Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Lifestyle Medicine > Section 8: Sleep Health Science > Flashcards

Section 8: Sleep Health Science Flashcards

1
Q

Sleep Physiology

A
  • General sleep requirements: 7-9 hours/day, but subjective sleep per individuals may vary
  • Sleep def. impairs functional performance, but individuals are unaware of the level of impairment
  • Endogenous/internal circadian oscillators: cells, tissues that make up the body’s internal clock/

Central oscillators: found in suprachiasmic nucleus (body’s main clock”
Peripheral oscillators present in every major organ in the body (i.e. kidney, liver)

Entrainment: the ability to be brought into a rhythm
- Synchronization of the internal endogenous oscillators based on external inputs (out of body)
- Human circadian rhytm is closer to 24.2 hours but is entrained to a 24 hour day
- For most people, it’s easier to stay up late than go be earlier
- Easier to travel westward, experiencing a day greater than 24 hours
- Awakening cortisol spike - entrained by food anticipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Suprachiasmatic Nucleus

A
  • Central clock
  • Portion of hypothalamus that regulates melatonin secretion
  • responsible for awakening cortisol spike
  • Splanchnic nerves innervate organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Retinal ganglion cells (RGC)

A
  • Nonvisual light sensitive retinal neurons
  • Relay light intensity/spectra to SCN
  • Melanopsin is the photopigment in RGC, it’s sensitive to short wavelengths of light (blue light ~480nm) and stimulate the RGC nenurons.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

External and environmental factors that entrain circadian rhythm (Inputs)

A
  1. Light intensity
  2. Wavelength (frequency, color)
  3. Food (mainly carbs)
  4. Fluid (blood osmolality), measurement of particles like sodium, potassium dissolved in plasma.
  5. Ambiet temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Change amount of input that gets to the body’s operators (Modifiers)

A
  1. Pupillary reflex
  2. Sunglasses or backlight on electronic devices
  3. Single nucleotide polymorphisms (SNPs) - genetic variations in the DNA (PER and CRY proteins), which inhibit functions of other proteins (clock and cycle). Exposure of retinal ganglion cells to light causes more PER protein to be produces.
  4. Cutaneous fat stores
  5. Vascular tone: fluid volume in blood vessels, modifying core and peripheral temperatures
    - Nitric oxide and estrogen enhance vasodilation - lowers blood pressure
    - Sodium causes acute vasoconstriction - raising blood pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Operators

A

Body’s reaction or response to the modified inputs
- Core body temperature changes
- Melatonin suppression/secretion
- Cortisol secreion
- Cutaneus blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outputs

A

Behavioral and physiological consequences of the operators
- Sleep
- Functional performance
- Food seeking behaviors
- Alertness etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sleep Physiology

A
  1. Sleep onset - Darkness triggers melatonin secretion > cutaneus vasodilation > extremity warming > cooling of core body temp > sleep initiation
  2. Early sleep: sleep onset to mid-sleep
    - Continued rise in melatonin (low point reached at 2-3 hours before awakening)
    - Predominantly slow wve on electroencephalogram (EEG)
    - The dec in core body temp with inc. peripheral skin temp signals restorative process throughout the body
    - Decreased blood pressure and sympathetic tone
  3. Throughout sleep: restoration and repair
    - DNA remodeling
    - Leptin and ghrelin secretion (control appetite)
    - Gradual inc. in cortisol, etch
  4. Late sleep: mid sleep to awakening
    - Declining melatonin levels, dec, peripheral skin temp > inc. core body temp
    - REM
    - Inc blood pressure, sympathetic tone, baroreceptor sensitivity ( body’s ability to change HR, heart contraction, peripheral vascula tone)
  5. Awakening
    - Cortisol spike (24 hour peak), this spike is important for transition from sleep to wakefulness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Blue light

A
  • 420-480 nm
  • Blue light creates greater melatonin suppression at lower intensities and shorter duration
  • At night, it inc HR, BP, and core body temp. Dec. sleepiness, suppresses melatonin
  • TV screens, phones, backlit computers have strong blue light spectra hence powerful melatonin suppressive effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Light Timing

A

During the day:
- Melatonin suppression, support alertness

At night (blue light)
- Inc cortisol, BP, HR, etc.
- Suppress melatonin
- Inhibits sleep

Low daylight
- Dec., daytime activity, alertness, etch
- Inc. melatonin suppression with evening light
- Low daytime light significantly increases sensitivity of melatonin suppression from light at night! Hence, if low light occured 2-3 days prior, SCN is more sensitive to light at night > delayed onset of sleep, shifting of sleep cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Endogenous SCN Clock

A
  • Before, it was easier for circadian rhythm to set phase. Now due to electricity it’s harder

DELAYED PHASE SHIFTS
a. On evening exposure, there is 1-3 hours delay of sleep onset. Over time people get more and more behind objective time clocks

b. can occur with eastward travel
c. can occur with home lighting of 100-1,000k. Home lighting can lead to almost 100% melatonin suppression
d. Night owls (those who prefer staying up light) more susceptible to melatonin suppression and delay.

