercise, noise, light, hunger

Question 19

describe melatonin therapy (and what for)

Answer 19

what: neuro-hormone produced by the pineal gland
for?: therapy for sleep-phase onset delay (insomnia, s/e of narcolepsy)
how take: 30mins before bedtime

Question 20

describe CBT

Answer 20

• aim of changing a person’s beliefs and attitudes about insomnia
• combined w behavioural intervention (eg stimulus control, sleep restriction, relaxation training)