Consciousness and sleep

Question 1

What is consciousness?

Answer 1

A state of awareness of self and the environment

Question 2

What are the 3 states of unconsciousness?

Answer 2

• Coma / death - progresses from clouding, drowsiness
• Deep sleep
• Unconscious mind - Unrepressed memorise and emotions can be recalled

Question 3

What is clouding?

Answer 3

Stage of drowsiness with memory disturbances and disorientation. Impaired attention, concentration, recognition, comprehension, understanding and judgement

Question 4

What is drowsiness?

Answer 4

Tendency to drift into sleep without sensory stimulation. Have slow actions, slurred speech, reduced reflexes and muscle tone

Question 5

What defines a coma?

Answer 5

GCS - Reduced eye opening, motor and verbal responses

Question 6

What is normal perception?

Answer 6

Ability to distinguish between perceiving with sense organs and imaginary. It is quantifying objectivity to see if true and real.

Question 7

What is perception reliant on?

Answer 7

The relevance of the situation to emotions and actions. It is involuntary and independent to others’ experiences

Question 8

What is a sensory distortion?

Answer 8

Distortion of the intensity or quality of perception and its associated feelings

Question 9

What causes an illusion?

Answer 9

A misinterpreted perception of a sensory experience from how it was in reality.

Question 10

What types of illusions are there?

Answer 10

Complete = Fill in missing gaps
Affect = Misinterpretation due to emotional state
Pareidolic = misinterpreting an obscure stimulus as clear and recongnisable

Question 11

What is a hallucination?

Answer 11

The experience of percieving something that is not present. It is perception in the absence of a stimulus. It is spontaneous and out of the individuals control.

Question 12

What is a pseudohallucination?

Answer 12

An involuntary sensory experience that is a hallucination but recognised by the individual to not be real.

Question 13

What is the definition of sleep?

Answer 13

Not just the absence of waking but a regular reversible state of reduced responsiveness to external cues, that is easily reversed by meaningful stimuli.
Characterised by lack of mobility, closed eyes and reduced responses

Question 14

How can sleep be measured?

Answer 14

EEG, eye movements and muscle tone.
Polysomnography records levels of oxygen, HR, breathing, leg and eye movements and brain waves to diagnose sleep disorders

Question 15

What are the 5 stages of sleep?

Answer 15

Non-REM: Stage 1-4 (75% of sleep)
REM: (25% of sleep) Characterised by rapid eye movements and paralysis of muscles. Usually 4-6 cycles a night of 90 minutes. Stage of vivid dreaming.

Question 16

What determines sleep/wake cycles?

Answer 16

Suprachiasmatic nucleus controls sleep- wake cycles through circadian rhythm via neural and endocrine regulators. Uses clock genes and oscillations. Adenosine levels are high during waking.

Question 17

What mutation causes the loss of the circadian rhythm and what does it result in?

Answer 17

Mutation in Bmal 1 causes immediate loss of circadian rhythm when in constant darkness so light does not cause awaking.

Question 18

What is narcolepsy?

Answer 18

Sleep-wake dysregulation with reduced REM latency causing sudden entry into sleep during the day due to inability to regulate cycles.
Characteristed by cataplexy (sudden muscle weakness from strong emotions), sleep paralysis and sensory hallucinations

Question 19

What may cause sleep disruption?

Answer 19

Obstructive sleep apnoea
Depression
REM sleep behaviour disorder
Parasomia 
Restless leg syndrome
PD and MS

Question 20

What may cause a circadian misalignment?

Answer 20

Shift work
Time zone changes
Irregular sleep wake pattern

Question 21

What is parasomnia?

Answer 21

Occurs during stage 4 sleep causing sleep walking, abnormal movements, emotions and perceptions, night terrors whilst asleep and unaware of activity. Must prevent injury whilst in this stage

Question 22

What happens in REM sleep disorder?

Answer 22

There is presence of muscle tone during REM with active complex behaviours. Act out dramatic dreams. Onsets within 90 minutes of falling asleep. Can remember the dream but not the actions.

Question 23

What is restless leg syndrome?

Answer 23

A strong, irresistible urge to move legs due to an unpleasant feeling / Dysaethesia. Relieved by voluntary motor movement. The more movement is suppressed the more discomfort increases.

Question 24

What is the treatment for narcolepsy?

Answer 24

Modafil, antidepressants and sodium oxybate

Question 25

What is apnoea and the two types? How does it present?

Answer 25

Brief interruptions of breathing during sleep of upto 30 in one hour.
Central = control of respiration not initiated
Obstsructive = in airway
Causes arousal from deep sleep as oxygen falls and pCO2 rises.
Presents with hypertension, tiredness, irritability, poor concentration, obestity

Question 26

What are the treatments options available for OSA?

Answer 26

Hygiene
Positioning
Weight loss
modafil
CPAP
Surgery

Question 27

What is insomnia?

Answer 27

Inadequate or poor quality sleep that can include difficulty falling asleep, Waking frequently and difficulty returning, waking early and feeling unrefreshed.
Causes lack of energy and irritability.
Can be transient for <2wks, intermittent for 2-4wks or chronic

Question 28

What are the RF of insomnia?

Answer 28

Increased age
Hyperthyroidism
Female
Depression/anxiety
Chronic disease
Substances
Shift work
Exercise
Sleep
Iatrogenic

Question 29

What are the non-pharmacological treatments for insomnia?

Answer 29

Avoid exacerbating factors such as alcohol and caffeine and naps.
Sleep in a dark environment in a regular routine.
Recondition - Bed is only for sleep, get up and do something if not sleeping
Cognitive restructuring (not thinking about lack of sleep)
Relaxation therapy
Sleep restriction to increase drive

Question 30

What are the pharmacological treatments for insomnia?

Answer 30

Sedatives e.g. Benzodiazepine, temazepam

Question 31

What is the main worry of Pts with sleep deprivation?

Answer 31

Leads to errors, loss of attention and increased RTA.