ADVANCE PHASE SHIFT
a. Premature or early resetting of circadian rhythm. Clock is shorter than 24 hours.
b. occur with exposure to light earlier in day (like traveling eastward)
c. susceptible people are morning people or “larks”. Susceptible to desynchrony due to morning light.

  • In general , SCN needs to be reset forward (advance) or backward (delayed) by 5-15 min. a day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Daily Entrainment Requirements

A

If shorter than 24 hours:
- advancement of 10min or less (i.e delay morning light exposure by 10 min.)

If longer than 24 hours
- Backward seeing of 20min or less (i.e. limiting light 20min earlier in evening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effects of sleep delay/disruption

A
  • Dec. daytime activiety
  • Dec. caloric burn, leptin (appetite control hormone) and core body temperature
  • Inc. appetite and insulin resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Food effects on sleep

A

CARBS
- Skipped, late, or low carb breakfast leads to decreased cortisol awakening rise
- Eating shortly after wakening may help shift wake up time earlier
- Eating high carb breakfast may improve sleep-wakefulness transition
- Eating dinner to early may contributo to falling asleep too early

How to Shift Carbs:
- If falling asleep too early, then eat more carbs at dinner
- If falling asleep too late, then shift carbs to earlier meals, avoid snacking and carb rich dinners, and eat an earlier dinner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Exercise effects

A
  • Morning and afternoon exercise have PHASE ADVANCING effects
  • Evening exercise have PHASE DELAYING effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fluid status and sleep

A

3 main elements controlling body temp:
- core body temp
- peripheral temp
- ambient temp

During afternoon:
- core body temp rise, peripheral cool off

At night:
-opposite occurs

Blood osmolality
- In afternoon, higher blood osmo. leads to higher afternoon peak core body temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ambient Temperature

A
  • If peripheral body is not warm enough during transition to sleep, sleep onset may be inhibited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Populations that are more sensitive to melatonin suppression

A
  • Major Depressive Disorder
  • Seasonal Affective Disorder
  • Bipolar Disorder
  • Elderly adults (natural trend toward lower melatonin production each decade of life), also due to cataracts corneal opacity

45 year old has 50% lower retinal illuminance than a 10 year old
65 year old has 50% lower retinal illuminance than a 45 year old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

BEHAVIORALLY INDUCED INSUFFICIENT SLEEP SYNDROME (BIISS)

A

BEHAVIORALLY INDUCED INSUFFICIENT SLEEP SYNDROME (BIISS)
- Voluntary restriction of sleep time
- longer sleep duration on week ends
- Association with young age, alcohol abuse, longer work hours, stress, depression

20
Q

CHRONIC INSOMNIA

A
  • Most common sleep disorder
  • On going for at least 3 months and occurring at least 3x weekly
  • Associated with fatigue, memory impairment, mood disturbance, irritability
21
Q

OBSTRUCTIVE SLEEP APNEA

A

Recurrent apnea or hypopnea during sleep
- Lasts 10 sec. or higher or longer
- Quantified as Apnea-Hypopnea Index (AHI)
mild: 5-15, moderate: 15-30, sever: 30+
- 80% are undiagnosed

Associated with:
- overweight or obese
- metabolic syndrome
- hypertension
- atrial fibrillation
- Increased neck circumference
- Loud snoring

22
Q

RESTLESS LEG SYNDROME (RLS)

A
  • Sensorimotor disorder characterized by feeling an urge to move limbs or torso when one is at rest
  • Can present as parasthesia or pain
  • Worse in the evenings
  • Symptoms are not due to another primary medical cause
  • 5-15% of US population

Associated with:
- Periodic movements of sleep (in 85% of px with RLS)
- Phase delay sleep
- Sleep disruption, fatigue
- Involuntary and jerky movements of limbs while awake or at rest
- Iron abnormalities: low ferritin <75 ng/ml, elevated ferritin

Associated with:

23
Q

SLEEP MISPERCEPTION

A
  • Perceives less sleep than actual sleep duration
24
Q

SECONDARY INSOMNIA

A
  • Possibly due to medications, vascular dysfunction, visual impairmen, or fluid balance
25
Q

