Module 9 - Sleep (Test 2) Flashcards
What sleep does
- Essential biological process and need for wellbeing
- Stimulates and reinforces immune function
- Regulation of mood and stress processes
- Consolidation of learning and memory
- Maintenance of cognitive functions
- Regeneration of energy stores of muscle and nerve cells
- Regulation of functions such as blood glucose (disturbed metabolism, risk of weight gain)
- Elimination of toxins
Polysomnography
A medical examination consisting of recording, during the patient’s sleep, several physiological variables
Laboratory assessments of sleep
- Polysomnography
- Respiratory and cardiac rhythm
- Electroencephalogram
- Electromyogram of the muscles of the arms of legs
- Nocturnal blood-oxygen saturation
The sleep cycle
- 90 minutes
- stage 4 sleep decreases and REM sleep increases with every cyle
Stage 1 - 4»_space; 4 - 2»_space; REM Sleep
Delta Waves
Stage 3-4 (Deep sleep)
Alpha Waves
Awake
Two stages with practically identical brain waves
Stage 1 and REM sleep
Circadian Rythms (Biological Clock)
- Occur on a 24h cycle
- Include sleep and wakefulness
- Can be altered by artificial light
Light’s role in the circadian rhythm
Triggers the suprachiasmatic nucleus to decrease (in the morning) melatonin from the pineal gland and increase (in the evening) it at nightfall
Night terrors
Confusion and terror but still asleep
Parasomnias happen in …
Deep sleep or REM sleep
Confusional Awakenings (P)
Episodes of confusion occuring during or after awakening
Sleepwalking (P)
Walking (or doing something else!) during sleep - Often due to sleep
Hallucinations (P)
Hypnagogic (while falling asleep) or hypnopompic (while awakening)
Sleep rhythms (P)
Repetitive movements of the muscles (head, neck)
Myoclonia (P)
Rapid muscular tremors while falling asleep
Sleep paralysis (P)
Muscle atonia during sleep
REM sleep behavior disorder (P)
Acting out dreams physically
Bruxism (P)
Grinding Teeth
Somniloquy (P)
Talking in your sleep
Enuresis (P)
Bed Wetting
Exploding head syndrome (P)
Intense migraine
Narcolepsy (Gélineau disease)
Paradoxal sleep attacks that happen at any time
Narcolepsy stats
- 1 in 2800 people in North America
- manifests in adolescence
- gender ratio : 1:1
- Multiple awakenings at night
Can narcolepsy be cured?
No but symptoms can be treated with medication
Narcolepsy treatments
- Pharmacological treatment (modafinil) reduces falling asleep in 70% of cases
- Low-dose antidepressants
- Behavioural treatment: helping the person learn to live with the disease and reduce the risk of accidents
Restless leg syndrome (Willis Ekbom syndrome) (D)
- irresistible urge to move your legs during period of rest or inactivity
- discomfort/pain
- relieved or suppressed by movement
Restless Leg Syndrome stats
- 10% of Can. population (1/3 moderate to severe)
- Stable or deteriorates up to age 70-80
- Female:male ratio 2:1
- 40-90 % positive family history
Restless leg syndrome causes
- Central nervous system disorder
- Genetics
- Iron deficiency ?
Restless Leg syndrome treatments
- Physical activities of mild to moderate intensity
- leg massages
- hot or cold bath
- mental distraction
- vitamin supplements (iron, magnesium, vitamin C)
- dopamine agents
Sleep apnea (D)
Respiratory disorder is characterized by frequent pauses in respiration (apnea) or decreased respiratory flow (hypopnea) , decrease of oxygen
sleep apnea is 2 x more common in…
men
Risk factors for sleep apnea
- Obesity
- Age
- Gender
- Certain abnormalities of the airways or jaws
- Genetic factors
- Neck Circumference
- Nasal Obstruction
- Alcohol consumption and smoking
- Certain meds
- Type 2 diabetes
2 types of causes to sleep apnea
Obstructive and Neurological
Obstructive causes
- Overweight
- Large tonsils
- Excess of fatty tissue in the throat
- Lower Jaw too short or recessed
Neurological causes to sleep apnea
Central sleep apnea syndrome (CSAS)
Apnea treatments
CPAP (continuous positive airway pressure) device, dental prosthesis, positional therapies
Effect of aging on sleep
- Deterioration of the hypothalamus (age-related) affects circadian rhythms
- Increase in cortisol level
- Decreased sleep time due to reduction of the secretion of human growth hormone
- Reduced sensitivity of the retina to light
Insomnia (D)
- Most common sleep disorder
DSN definition of insomnia
- Difficulty initiating sleep ( 30mins+ 3x/week)
- Difficulty maintaining sleep ( frequent awakenings or problems falling asleep after awakenings)
- Early morning awakenings ( awakening with the inability to fall back to sleep again
- Has to interfere with a person’s life
medical cause of insomnia
chronic pain, asthma, reflux, meds
psychological cause of insomnia
depression, anxiety, stress, mania
life causes of insomnia
children/parents, school, work, too many rotating shifts, habits.
Predisposing factors of insomnia
Age, gender, family history, anxiety, etc.
Preticipating factors of insomnia
(life bombs) : divorce, grief, etc
Perpetuating factors of insomnia
(becomes a bad habit) : habits & behaviours, beliefs, attitudes
Therapeutic strategies for insomnia
- Relaxation, diaphragmatic breathing, mediation, biofeedback, imagery
- Cognitive behavioural therapy
- Pharmacotherapy
When should a person use pharmacotherapy to treat insomnia?
- Situational insomnia ( stress, change of environment, time zone)
- Initial therapy for chronic insomnia
- Insomnia associated with a medical or psychiatric condition
Types of pharmacological treatments for insomnia
- benzodiazepine
- other non-benzodiazepine hypnotics
- Rx off-label antidepressants, anti-psychotics
- antihistamines
- natural products/otc (valerian, melatonin)
Positive effects of using pharmacological treatments to treat insomnia
- Reduction of sleep latency and awake time during the night
- Reduction of the number of awakenings
- Overall sleep time increase
Negative effects of using pharmacological treatments to treat insomnia
- Increase stage 2 sleep
- Reduced stages 3-4 and REM sleep
- Anterograde amnesia
Risks and limitations of BZD and non-BZD
- Cognitive, psychomotor, neuropsychological and residual daytime fatigue problems
- Danger of abuse in people dependent on alcohol or other substances
- 40% of patients don’t respond
- special management in elderly and pregnant or breastfeeding women
Cognitive behavioural therapy for insomnia
- Sleep hygiene (favourable conditions for sleeping)
- Behavioral (Restriction of time spent in bed)
- Cognitive ( Beliefs and attitudes)
Why do we dream?
- To develop and preserve neural pathways
- To make sense of neural static
- To reflect cognitive developpement
