Chapter 8 ( Sleep And Sleep Disorders ) Flashcards

1
Q

Characters of NREM ?

A

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

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2
Q

Characters of REM ?

A

Aroused EEG pattern
Sexual arousal
Saccadic eye movement
Dreaming

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3
Q

Sleep waves associated with stage 1 ?

A

Theta waves

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4
Q

Sleep waves associated with stage 2 ?

A

Sleep spindles

K complexes

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5
Q

Sleep waves associated with stage 3 ?

A

Delta waves

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6
Q

In REM sleep memories are consolidated by ?

A

Hippocampus

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7
Q

Changes in sleep deprived people ?

A
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
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8
Q

Biochemical trigger for REM sleep ?

A

Ration of ACh and NE

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9
Q

NE pathway which regulates REM sleep begins in ?

A

The pons

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10
Q

Neurotransmitter that helps to initiate sleep ?

A

Serotonin

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11
Q

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

A

ACh

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12
Q

Neurotransmitte that is lower during REM sleep ?

A

NE

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13
Q

Neurotransmitter that regulate arousal , wakefulness and appetite ?

A

Orexin ( hypocretin )

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14
Q

Action of Melatonin ?

A

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

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15
Q

Melatonin production ?

A

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

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16
Q

Ttt of seasonal affective disorder ?

A

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

17
Q

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

A

Limited decrease in REM and stage 4 sleep

Sleep latency will increase

18
Q

Moderate alcohol consumption effect on sleep ?

A

Early sleep onset

Increased wakefulness during the second half of the night

19
Q

Alcohol intoxication effect on sleep ?

A

Decreases REM

20
Q

Effect of withdrawal of alcohol or barbiturate on sleep ?

A

REM rebound ( with nightmares )

21
Q

Major depression effect on sleep ?

A

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

22
Q

Narcolepsy mechanism ? Symptoms ? Ttt ?

A

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
23
Q

Clinical presentation of sleep apnea ?

A

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

24
Q

Ttt of insomnia ?

A

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

25
Q

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

A

3

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

Benzodiazepines

26
Q

Nightmares occurs in which sleep stage ? Presentation ? Ttt ?

A

REM

Common during stressful times
With memory for the event

Antidepressants

27
Q

Somnambulism occurs in which sleep stage ? Presentation ? Ttt ?

A

3

Confused and disoriented if awakened
Common in children
May harm themselves

Benzodiazepines

28
Q

Bruxism occurs in which sleep stage ? Presentation ? Ttt ?

A

2

Stress related

Teeth guards

29
Q

Enuresis occurs in which sleep stage ? Presentation ? Ttt ?

A

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