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PSY4408 > Module 1: Sleep and Mental Health > Flashcards

Module 1: Sleep and Mental Health Flashcards

1
Q

How much of our lives are spent asleep?

A

1/3

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2
Q

What is amplitude and frequency?

A

amplitude (height) and frequency (distance between waves) of the electrical signals being emitted by the brain on EEG

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3
Q

What are the 2 sleep states?

A

rapid eye movement (REM) and non–REM (NREM)

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4
Q

Stage 1 Sleep

A

o lightest stage.
o usually closely intertwined with wakefulness.
o thought of as being very drowsy rather than asleep
o dominated by theta waves- low amplitude and low frequency EEG signal.

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5
Q

What are the dominate waves in stage 1 sleep?

A

theta waves- low amplitude and low frequency EEG signal.

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6
Q

Stage 2 Sleep

A

o indicator that an individual has in fact commenced a sleep episode
o characterised by a higher frequency signal on EEG, but with the same low amplitude seen in stage 1.
o The onset of stage 2 sleep is generally identified by the observation of sleep spindles and K-complexes which are only in this stage

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7
Q

What stages of sleep are sleep spindles and K-complexes seen in?

A

Stage 2 sleep

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8
Q

Stage 3 and 4 sleep

A

o Usually grouped together and called slow wave sleep
o possess subtle differences but it is not necessarily clinically informative to segregate them
o characterised by very low frequency and high amplitude on an EEG signal.
o Is our ‘restorative’ sleep and component of sleep resulting in reduction of ‘sleep debt’.

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9
Q

What are the dominate waves in slow wave sleep?

A

very low frequency and high amplitude

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10
Q

What stage of sleep is our ‘restorative sleep’

A

Slow wave sleep (stages 3 and 4)

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11
Q

REM Sleep

A

o Where dreams typically occur
o the brain paralyses skeletal muscles to prevent acting out dreams
o In addition to an EEG trace (i.e., signals being emitted by the brain), REM is identified by examining the signals being emitted by the eyes (with electrooculography; EOG), as well as the electrical activity of the muscle tissue (with electromyography, EMG).
o Due to the paralysis of the skeletal muscles:
 an EMG signal will fall flat during REM,
 while the signal from both eyes will be sharp, synchronised movements.
o EEG traces during REM tend to closely resemble wakefulness, and as such, the EMG and EOG signals are required to distinguish between these two states.

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12
Q

How is REM Measured?

A

EEG, EOG and EMG

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13
Q

When do REM episodes typically occur?

A

REM episodes tend to be relatively short in the earlier part of the night, becoming longer toward the morning or end of the sleep episode.

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14
Q

How many sleep cycles do most people go through per night?

A

3-5

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15
Q

How long are REM stages?

A

The first episode of REM occurs about 80 to 100 minutes later.
Thereafter, NREM sleep and REM sleep cycle with a period of about 90 minutes

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16
Q

What stage do newborns start their sleep cycle in?

A

REM (called active sleep for newborns) then go into NREM (called quiet sleep)

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17
Q

How long is a newborns sleep cycle?

A

about 50 minutes

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18
Q

What percentage of sleep is REM sleep?

A

20-25%

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19
Q

How is sleep onset measured?

A

EMG, EOG and EEG - it is hard to accept a single variable as marking sleep onset

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20
Q

What are some Behavioral Concomitants of Sleep Onset ?

A
  • Don’t tend to smell the deeper you go to sleep
  • Reaction times get slower
  • More likely to hear meaningful stimuli (our names) compared to unmeaningful (someone else’s name)
  • If you awaken and query someone shortly after the stage 1 sleep EEG pattern appears, the person usually reports the mental experience as one of losing a direct train of thought and of experiencing vague and fragmentary imagery, usually visual.
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21
Q

What is hypnic myoclonia?

A

o is experienced as a general or localized muscle contraction (movement or jerk) very often associated with rather vivid visual imagery.
o they tend to occur more commonly in association with stress or with unusual or irregular sleep schedules.
o According to one hypothesis, the onset of sleep in these instances is marked by a dissociation of REM sleep components, wherein a breakthrough of the imagery component of REM sleep (hypnagogic hallucination) occurs in the absence of the REM motor inhibitory component.

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22
Q

How does age affect sleep stage distribution?

