Lecture 10

Question 1

How to measure sleep stages

Answer 1

EEG
EOG
EMG

Question 2

Sleep stages

Answer 2

Stage 1, 2,3, 4 and REM

3 and 4 are slow wave

Question 3

PET scan during sleep stages

Answer 3

awake: little peaks
Stage 1: similar to awake
Stage 2: spindles and K-complex (big wave) 
Stage 3: big waves
REM: looks like awake

Question 4

PET: Brain activity during normal slow wave sleep

Answer 4

40% lower

Prefrontal, anterior cingulate, brainstem, basal ganglia

Question 5

Normal REM increases/decreases brain activity in:

Answer 5

Increases: amygdala, hippocampus, anterior, cingulate
Decreases: dorsolateral, PFC

Question 6

Diaganostic criteria of chronic insomnia

Answer 6

can’t fall asleep, can’t stay asleep OR wake up really early

• symptoms last 3+ months
• 3xs per week
• daytime consequences

Question 7

Effects of insomnia

Answer 7

• cognitive impairements
• physiological disturbances (weight gain, insulin dysregulation)
• cause mental problems
  meantal health problems can lead to insomnia
• insomnia back and forth relation with psychiatric problems (mood)

Question 8

Risk factors of insomnia and prevalence

Answer 8

Women 
Older age
Shift work
Mental health problems (40%) 
- 6% chronic insomina; 50% acute

Question 9

Hypersomnia

Answer 9

• excessive sleep (day)
• excessive sleepiness
• excessive time in bed**

Question 10

Effects if sleepines

Answer 10

negative effect performance equivalent to intoxication

Question 11

Sleep and Mood disorders

Answer 11

MDD:

- insomnia symptoms 60-84%

Question 12

Sleep disturbance as a core mechanism

Answer 12

Risk factor:

• first onset and recurrence
• precursor to both unipolar and bipolar depression

Common residual symptom:
- more common among formerly depressed (45% vs. 17%)

Contribution to relapse:
- sleep complains after remission in MDD

Question 13

Changes in sleep architecture

Answer 13

MDD:

• increases stage 1
• decreased slow-wave (3+4)
• Get to REM faster
• Higher density of eye movements during REM

Question 14

Consequences of altered REM

Answer 14

• affects memory
• affects processing of emotional info
• affects brain function

Question 15

is bad sleep a trait or state?

Answer 15

• symptom present during the diseases…was is there before the disease? or only when the disease is there?
• because you can’t really ask patients this; you look at healthy first degree relatives

Question 16

To study sleep disturbances as risk factor

Answer 16

• healthy never depressed 1st degree relatives of patients

- control for confounds like residual symptoms and meds

Question 17

Munich Vulnerability Study - EEG at baseline and 3.5 years; follow relatives

Answer 17

Results:

• increased REM density in relatives
• REM density stayed stable overtime
• 20 became depressed in 4 years
• REM density at baseline predicted depression

Question 18

Effects of antidepressant treatment on sleep

Answer 18

• one night of sleep deprivation IMPROVES depression in 40-60% of patients
• However, long term effects not promising
• Antidepressants tend to suppress REM sleep

Question 19

CBT for insomnia

Answer 19

aims to change dysfunctional beliefs and expectations about sleep

Question 20

Additional techniques in treating

Answer 20

psycho-education

- relaxation exercises

Question 21

STUDY: Meta-Analyses on CBT-i

Answer 21

Results:

• sleep onset latency improved
• wake after sleep onset improved
• total sleep time improved
• sleep efficiency improved
• changes seemed to be sustained at later time

Question 22

Summary of REM sleep and depression

Answer 22

• REM sleep is increased
• REM sleep starts earlier
• REM alterations go together with altered
  prefrontal activity
• REM sleep changes (esp. latency) also
  visible in healthy family members of
  patients