Lecture 5

Question 1

Sleep cycles

Answer 1

Each cycle lasts approximately 90 minutes

Alternates between REM and NREM (SWS)

SWS predominates first half of the night (slow wave sleep)

REM predominates second half

Question 2

Daylight savings

Answer 2

Even a small change in sleep can cause problems

In the days immediately following daylight savings time (spring forward) there has been:
* 24% increase in myocardial infarction
* 6% increase in traffic accidents
* Increased mood disturbances and suicide
* Volatility in the stock markets (Attributed to impact of sleep deprivation on frontal lobe functioning…)

American Academy of Sleep Medicine: these seasonal
time changes should be abolished in favor of a fixed, national, year-round standard time.

Question 3

Effects of Sleep Deprivation

Answer 3

• Extensive sleep deprivation is fatal in rats
• Death! (see next slide)
• One potential etiology: Sleep destroys free radicals and prevents their damaging effects

Question 4

Fatal Familial Insomnia

Answer 4

Inherited neurological disorder

progressive insomnia

Causes:
* Results in damage to portions of thalamus
* Death after 12 months

Question 5

Adenosine (inhibitory)

Answer 5

Inhibitory response

Steps:
1) Astrocytes store glycogen for “emergency energy,” break down into glucose to give to neurons
2) By product of that is adenosine,
3) Accumulation of adenosine triggers DELTA sleep
4) throughout day body naturally accumulates adenosine, which helps us feel sleepy at night
5) during the night, body recycles adenosine

Sleep Deprivation = ↓ Glycogen Stores & ↑ Adenosine = SLEEPINESS

Question 6

What does sleep deprivation due to your glycogen stores and adenosine levels

Answer 6

Sleep Deprivation = ↓ Glycogen Stores & ↑ Adenosine = SLEEPINESS

Question 7

Caffeine and Adenosine

Answer 7

Caffeine blocks adenosine receptors = ↓ Sleepiness BUT ↑ fatigue.

it only reduces the feeling of sleepiness but your body is still sleepy

Question 8

Where is melatonin produced and when

Answer 8

Produced by the Pineal Gland in response to evening/darkness about 2 hours before normal sleep time

Question 9

_____ is converted into melatonin

Answer 9

Serotonin

Question 10

Exogenous melatonin

Answer 10

Exogenous melatonin = take 1-2mg 30 to 1 hr before bedtime (higher just pee it out)

Doesn’t keep you asleep, just puts you to sleep

Question 11

Who should you not prescribe melatonin to?

Answer 11

older adults with dementia & those with dementia

Question 12

Sleep hormones

Answer 12

Acetylcholine: high when you are awake, low in SWS, and high in REM

Most go high to low

Question 13

Sleep trends in US: _____ less sleep than earlier generations

Answer 13

25

Question 14

Sleep trends in US: _____ americans in shift work

Answer 14

20

Question 15

Sleep trends in US: _____ adults report falling asleep during the day without meaning to at least once a
month

Answer 15

40

Question 16

Insomnia effects how many adults, and what gender

Answer 16

30% of adults

more common in women (40%) and men (30%)

Question 17

Primary and secondary insomnia

Answer 17

Primary insomnia = difficulty falling asleep after going to bed or after awakening during the night.

Secondary insomnia = inability to sleep due to another mental or physical condition (e.g., pain, medication)

Question 18

Insomnia disorder and medical conditions

Answer 18

Insomnia disorder has a high comorbidity rate with chronic medical conditions (20% to 80%)

Drug dependency insomnia—within 3 days of drinking (causes bad sleep)

Question 19

Rebound insomnia

Answer 19

Chronic use of sleep-promoting drugs can cause rebound insomnia

Question 20

Most effective treatment for Insomnia

Answer 20

CBTI most effective tx

drugs and CBTI=no advantage

Question 21

Narcolepsy: causes

Answer 21

Orexin-Related Neurological d/o
* missing >85% Orexin-Producing Neurons
* REM-related symptoms occur inappropriately
* Hereditary component

Orexin: high during alert/awake

Question 22

Narcolepsy: cataplexy

Answer 22

sudden muscle weakness/paralysis

• Triggered by strong emotional reaction or physical exertion
• Remain fully conscious.
• Loss of muscle control d/t massive inhibition of motor neurons in spinal cord

Question 23

Narcolepsy: Sleep paralysis

Answer 23

inability to move before onset of sleep or waking

hypnagogic Hallucinations (visual)

Question 24

Narcolepsy: Sleep attacks

Answer 24

overwhelming urge to sleep
* Triggered under boring & monotonous conditions
* Lasts 2-5 mins
* Wake up refreshed.

Most people have sleep attacks (overwhelming urge to sleep during something boring) -> but people with narcolepsy just fall asleep

Question 25

Narcolepsy treatment

Answer 25

Modafinil, SSRIs

Question 26

REM Sleep Behavior D/O

Answer 26

Lack of muscle paralysis during REM –> acting out of dreams

Can be comorbid narcolepsy (Drugs that are used to treat the symptoms of cataplexy will worsen the
symptoms of REM sleep behavior disorder)

later in life (if you are young, caused because of medication or leisures)

Neurodegenerative (common to develop parkinsons or Dementia with lewy body)

Question 27

REM Sleep Behavior D/O: Treatment

Answer 27

Treatment = Clonazepam

Question 28

Sleep Apnea

Answer 28

Difficulties sleeping and breathing at the same time ↑CO2 = stimulates chemoreceptors –> wake up gasping for air & decreased slow wave activity

Question 29

Untreated Sleep Apnea

Answer 29

Significant deficits in attention, memory, & exec fxns.

Increase risk of Stroke, MI

In kids 2.5x risk of behavioral problems

Question 30

Sleep Apnea: Treatment

Answer 30

CPAP, BiPAP
* Can reverse cognitive deficits with treatment

Question 31

Types of sleep apnea

Answer 31

Obstructive Sleep Apnea = d/t narrowing of airway (obesity, enlarged tonsils, hormonal changes)

Central Sleep Apnea = brain does not signal need to breath.