Chapter 8 ( Sleep And Sleep Disorders )

Question 1

Characters of NREM ?

Answer 1

Slowing of EEG rhythm
Higher muscle tone
Absence of eye movements
Absence of thought like mental activity

Question 2

Characters of REM ?

Answer 2

Aroused EEG pattern
Sexual arousal
Saccadic eye movement
Dreaming

Question 3

Sleep waves associated with stage 1 ?

Answer 3

Theta waves

Question 4

Sleep waves associated with stage 2 ?

Answer 4

Sleep spindles

K complexes

Question 5

Sleep waves associated with stage 3 ?

Answer 5

Delta waves

Question 6

In REM sleep memories are consolidated by ?

Answer 6

Hippocampus

Question 7

Changes in sleep deprived people ?

Answer 7

1- cortisol level rises 
2- blood pressure rises 
3- glucose tolerance is reduced 
4- greater amygdala activation
5- lower prefrontal cortical activity 
6- increased negative mood

Question 8

Biochemical trigger for REM sleep ?

Answer 8

Ration of ACh and NE

Question 9

NE pathway which regulates REM sleep begins in ?

Answer 9

The pons

Question 10

Neurotransmitter that helps to initiate sleep ?

Answer 10

Serotonin

Question 11

Neurotransmitter higher during REM sleep and is associated with erections in males ?

Answer 11

ACh

Question 12

Neurotransmitte that is lower during REM sleep ?

Answer 12

NE

Question 13

Neurotransmitter that regulate arousal , wakefulness and appetite ?

Answer 13

Orexin ( hypocretin )

Question 14

Action of Melatonin ?

Answer 14

Regulates the sleep-wake cycle by inhibiting the circadian alerting system in the suprachiasmatic nucleus

Question 15

Melatonin production ?

Answer 15

Converted from serotonin in the Pineal gland under directions from the body’s internal circadian clock

Question 16

Ttt of seasonal affective disorder ?

Answer 16

By bright environmental light

Which capable of activation of photoreceptors in the retina , a process which suppress human melatonin production —> reverses the winter depressive symptoms of patients with SAD

Question 17

Benzodiazepines effect on sleep ? What will happen if used chronically then stopped

Answer 17

Limited decrease in REM and stage 4 sleep

Sleep latency will increase

Question 18

Moderate alcohol consumption effect on sleep ?

Answer 18

Early sleep onset

Increased wakefulness during the second half of the night

Question 19

Alcohol intoxication effect on sleep ?

Answer 19

Decreases REM

Question 20

Effect of withdrawal of alcohol or barbiturate on sleep ?

Answer 20

REM rebound ( with nightmares )

Question 21

Major depression effect on sleep ?

Answer 21

Increases REM
Decreases REM latency ( 45 mins rather than 90 mins )
Decreases stage 3 and 4 sleep
Early morning waling and multiple awakening during the night

Question 22

Narcolepsy mechanism ? Symptoms ? Ttt ?

Answer 22

Its a REM disorder in which the patient enter REM within 10 mins
Its linked to a deficiency in Hypocretin

1- sleep attacks and excessive day time sleepiness
2- Cataplexy
3- Hypnopompic and Hypnogogic hallucinations
4- sleep paralysis : inability to move or speak while falling asleep or waking up

Ttt : 
Modafilnil 
Psychostimulants  to treat sleepiness 
Antidepressants to treat cataplexy 
Gamma hydroxybutirate ( GHB ) to treat both cataplexy and day time sleepiness

Question 23

Clinical presentation of sleep apnea ?

Answer 23

High risk of sudden death during sleep
Development of severe nocturnal hypoxemia
Pulmonary and systemic hypertension
Nocturnal cardiac arrhythmias
Bradycardia then tachycardia
Dry mouth , headache , daytime restlessness , loud snoring

Question 24

Ttt of insomnia ?

Answer 24

Sleep hygiene
Behavioral modification : stimulus control
Zaleplon , Zolpidem , Eszopiclone
Ramelteon ( melatonin receptor agonist )

Question 25

Night terror occurs in which sleep stage ? Presentation ? Ttt ?

Answer 25

3

Common in young boys
Familial
Wake up in middle of night and scream

Benzodiazepines

Question 26

Nightmares occurs in which sleep stage ? Presentation ? Ttt ?

Answer 26

REM

Common during stressful times
With memory for the event

Antidepressants

Question 27

Somnambulism occurs in which sleep stage ? Presentation ? Ttt ?

Answer 27

3

Confused and disoriented if awakened
Common in children
May harm themselves

Benzodiazepines

Question 28

Bruxism occurs in which sleep stage ? Presentation ? Ttt ?

Answer 28

2

Stress related

Teeth guards

Question 29

Enuresis occurs in which sleep stage ? Presentation ? Ttt ?

Answer 29

3

In boys twice as girls
With often history with same sex parent

Check for life stressors
Desmopressin : safer for long term ttt
Imipramine
Bell pad technique