A

o biggest changes are found in newborns
o Slow wave sleep (SWS) is maximal in young children and decreases markedly with age.
o marked quantitative change in SWS occurs across adolescence, when SWS decreases by about 40% during the second decade, even when length of nocturnal sleep remains constant
o By age 60 years, SWS is quite diminished, particularly in men; women maintain SWS later into life than men.

23
Q

What is the two process model? What is process S and process C?

A
  • is the most widely accepted explanation of how sleep is regulated
  • These are known as process S, or the ‘sleep debt’ component, and process C, or, the ‘circadian’ or ‘clock’ component.
  • Throughout the day process S builds up while process C balances it. Process C spikes to keep us going until bed when it begins to reduce. PRocess S is reduced quickly in sleep so then C kicks in again to help us stay asleep.
24
Q

What is the Wake center?

A

core parts of the brain rather than in the cortex, which develop later, so it is located in the brain stem.

25
Q

What is the sleep center?

A

the area of the brain that essentially switches the wake state off, again, is in the interior hypothalamus. This is ventrolateral preoptic area. We call it the VLPO or the sleep switch.

26
Q

What is sleep regulated by?

A

2 different processes:
o homeostatic perspective (essentially drive to sleep)
o circadian timing system

27
Q

What is non-declarative memory?

A

o those unable to be recalled to conscious awareness (e.g. procedural memory - how to play tennis)
o consolidated in sleep not the passage of time

28
Q

What is declarative memory?

A

information that can be retrieved into conscious awareness, including memory for specific life events (episodic memory; e.g., eating dinner last night) and memory for facts and general knowledge (semantic memory; e.g., the capital of France).

29
Q

What are the costs of sleep disorders in Aust?

A

over $800 mill per year in healthcare costs per year, and $4.3 billion in indirect costs (e.g., lost productivity)

30
Q

Approximately how many Australians experience common sleep disorders?

A

9%

31
Q

What are the major sections of the ICSD3?

A 
insomnia,
sleep-related breathing disorders,
central disorders of hypersomnolence, 
circadian rhythm sleep-wake disorders, 
parasomnias, and
sleep- related movement disorders.
32
Q

What percent of population is impacted by insomnia?

A

Approx 3-6%

33
Q

What are the predisposing, precipitating, and perpetuating factors of insomnia?

A 
o	Predisposing factors: psych or biological characteristics (female, anxious, hyperarousal)
o	Precipitating factors: life events, medical, environmental (death, illness, stress, exams, medication)
o	Perpetuating (extending bed time, sleep in morning, napping, excessive worry about sleep)
34
Q

What are the two types of insomnia?

A

o Onset insomnia - specifically manifests at the point of sleep initiation. Once asleep they will typically experience adequate quality sleep and will wake up at the desired time
o Maintenance insomnia - an inability to remain asleep once sleep is achieved. This may mean frequent awakenings throughout the night, and/or early termination of sleep coupled with an inability to return to sleep

35
Q

Whats the difference between chronic and short term insomnia?

A

o Chronic insomnia – at least 3 months regardless of etiology, the presence of symptoms at least three times per week
o Short term insomnia – less than 3 months
o An ICSD3 insomnia diagnosis also requires associated daytime consequences (e.g., fatigue, impaired concentration, mood disturbance, or other occupational, social, or academic impairment) and adequate opportunity and environmental circumstances for sleep.

36
Q

What are the sleep related breathing disorders?

A

o (1) obstructive sleep apneas (OSAs),
o (2) central sleep apnea (CSA) syndromes,
o (3) sleep-related hypoventilation disorders,
o (4) sleep-related hypoxemia disorder.

37
Q

What is obstructive sleep apneas (OSAs)?

A

 MOST COMMON for Australians
 repetitive episodes of cessation of breathing (apneas), reduced breathing (hypopneas), or arousal associated with increased airway resistance and respiratory effort
 usually heavy snoring
 Diagnosis requires the presence of five or more events (apnea, hypopneas, or respiratory effort related arousals) coupled with at least one sign or symptom (e.g., snoring, observed pauses, excessive sleepiness, insomnia) or medical or psychiatric complications. A predominantly obstructive event frequency of greater than 15/hour meets diagnostic criteria regardless of the presence or absence of symptoms.

38
Q

What are the central disorders of hypersomnolence?

