Lecture 10 Flashcards
How to measure sleep stages
EEG
EOG
EMG
Sleep stages
Stage 1, 2,3, 4 and REM
3 and 4 are slow wave
PET scan during sleep stages
awake: little peaks Stage 1: similar to awake Stage 2: spindles and K-complex (big wave) Stage 3: big waves REM: looks like awake
PET: Brain activity during normal slow wave sleep
40% lower
Prefrontal, anterior cingulate, brainstem, basal ganglia
Normal REM increases/decreases brain activity in:
Increases: amygdala, hippocampus, anterior, cingulate
Decreases: dorsolateral, PFC
Diaganostic criteria of chronic insomnia
can’t fall asleep, can’t stay asleep OR wake up really early
- symptoms last 3+ months
- 3xs per week
- daytime consequences
Effects of insomnia
- 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)
Risk factors of insomnia and prevalence
Women Older age Shift work Mental health problems (40%) - 6% chronic insomina; 50% acute
Hypersomnia
- excessive sleep (day)
- excessive sleepiness
- excessive time in bed**
Effects if sleepines
negative effect performance equivalent to intoxication
Sleep and Mood disorders
MDD:
- insomnia symptoms 60-84%
Sleep disturbance as a core mechanism
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
Changes in sleep architecture
MDD:
- increases stage 1
- decreased slow-wave (3+4)
- Get to REM faster
- Higher density of eye movements during REM
Consequences of altered REM
- affects memory
- affects processing of emotional info
- affects brain function
is bad sleep a trait or state?
- 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
To study sleep disturbances as risk factor
- healthy never depressed 1st degree relatives of patients
- control for confounds like residual symptoms and meds
Munich Vulnerability Study - EEG at baseline and 3.5 years; follow relatives
Results:
- increased REM density in relatives
- REM density stayed stable overtime
- 20 became depressed in 4 years
- REM density at baseline predicted depression
Effects of antidepressant treatment on sleep
- one night of sleep deprivation IMPROVES depression in 40-60% of patients
- However, long term effects not promising
- Antidepressants tend to suppress REM sleep
CBT for insomnia
aims to change dysfunctional beliefs and expectations about sleep
Additional techniques in treating
psycho-education
- relaxation exercises
STUDY: Meta-Analyses on CBT-i
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
Summary of REM sleep and depression
- 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
