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Neuroscience > Neuroscience Week 7: Sleep Disorders > Flashcards

Neuroscience Week 7: Sleep Disorders Flashcards

1
Q

How is sleep regulated at a cellular level

A

There are sleep-promoting neurons and wake-promoting neurons that inhibit each other

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2
Q

flip-flop switch circuit of sleep

A
  • There are sleep-promoting neurons and wake-promoting neurons that inhibit each other
  • notice which segments fire during wakefulness or sleep
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3
Q

sleep pressure

A

builds throughout the day to make you want to sleep

need more stuff on this!!!

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4
Q

physiological variables and circadian rhythyms

A
  • Core body temperature
  • Cortisol
  • Urine volume
  • thyroid stimulating hormone
  • Growth hormone
  • Prolactin
  • Parathyroid hormone
  • Motor activity
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5
Q

Clock genes description and function

A

at least 10 of them

(e.g Bmal1, Clock, Per, Cry, etc.)

create circadian oscillations generated by negative feedback loops

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6
Q

The main timekeeper of brain

A

Suprachiasmatic nucleus

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7
Q

Suprachiasmatic nucleus location

A

above the optic chiasm

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8
Q

Key Zeitgebers

4 listed

A
  • Light
  • Feeding schedules
  • Melatonin
  • Activity
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9
Q

zeitgeber definition

A

time givers

or

time cues

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10
Q

length of internal clock

A

24.2-24.9 hours

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11
Q

Neurotransmitter systems active during sleep

A

Preoptic area (inhibits wakeful ness neurons

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12
Q

SCN uses __________ to help synchronize or reset the clock daily

A

Zeitgebers

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13
Q

Neurotransmitter systems that promote wakefulness and inhibit the sleep-promoting neuro systems

A
  • Basal Forebrain
  • Locus coeruleus
  • Tuberomammillary nucleus
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14
Q

Lighten up to stay awake

A
  • sun comes into eyes
  • Retinohypothalamic tract
  • tells SCN that it is time to be active
  • NE to superior cervical ganglion to rest of body
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15
Q

Melatonin is built up by

A

NE breakdown

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16
Q

Melatonin release is inhibited by?

A

Light

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17
Q

Process for sleep cycles

A
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18
Q

What releases melatonin?

A

Pineal gland

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19
Q

Homeostatic Sleep Drive AKA

A

Sleep pressure

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20
Q

Sleep pressure _________ the longer we are awake

A

increases

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21
Q

What comprises sleep pressure?

A

Adenosine rises as sleep debt builds up (a by-product of ATP)

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22
Q

Adenosine rises as sleep debt builds up and causes

A
  • inhibits body processes of wakefulness
  • “Rinsed out” during sleep
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23
Q

What reduces adenosine levels?

A

sleep

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24
Q

How does coffee work?

A

caffeine antagonizes adenosine

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25
Q

caffeine antagonizes

A

adenosine

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26
Q

Polysomnography

A
  • awake eyes and dreaming eyes look very similar
  • chin tone: should be really skinny and relaxed ( if movement could be grinding teeth)
  • K complexes (stage 2 sleep)
  • Spindles (stage 2 sleep)
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27
Q

K complexes are present in this stage

A

stage 2 sleep

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28
Q

spindles come from this stage of sleep

A

Stage 2 sleep

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29
Q

Spindles function

A

thalamus telling brain to ignore sensory signals

packets of info when consolidating memory

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30
Q

K complexes

A

from cortices telling theyre still busy

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31
Q

alpha is seen when

A

someone is about to go to sleep

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32
Q

Nasal line flat

A

no air coming in

trying to breath but no air is coming in

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33
Q

Polysomnographic features of normal REM sleep

5 listed

A
  • Rapid eye movements
  • Low chin tone
  • EEG dyssynchrony
  • Heart rate variability
  • Respiratory variability
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34
Q

Question 1

A

C. 70-120 minutes

In a depressed person? - 30-70 minutes

Treated for depression? - 120-180 minutes

sleep deprived? - 15-30 minutes

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35
Q

Average time % spent in NREM1

A

5%

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36
Q

Average time % spent in NREM2

A

45%

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37
Q

Average time % spent in NREM3

A

25%

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38
Q

Average time % spent in REM

A

25%

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39
Q

Hardest stages to wake up?

A

darker colors harder to wake up

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40
Q

stages most asleep?

A

darker colors

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41
Q

The most common sleep complaint

A

Insomnia

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42
Q

Types of insomnia

2 listed

A
  • Chronic insomnia disorder
  • Short-term insomnia disorder
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43
Q

Insomnia description

A

complaint of sleep quantity or quality associated with problems falling asleep, staying asleep and or early morning awakenings

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44
Q

Insomnia criteria

3 listed

A
  • causes distress/impairment
  • sleep problem occurs at least 3 nights/week
  • The sleep problem occurs despite adequate opportunity for sleep
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45
Q

Insomnia Non-pharmacological treatment

A
  • CBT-I - Cognitive behavioral therapy (4-8 weeks)
  • Learn healthy sleep habits and develop new sleep behaviors to improve sleep quality and consolidation
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46
Q

Insomnia first-line treatment

A

CBT-I

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47
Q

Sleep hygiene

11 listed

A
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48
Q

FDA medications approved for insomnia

A
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49
Q

FDA medications approved for insomnia: Classes

5 listed

A
  • Benzodiazepine receptor agonists
  • Non-Benzodiazepine receptor agonists
  • Selective melatonin receptor agonists
  • Antidepressant
  • Orexin receptor antagonist
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50
Q

Benzodiazepine receptor agonists for insomnia

A
  • Triazolam
  • Temazepam
  • Estazolam
  • Quazepam
  • Florazepam
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51
Q

Non-Benzodiazepine receptor agonists for insomnia

3 listed

A
  • Zaleplon
  • Zolpidem
  • Eszopiclone
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52
Q

Selective melatonin receptor agonist for insomnia

A

Ramelteon

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53
Q

antidepressant for insomnia

A

Doxepin

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54
Q

Orexin receptor antagonist for insomnia

A

Suvorexant

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55
Q

Suvorexant halflife

A

medium

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56
Q

Doxepin half-life

A

medium

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57
Q

Ramelteon half-life

A

short

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58
Q

Eszopiclone half-life

A

6 hr

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59
Q

zolpidem half-life

A

3 hr

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60
Q

Zaleplon half-life

A

1 hr

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61
Q

Florazepam half-life

A

longest

62
Q

Quazepam half-life

A

Longer

63
Q

Estazolam half-life

A

long

64
Q

Temazepam half-life

A

short

65
Q

Triazolam half-life

A

shortest

66
Q

sleep-related breathing disorders

3 listed

A
  • Obstructive apnea
  • Central apnea
  • Mixed apnea
67
Q

We classify sleep apnea in a ______ based upon _________ effort during absent airflow

A
  • PSG
  • INSPIRATORY
68
Q

Obstructive sleep apnea and symptoms

9 listed

A
69
Q

Obstructive sleep apnea risk factors

6 listed

A
  • male sex
  • older age (40-70)
  • Postmenopausal status
  • BMI >35
  • Hypertension
  • Large neck circumference
70
Q

Obstructive sleep apnea consequences

9 listed

A
  • stroke
  • heart failure
  • atrial fibrillation
  • heart attack
  • insulin resistance
  • obesity
  • sudden death
  • mood problems
  • memory problems
71
Q

Treatment for Obstructive sleep apnea

5 listed

A
72
Q

Obstructive sleep apnea CPAP

A

continuous positive air pressure therapy

73
Q

Obstructive sleep apnea psychiatric

A

behavioral therapies are often helpful in desensitizing treatment options improving overall sleep hygiene and alleviating underlying causes of anxiety and depression

74
Q

Obstructive sleep apnea dental devices

A

small and easy to wear dental devices are an excellent treatment for mild to moderate sleep apnea

75
Q

Obstructive sleep apnea weight loss

A

a loss of 10% body weight may be an effective treatment for some sleep apnea cases

76
Q

Obstructive sleep apnea surgical

A

New treatments require less recovery time, and some can be performed in an outpatient setting

77
Q

Before and after PAP

A
78
Q

Narcolepsy description

A

an irresistible need to sleep due to loss of orexin neurons

79
Q

Narcolepsy symptoms

A

5 listed

80
Q

Narcolepsy sleep attacks

A

irresistible need to sleep

81
Q

Narcolepsy sleep paralysis

A

REM atonia when going to sleep or waking

82
Q

Narcolepsy Hypnagogic hallucinations

A

dream intrusion into wake

83
Q

Narcolepsy poor sleep at night

A
  • due to sleep fragmentation
  • poor sleep/wake stability
84
Q

Narcolepsy Cataplexy (Type I)

A
  • sudden loss of voluntary muscle tone
  • Reflexes are absent
  • in response to strong emotional stimuli
85
Q

Narcolepsy Treatment

A
86
Q

Narcolepsy Treatment: Hypersomnolence

3 listed

A
  • timed SHORT naps during the day
  • Stimulant medications (methylphenidate and amphetamines)
  • Wakeful promoting agents (Modafinil and Armodafinil)
87
Q

Narcolepsy Treatment: Cataplexy

A
  • Antidepressants
  • decrease REM intrusion
  • Sodium Oxybate (only FDA approved RX)
88
Q

Only approved Rx for Narcolepsy Cataplexy

A

Sodium Oxybate

89
Q

Narcolepsy Treatment: Poor sleep at night

2 listed

A
  • Sodium Oxybate
  • Timing of naps and stimulant use
90
Q

Circadian Rhythm Disorders

6 listed

A
  • Delayed sleep-wake phase disorder
  • Advanced sleep-wake phase disorder
  • Irregular sleep-wake rhythm
  • Non-24-hour sleep-wake rhythm disorder
  • Shift work disorder
  • Jet lag disorder
91
Q

Delayed Sleep phase syndrome may look like?

A

Sleep onset insomnia

92
Q

Delayed Sleep phase syndrome symptoms

4 listed

A
  • Inability to arise in the morning
  • normal sleep if initiated at a delayed bedtime
  • Bedtime & wake times are later on vacations (4 a.m. - 12p.m.)
  • Peak onset at adolescence
93
Q

Delayed Sleep phase syndrome prevalence

A

peak onset in adolescence

94
Q

Delayed Sleep phase syndrome differentials

A
  • sleep-onset insomnia
  • bipolar disorder
  • inadequate sleep hygeine
95
Q

NREM Parasomnias description

A

unwanted nocturnal behaviors

96
Q

NREM Parasomnias pathogenesis

A

heritable

97
Q

NREM Parasomnias occurs when and what sleep stage

A
  • often in the first 3rd of the night
  • NREM 3 stage
98
Q

NREM Parasomnias prevalence

A

most common in children

99
Q

NREM Parasomnias increased with?

4 listed

A
  • Sleep deprivation
  • sickness
  • stress
  • side effects to medications
100
Q

NREM Parasomnias examples

4 listed

A
  • Night terrors
  • Confusional arousals
  • sleepwalking
  • sleep-related eating disorders
101
Q

Night Terrors characteristics

7 listed

A

Episodes of abrupt terror

intense fear

autonomic arousal

inconsolable

eyes open

brief to 30+ minutes

not easily remembered in the AM

102
Q

Confusional arousals characteristics

3 listed

A
  • Mental confusion or confused behavior
  • absence of terror or ambulation
  • not easily remembered in the AM
103
Q

Sleepwaking AKA

A

Somnambulism

104
Q

Sleep talking AKA

A

Somniloquy

105
Q

Bedwetting AKA

A

Enuresis

106
Q

Teeth grinding AKA

A

Bruxism

107
Q

Sleep-related eating disorders characteristics

A

eating while asleep

108
Q

REM Parasomnias examples

3 listed

A
  • REM sleep behavior disorder
  • Recurrent isolated sleep paralysis
  • Nightmare disorder
109
Q

Nightmares memory and time of occurence

A

recall intact upon awakening

second half of the night

110
Q

Sleep paralysis definition

A

awake but unable to move

111
Q

Sleep-related hallucinations subtypes

2 listed

A
  • Hypnogogic (when falling asleep)
  • Hypnopompic (when waking up)
112
Q

REM Behavioral Disorder memory

A

recall intact upon awakening

113
Q

REM Behavioral Disorder characteristics

A

dream enactment (themes of being pursued or fear)

114
Q

REM Behavioral Disorder associated with?

A

Neurodegenerative diseases

115
Q

Predates onset of Alpha-synucleinopathies: REM Behavioral Disorder

3 listed

A
  • Parkinson’s disease
  • Multiple system atrophy
  • Dementia with Lewy bodies
116
Q

REM Behavioral Disorder: Lesions affecting the brainstem

3 listed

A
  • Multiple Sclerosis
  • Narcolepsy
  • Stroke
117
Q

REM Behavioral Disorder: Medications

A

Antidepressants

118
Q

Normal Neurophysiology of REM Sleep

A
119
Q

REM sleep without Atonia

A

ACh from the superior pons starts dreaming but the glycine is not activated to inhibit the anterior spinal horn cells and REM behavioral disorder is caused

120
Q

Acting out dreams

A
121
Q

RBD Treatment

REM Behavioral Disorder

A
  • Ensure safe environment
  • Melatonin
  • Clonazepam
  • Antidepressant change
  • Other medications: Selegeline, Donepzil , Barbiturate withdrawal, bisoprolol
122
Q

Medications linked to RBD

5 listed

A
  • Antidepressants
  • Selegiline
  • Donepezil
  • Barbiturate withdrawal
  • bisoprolol
123
Q

Sleep-related movement disorders examples

4 listed

A
  • Restless leg syndrome
  • Periodic limb movement disorder
  • Sleep-related leg cramps
  • Sleep-related bruxism
124
Q

Restless leg syndrome

A

URGES

125
Q

Restless leg syndrome improvement with

A
  • getting up
  • dopaminergic therapy
126
Q

Restless leg syndrome limb movements in sleep

A

80%

127
Q

Restless leg syndrome deficiency

A

Serum ferritin <50 mg/L

128
Q

Restless leg syndrome Prevalence

A
  • Family history
  • middle to older age
  • usually progressive course
129
Q

Restless leg syndrome vs Periodic limb movement disorder

A
130
Q

Restless leg syndrome is bothersome when?

A

While awake

131
Q

Restless leg syndrome is associated with?

3 listed

A
  • Iron deficiency
  • FHx
  • overlap with periodic limb movements disorder 80%
132
Q

Restless leg syndrome treated with

2 listed

A
  • iron
  • dopamine agonists
133
Q

Periodic Limb Movement Disorder is bothersome when?

A

during sleep

134
Q

Periodic Limb Movement Disorder and effect on sleep

A

movements interrupt/worsen sleep

135
Q

Periodic Limb Movement Disorder is associated with?

A

Overlap with Restless Leg Syndrome 20%

136
Q

Periodic Limb Movement Disorder​ criteria

2 listed

A

may not be a disorder if:

  • it is not interrupting sleep
  • not causing daytime dysfunction
137
Q

Question 1

A
138
Q

Question 2

A
139
Q

Question 3

A
140
Q

Question 4

A
141
Q

Core body temp during sleep

A

↓

142
Q

Cortisol during sleep

A

steady ↑ where it is at its maximum as soon as waking

143
Q

Urine volume during sleep

A

remains ↓

144
Q

TSH during sleep

A

slow ↓

145
Q

GH during sleep

A

↑↑↑

146
Q

Prolactin during sleep

A

mild ↑ to plateau

147
Q

Parathyroid hormone during sleep

A

initial ↑ and then ↓

148
Q

Motor activity during sleep

A

should basically be none

149
Q

What promotes REM atonia?

A

Glycine in the spinal cord anterior horn

150
Q

REM sleep Superior pons

A

ACh on

151
Q

REM sleep Locus Coeruleus

A

Off

152
Q

REM sleep Raphe Nucleus

A

5HT off

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