A
  1. Narcolepsy Type 1.
  2. Narcolepsy Type 2.
  3. Kleine-Levin syndrome.
  4. Insufficient sleep syndrome.
  5. Idiopathic hypersomnia.
39
Q

Difference between Narcolepsy Type 1 and type 2?

A

o Narcolepsy type 1 is diagnosed on the basis of complaint of excessive sleepiness and the presence of definite cataplexy plus multiple sleep latency test (MSLT) findings (mean sleep latency ≤8 minutes and evidence of two or more sleep-onset REM periods
o Narcolepsy type 2 criteria include subjective sleepiness and the MSLT findings described previously for narcolepsy type 1. Cataplexy is absent, and hypocretin levels, if obtained, must not meet type 1 criteria.

40
Q

What is delayed sleep phase disorder DSPD?

A

o characterised by a clinically significant delay in the timing of sleep relative to a desired bedtime
o It has been found that individuals with DSPD experience increased sensitivity to light compared to healthy sleepers

41
Q

What are the Parasomnias?

A 
o	NREM parasomnias (confusional arousal, sleepwalking, and sleep terrors and closely related Sleep-related eating disorde)
o	Sleep-related eating disorder
o	REM sleep behavior disorder (RBD) (dream enactment)
o	Recurrent isolated sleep paralysis  
o	Nightmare disorder
o	Sleep enuresis (bed wetting)
o	Exploding head syndrome 
o	Sleep-related hallucinations
42
Q

What are sleep-related movement disorders?

A

o characterized by relatively simple, usually stereotyped movements that disturb sleep
o periodic limb movement disorder and restless legs syndrome (RLS)
o Sleep-related bruxism (teeth clenching)
o Sleep-related rhythmic movement disorder
o Propriospinal myoclonus(recurrent sudden muscular jerks in the transition from wakefulness to sleep)

43
Q

What are some sleep-related medical and neurologic disorders?

A
  1. Fatal familial insomnia.
  2. Sleep-related epilepsy.
  3. Sleep-related headaches.
  4. sleep-related laryngospasm (choking, stop breathing)
  5. sleep-related gastroesophageal reflux.
  6. sleep-related myocardial ischemia (reduction of blood flow)
44
Q
  • Malhi and Kuiper (2013) suggest that sleep-wake disturbance in mood disorders is linked to three biological systems:
A

the circadian system (process C), the sleep homeostat (process S) and the core stress system.

45
Q

What is a prominent circadian theory ?

A

phase-shift hypothesis - which suggests a misalignment between the individuals circadian rhythms and sleep time. This misalignment may occur in either direction (i.e., circadian functioning peaks too early or too late in the day).

46
Q

what axis is directly correlated with sleep disturbance?

A

hypothalamic-pituitary-adrenal (HPA) axis (Stress system)

47
Q

What are the objective measures of sleep?

A
  1. electroencephalography (EEG).
  2. Actigraphy
  3. Polysomnography (PSG)
  4. Multiple sleep latency test
48
Q

What are the subjective measures of sleep?

A
  1. sleep diaries
  2. sleep questionnaires/scales
  3. semi-structured interview approach
49
Q

what are some Pharmacological Interventions?

A
  1. sleeping pills: benzodiazepines and barbiturates (short term only).
  2. melatonin
50
Q

What is sleep hygeine?

A

Includes a range of basic practices that can be implemented in order to prepare the ‘best possible environment’ for sleep to occur.
Removing things or behaviours that may stop sleep onset and developing routines to encourage body and brain for sleep onset (e.g. no electronics)

51
Q

What are the 5 sleep tips?

A 
Step 1: healthy sleep routine
Step 2: regular sleep and wake schedule
Step 3: stop watching the clock
Step 4: create optimal sleep environment (dark, quiet and cool)
Step 5: unplug
52
Q

What is CBT-i

A

For insomnia. Intensive and short treatment (4-8 weeks).- goes much further than sleep hygiene practices by attempting to identify dysfunctional beliefs about sleep, develop strict structure and habits around sleep, improve sleep efficiency (i.e., reduce time in bed spent awake) and teach relaxation techniques.
Very effective

53
Q

What are the components of CBT-i

A
  1. Cognitive therapy (challenging and replacing negative beliefs.
  2. Stimulus control (e.g. leave bed when unable to sleep)
  3. sleep restriction (e.g. limiting time in bed)
  4. sleep hygeine (e.g. dont look at clock)
  5. relaxation (e.g. meditation)

PSY4408 (5 decks)

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