NARCOLEPSY

A
  • Sudden, uncontrollable onset of sleep
  • Dx of exclusion
26
Q

PERIODIC LIMB MOVEMENTS

A
  • Associated with restless leg syndrome
  • Movements occur at 30 sec interval during sleep
27
Q

Healthy vs Impaired Sleep

A

Healthy sleep:
- Low cortisol and glucose levels
- Greater insulin sensitivity
- Higher daytime leptin, reduced food seeking behavior

Impaired:
- Higher night time cortisol and glucose
- Reduced insulin sensitivity
- Higher glucose levels
- Low daytime leptin
- Dec testosterone, growth hormones,
- Increased advanced glycation end product (AGE) deposition in vascular system
- Dyslipidemia
- Endothelial dysfunction

Shirt Duration sleep:
- Inc. BMI
- Obesity
- Metabolic Syndrome
- T2DM
- Cardiovascular risk and mortality

28
Q

Sleep and Mood, Cognition

A

Healthy:
- Higher proportion of sleep time is slow wave sleep (stage 3, deepest most resorative stage of non- REM sleep)
- Higher proportion in REM

Impaired:
- Less slow wave and REM
- Reduced Brain derived Neurotrophic factor (BDNF)
- Impaired learning and memory
- Emotional distress

29
Q

Sleep and cancer

A

Healthy:
- DNA repair and histone remodeling
- Apoptosis and anti cancer cytokines, TNF alpha

Impaired:
- Melatonin and immune system suppression
- Inc. cancer stimulating cytokines
- Dysfunction in gene transcription and cell cycle
- Aberrant DNA methylation, meaning DNA expression is not being coded correctly

Correlated Cancers:
- Breast Ca
- Endometrial Ca
- Prostate Ca
- Colorectal Ca
- Acute Myeloid Leukemia

30
Q

Lifestyle Prescription for sleep

A
  • Use bed for sleep and sex only
  • Establish regular sleep cycle for bedtime and wake time
  • Increase bedtime peripheral vasodilation: bath/shower, socks or heating pad for cold feet, non caffeinated beverages
  • Minimize or eliminate bedroom noise and lights
  • Power naps only for 30min or less
  • Increase Light exposure during the day
  • Increase Day time physical activity
  • Decrease light at night, turn off light at least 1 hour before bedtime . Use 2,500 k color warm spectrum lights
31
Q

Sleep and dietary, exercise prescription

A

Diet
- No caffeinated drinks at night
- Avoid alcohol 3 hrs before bed
- Eliminate after dinner and late night snacking
- Avoid high sodium foods esp. at dinner because it affects vascular tone vasodilation
- Assure adequate fluid intake like sodium above reasons
- Weight reduction if BMI elevated

Exercise
- Inc. daytime activity
- Move at least once an hour
- Inc. morning and afternoon activity
- Minimize stress
- Stop working 90min before bed
- Mitigate night time worrying, planning, and ruminating
- Practice cognitive behavioral therapy

32
Q

Intensive therapies

A
  • Cognitive behavioral therapy
  • Recommended as first line tx for chronic insomnia over medications
  • Most likely to produce sustained benefit
  • Less risk of side effects
  • Cognitive therapies + Behavioral therapies have been shown to facilitate getting off sleep medications and staining sleep over time

BEHAVIORAL METHODS
- Sleep restriction
- Stimulus control
- Relaxation training therapy
- Sleep hygiene
- cognitive methods - address anxiety producing beliefs about sleep or lack of sleep

SUPPLEMENTAL MELATONIN
- efficacious for jetlag mitigation and circadiam rhythm disorders
- mixed evidence for insomnia
- No evidence for adv. effects at 1-6mg doses. Possible interaction with come p450 drugs
- Supplements with vit b6 may cause acute altering effect in some individuals
- Hypnotics or sedative meds: Benzodiazepines or Benadryl/doxylamine have side effects
- sublingual preparation may have better bioavailability

33
Q

Jet Lag Traveling East Tx

A
  • Get exposure to bright light, preferrably outdoors, close to new ideal wake-up time
  • Get only dim light exposure starting 1 hours before new ideal sleep time

Diet: eat hearty breakfast WITHIN 30-45 min of new ideal wake-up time
- Take melatonin 1mg sublingual 1 hours before new ideal sleep time

34
Q

Jet Lag Traveling West

A
  • Get late afternoon and early evening bright light, preferably outdoors
  • Avoid dim light exposure until 1 hour before new ideal sleep time

Diet:
- Eat hearty breakfast within 30-45 min AFTER new ideal wake up time
- Eat complex carbs rich dinner 2-3 hours before new ideal sleep time
- Take 1 mg melatonin sublingual 1 hour before new ideal sleep time

35
Q

Sleep Assessments

A

MINI SLEEP ASSESSMENT
- Typical weekday sleep hours
- Typical weekend sleep hours
- Perceived sleep quality
- Red flags:
1. Less than 7 hours sleep
2. 1 or more hours weekday weekend difference
3. Irregular sleep timing or duration (especially shift work)
4. Poor sleep quality despite 7 or more hours in bed
5. More than 9 hours sleep

36
Q

STOP BANG: Brief obstuctive sleep apnea (OSA) assessment 30 screens for OSA, not for central sleep apnea

A
  • Snoring loud
  • Tired often, fatigued, sleepiness during daytime that inhibits functioning
  • Observed patient apnea episodes
  • Pressure: elevated blood pressure or taking hypertension medications
  • BMI >35
  • Age greater than 50
  • Neck size >17 inches (43cm) in male, >16 inches (41cm) in a female
  • Gender: male
  • Scoring:
    a. 0-2 yes = low risk for OSA
    b. 3-4 yes = intermediate risk for OSA
    c. 5-8 yes = high risk for OSA: refer for sleep study
37
Q

Sleep Hygiene Assessment

A
  • Daytime naps more than 30min
  • Poor daytime hydration
  • Variations in sleep onset/offset
  • Prolonged non sleep periods in bed
  • Stimulating activities pre-bed time
  • Going to bed stressed, angry, or upset
  • Reading, watching TV, or eating in bed
  • Uncomfortable bed and or bedroom
  • Think, plan, worry in bed
  • Caffeine or alcohol within 3 hours of bedtime
38
Q

Epworth Sleepiness Scale (ESS)

A
  • Px with scores 8 or above, benefit from a thorough review
39
Q

Pittsburgh Sleep Quality Index (PSQI)

A
  • Self rated questionnaire that assess sleep qualitiy and disturbances over a 1 month time interval
40
Q

Delayed Sleep onset/difficulty sleep initiation

A

ENVIRONMENTt: sleep and sex on bed only, minimize noise and lights, warm extremities at ideal bedtime
LIGHT: inc. morning sunlight, inc. afternoon PA, dec. light at night
DIET: Reduce/eliminate night time caffeine, alcohol, high sodium foods, EAT CARBS RICH BREAKFAST, and LOW CARB DINNER.
EXERCISE: exercise in morning or afternoon if possible.
STRESS: start unwinding 1 hour before bed

41
Q

Sleep fragmentation/difficulty maintaining sleep

A

ENVIRONMENT: Darken bedroom, cool bedroom gradually at night, keep glass of cool water at bedside
LIGHT: inc. morning and mid afternoon sunlight, inc. PA, red tone lights if needed
DIET: INC. later afternoon hydration, avoid diuretic beverages.
STRESS: mitigate night time worrying, planning
seek exercise program

42
Q

Sleep def by waking up too early

A

Assure sufficient bedcovers to be warm early morning
Avoid bright light until ideal wake up time
INC LATE AFTERNOON and EVENING sunlight to inc. melatoninc production (larks naturally gravitate to more early morning light)
INC. evening PA
use blue spectrum 6,500k lights 1 hours before bed
Avoid caffeine 30-60min AFTER ideal wakup time
Shift CARBS from breakfast to DINNER

43
Q

Stimulus Control

A

Stimulus control seeks to re-associate bed and bedroom as a place of sleep and rest. Sleep hygiene is different than stimulus control yet both are included in CBT-I. Stimulus control does not seek to desensitize persons to stimulus. The focus is to remove stimulus. Stimulus control asks persons to go to bed when tired. It does not expect people to be in bed when fully awake—this is the opposite of associating the bed with sleep and rest.

44
Q

Sleep Restriction

A

Sleep restriction requires sleep logs as opposed to simple recall. Sleep restriction instructs a patient to set a time to go to bed and to wake up every day. When sleep time is greater than 90% of bedtime, then extend time in bed by 15-30 minutes.Although avoiding blue light emitting devices two hours prior to sleep is good advice, it is sleep hygiene.

45
Q

Bright Light Therapy

A

Bright light therapy is used for circadian disorder such as advanced phase disorder or delayed phase disorder.

46
Q

Light meals that are easily digested are associated with greater ease to fall asleep and stay asleep.

A

Lifestyle Medicine (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions