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Sleep Flashcards

1
Q

What percentage of people work night shifts?

A

20%

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2
Q

60 million have trouble sleeping but only 10% seek help. What indirect costs does this cause?

A

Presenteeism - at work, no productive
increase risk of long term disability
mistakes/accidents

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3
Q

There has been an increase in short sleep since the 1970s. What percentages haves <6 and <7 hours?

A

<6 - 20&

<7 - 37%

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4
Q

How much sleep does the average American get?

A

6 hr 57 mins

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5
Q

What are the endogenous oscillators?

A

Peripheral and central

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6
Q

What is the central oscillator? Where is it? What does it do? How?

A

SCN, in hypothalamus, regulates melatonin secretion, entrainment of circadian rhythm by connecting to other tissues/organs

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7
Q

Where are the periperal oscillators? What do they do?

A

in organs, synch to the central clock - SCN

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8
Q

What are the RGCs? What do they do? What do they contain?

A

non-visual light sensitive neurones
send spectra and wavelength of light to SCN to alter melatonin secretion
also AWAKENS CORTISOL SPIKE
contains melanopsin which is most sensitive to short wavelengths (blue - 480nm)

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9
Q

The peripheral and central oscillators are stimulated by what 5 things?

A
  1. light INTENSITY
  2. Light WAVELENGTH
  3. ambient temperature
  4. Food - CARBS
  5. FLUID - blood osmolality
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10
Q

What is entrainment?

A

Synchronisation of oscillators based on external inputs

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11
Q

Sleep propensity?

A

ability to GET TO SLEEP and STAY ASLEEP

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12
Q

Cricadian rhythms?

A

body clock
regulated of oscillatorys
brought into rhythm to align physiology and behaviours with solar cycle

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13
Q

Modifiers x 3?

A
  1. Pupillary reflex - limits light getting to RGC
  2. Sunglasses/back lights
  3. SNPs - Single Nucleotide Polymorphisms
  4. Cutaneous fat stores - affects core/peripheral temps
  5. Vascular tone - affects temps/fluid volume
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14
Q

Two factors affecting vascular tone:

A

Na - vasconstriction - increases BP

NO/oestrogen - increases vasodilaton - decreases BP

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15
Q

What are SNPs?

A

Single Nucleotide Polyomorphisms
genetic variations
If SNPs are found in in gene-coding portions can lead to non-functioning/enhanced/abnormal proteins

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16
Q

If SNPs form in x 2 what can cause circadian rhythm to be impaired?

A

CRY
PER proteins

controls circadian rhythms in the peripheral oscaillators

they work by inhibiting function of other proteins until they degrade over 24 hours

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17
Q

What are the operators?

A

body’s reactions to the modifiers (pupillary reflec, sunglasses, backlights, SNPs)

  1. core body temp changes
  2. melatonin suppression/secretion
  3. cortisol secretion and timing of spike
  4. increase/decrease of blood flow
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18
Q

Outputs?

A

Sleep/function - e.g strength, stamina, food-seeking behaviour, alert, motor skills, precision, quantity and quality

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19
Q

Inputs?

A 
Light 
Cards
Exercise 
Fluid status
Ambient temp
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20
Q

What effects does low daytime light exposure have?

A

decreased mood
decreased daytime alertness and activity

DECREASED CORE BODY TEMP
INCREASED MELATONIN SUPRESSION AT NIGHT
e.g daytime 10K lux for 6 hours can’t suppress night melatonin from 90 lux

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21
Q

If low light exposure 2-3 days ago, causes?

A

more sensitive to light at night

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22
Q

Blue night exposure at night causes?

A

increased cortisol/BP/HR
alertness
increased body temp
decreased melatonin

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23
Q

Blue light?

A

420-480nm

greatest melatonin suppression at lower intensities and shorter duration

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24
Q

What is the kelvin of a colour?

A

dominant colour at a certain temp

lower - warm colours = red, orange

higher - cooler - blue, violent

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25
Q

Kelvin of blue light?

A

650

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26
Q 
Light intensity:
moonless night 
moon 
bright industrial light 
overcast 
street light 
cloud day 
nursing home 
bright sunlight at noon 
office/kitchen 
households
A 
moonless night 0.001-0.0001
moon 1 lux 
bright industrial light 1-5 lux 
overcast 2-10 lux 
street light 20 lux 
cloudy day 25 lux
nursing home 50
bright sunlight at noon 100k  
office/kitchen 200-500
households - 50-200
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27
Q

What is the process of sleep onset?

A

darkness>pineal gland secretes melatonin> cutaneous vasodilation> warmer extremities> cools core body temp> sleep initiaion

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28
Q

Sleep onset to mid sleep process?

A

melatonin continues to rise> peripheral skin temp increases>continued core cooling> NADIR

restorative process - decreases BP and symp tone

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29
Q

What is NADIR?

A

LOW POINT core temp - reached 2-3 hours before waking

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30
Q

Throughout sleep?

A 
leptin/ghrelin secretion 
gradual increase in cortisol 
FA metabolism
insulin regulation
ATP synthesis 
emotional regulation
memory encoding/consolidatio
DNA remodelling/repair 
Increase in GH
increased peptide synthesis
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31
Q

Late sleep?

A

mid sleep>waking

decrease in melatonin> decrease in peripheral temp> increase in core body temp

increase in BP/symp tone/baroreceptor sensitivity as body prepares to wake

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32
Q

Longer REM sleep?

A

fear estingushing/limb system functioning

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33
Q

Awakening?

A

cortisol spike (24 hr peak)

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34
Q

SCN clock length most people have and ideal?

A

ideal - 24 hr

most - 24.2

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35
Q

What is a delayed phase shift?

A

SCN longer than 24 hrs

e.g. 1-3 hrs of evening light - delays melatonin secretion - delays sleep

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36
Q

What direction of travel causes a delayed phase shift to the SCN clock?

A

Eastward travel

can also occur with home lighting

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37
Q

Why are nightowls nightowls?

A

Mor suscepible to evening light so melatonin supressed

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38
Q

Advanced phase shift?

A

SCN clock is shorter than 24 hours

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39
Q

When does an advanced phase shift occur?

A

with light exposure early in the day

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40
Q

What happens to morning people?

A

more susceptible to desynchronisation due to morning light - so shifts them to early morning waking

41
Q

If someone has a shorter cycle (<24 hrs due to being an early bird and therefore more sensitive to dysregulation) what do they need to do?

A

advancement of 10 minutes

42
Q

If someone has a longer SCN clock (>24 hrs) and are therefore night owls, what should they do?

A

backwards by 20 minutes

43
Q

If someone is falling asleep too late, what can alter food wise?

A

eat dinner earlier, eat less carbs at dinner, avoid after dinner snacks

eat high carb breakfast soon after waking

44
Q

If someone falls asleep too early, what food changes can they make?

A

eat later carb breakfast

45
Q

If you have a late breakfas or skip breakfast?

A

diminished cortisol awakening

breaskfast early - shifts ealier wake up time

46
Q

Healthy sleep causes an increase in leptin - what does that do?

A

decreases food seeking behaviour

healthy sleep also decreases cortisol/glucose and improves insulin sensitivity

47
Q

Impaired sleep and short duration cases?

A 
increased NIGHT CORTISOL AND GLUCOSE
decreased insulin sensitivity 
DECREASED DAY LEPTIN - INCREASES CARB INTAKE 
DECREASED TESTOSTERONE
DECREASED GH
INncreased CHO
endoethelial dysfunction
increased AGE deposition in vascular system

riased BMI, obesity, met dynrome, T2DM, CVD risk, mortality

48
Q

Is someone is phased advanced they?

A

wake early

49
Q

what exercise pattern is best for phase advancing?

A

morning and afternoon

50
Q

if you want to phase delay - exercise?

A

evening exercise

51
Q

WHat happens to core body temp in the afternoon?

A

opposite to night - core body temp increases and peripheral temp will decrease so HR and cardiac output decreases

52
Q

late afternoon blood osmolality?

A

increases> core body temp increases to peak

(if fluid volume is decreased, less cutaneous blood flow at night, so increase cardiac activation/symp tone - shunts blood to core)

53
Q

What 3 conditions are more sensitivty to melatonin suppression?

A

SAD
Bipolar
Major depressive disorder

54
Q

What factors affect light in elderly?

A

cataract/corneal opacity limits light retinal exposure

naturally lower production of melatonin with age

e. g 45 yr old has 50% retinal luminance than 10 year old
e. r 65 year old, has 50% lower compared to 45year old

55
Q

What is BIISS?

A

Behaviourally induced Insufficient sleep syndrome

voluntary sleep restriction - sleep longer on weekends
inadequate sleep for function
7-20% on pop

30-39 yrs
Alcohol abuse, working >40 hr weeks, stress, depression

56
Q

Chronic Insomnia?

A

most common
3/week for 3 months
diff initiating and or maintaining sleep despite adequate opportunity

fatigue, impaired concentration, decrease motivation, mood, work/driving errors, headaches, GI, persisting worries about sleep

57
Q

How much of OSA is undiagnosed?
Assoc?
Scale?

A

80%
OW/Obese/HTN/mrt syndrome/ AF

Apnoea hypopnoea Index - 5-15 mild, 15-30 mod, 30 severe

58
Q

Restless leg syndrome?

A 
5-15% US pop
sens/motor 
uncomfortable sensation at REST
LEGS 
can be pain/paresthesia 
worse - EVENINGS 
Jerky movements of limbs whilst awake 
GENETIC/ACQUIRED 
PHASE DELAY OF SLEEP 
 High or low iron - no correlation with levels 
MG 
VIT D
59
Q

Short sleep misperception?

A

less sleep then realised

60
Q

secondary insomnia?

A

meds/vascular dysfunction/ peripheral hypoperfusion/visual impairment/renin-angiotension dysfunction

61
Q

Periodic Limb Movement?

A 
patient unware
movement 30 sec intervals during sleep 
no abn sensations 
>50 years ++ 
assoc with restless leg syndrome 
may complain of restless sleep/waking in night/increase daytime sleepiness
62
Q

What is the deepest stage of sleep?

A

Non-REM sleep, stage 3 - slow-wave
healthy sleep will have high proportion

increases learning/memory/fast cognitive processing/ fear extinguishing

63
Q

Impaired sleep causes decreased?

A

BDNF - misinterpretation of social cues, decrease alertness/cog processing/diminished fear extinguishment (amygdala unable to get rid of fearful events), impaired learning

64
Q

CV changes with good duration and quality of sleep?

A

decreased symp tone
increase high periperhal perfusion and core body temp decrease
INCREASE CV STAMINA AND CV RECOVERY TIME

65
Q

Impaired sleep - CV effects?

A

increase symp tome, endoethelial injury, increase Cho, HTN esp at night, decreased peripheral perfusion
NO REDUCTION IN BP IN EARLY HOURS

increased risk of MI/CVD DEATH/VASOSPASTIC DISORDERS

66
Q

Poor sleep is associated with which cancers?

A

BEPCA

breast
endometrial 
prostate
colorectal 
AML
67
Q

Cancer and poor sleep risk factors?

A

poor sleep - increases cancer stimulating cytokines - IL10
aberrant DNA methylation

Healthy sleep helps - DNA repair/histone remodelling, apoptosis and anti-cancer cytokines - IL1, IL2, TNFalpha

68
Q

Short sleep deprivation:

A

pms

PTSD and traumatic brain injury worse if poor sleep before or after

69
Q

Lifestyle changes for better sleep?

A 
naps <30 mins
Bed - S&S only 
regular sleep/wake times
natural cooling throughout night
peripheral warming- hot de caff drinks/socks/heat pads/bath and showers
hide alarm clocks/light
70
Q

How to improve with respect to light?

A

increase daytime light exposure outdoors

decrease light at night - turn off lights/dim lights 1 hr before bed especially blue light

71
Q

What spectrum of light to use at night?

A

2500k colour warm

72
Q

Diet changes for better sleep?

A 
limit day caffeine/no night caffeine
no ALCOHOL 3 HOURS BEFORE BED
NO AFTER DINNER SNACKS
ADEQUATE DAYTIME FLUID (esp late afternoon)
avoid Na esp at dinner 
optimise weight
73
Q

PA to improve sleep?

A

increase morning or late afternoon PA

AT LEAST ONE HOUR A DAY

74
Q

Stress for better sleep?

A

settle down 1 hr before bed - music 60 bpm/editation
windown routine
stop stimulating things 90 mins before bed
MBSR/CBT

75
Q

Intensive treatments for chronic insomnia?

A

1st line - chronic insomnia - more likely sustained benefit

behavioural/stimulus control/rlaxation therapy/sleep hygiene

good for >60 yrs

76
Q

Significant differences in endogenous?

A

melatonin between individuals

77
Q

Supplemental melatonin:
best bioavailability?
sustained preps best for?
no adverse effects at dose?

A

sublingual
westward jet lag - but may cause morning jet lag
1-6mg - but may interaction with some cytochrome P-450 drugs

78
Q

Hypnotic meds risks?

A

death - esp 18-55years

increased all cause mortality in all age groups - OD, car accidents, falls, deperssion, cancer, suicide

79
Q

Difficulty maintaining sleep - tx?

A 
dark room, cool glass of water near bed, cooling room 
increase morning and mid afternoon light
avoid turning lights on if wakes
increase later afternoon hydration 
avoid evening soda/alc/caff 
exercise without creating pain
stress mx
80
Q

Sleep deficiency from early waking - tx?

A

warm bedcovers
avoid light until wake up time
increase PA
increase late afternoon sunlight to stimulate melatonin

81
Q

Jet leg travelling east?

A

hearty breakfast within 30-45 mins of new wake up time
GET LIGHT ESP OUTDOORS CLOSE TO NEW WAKE UP TIME
DIM LIGHT 1 HOUR PRIOR TO NEW SLEEP TIME
melatonin 1mg SL 1 hour before new bedtime

82
Q

Jet lag travelling west?

A

GET LATE AFTERNOON AND EVENING LIGHT
AVOI DIM LIGHT UNTIL 1 HOUR BEFORE NEW BEDTIME
BREAKFAST 30-45 MINS AFTER WAKE UP TIME
COMPLEX CARBS 2-3 HRS BEFORE NEW SLEEP TIME
1 MG SL melatonin

83
Q

Does P.I ncrease of decrease tiredness?

A

2-4 times more likely to be tired

84
Q

restless legs more common in?

A

DM

85
Q

Dyssommnia? Parasomnia?

A

sleep disordes that negatively impact quantity and quality of sleep

unusual physical events before sleep/during sleep/arousal e.g. abn movements/sleep terrors

86
Q

> 8.5hrs assoc with?

A

obesity

87
Q

Sustained release melatonin

A

best for westward travel but morn drowsiness

88
Q

how long should sleep diaries be?

A

one week (for first visit)

89
Q

STOP is an assessment tool for?

A

OSA

snore loudly?
tired?
observed you stop breathing?
pressure? BP
Bmi>35, large nexk 40cm, M

> 2 increased risk

90
Q

sleep cycle?

A
  1. theta - very light - hallucinations
  2. light/transitional - theta + K-complex
  3. deep sleep - theta and delta
  4. deep - only delta
  5. REM - dream sleep
91
Q

coffee blocks?

A

adenosine R

92
Q

red light

A

2500k

93
Q

short term sleep deprivation can increase?

A

BP

94
Q

cortisol increases?

A

morning, up by 50% in 20-30 mins from waking

95
Q

sleep depreivation ghrelin and leptin

A

ghrelin - increases appetite and obesity

leptop decreases appetite

96
Q

irregular sleep affect on leptin

A

decreases appetite

97
Q 
Sleep for:
newborns 0-3m
infants - 4-11months
toddler 1-2 years
pre-school 3-5yrs 
school age 6-13 yrs 
teens 14-17 yrs 
younger adult - 18-25yrs
adults 26-64yrs
older adult >65
A 
newborns 0-3m - 14-17 hrs
infants - 4-11months - 12-15 hrs
toddler 1-2 years - 11-14 hrs
pre-school 3-5yrs 10-13 hrs
school age 6-13 yrs 9-11 hrs
teens 14-17 yrs 8-10 hrs
younger adult - 18-25yrs 7-9 hrs
adults 26-64yrs 7-9 hrs
older adult >65 7-8 hrs
98
Q

REM sleep at different ages?

A

50% in REM sleep
25% 10 yrs old
15% over 50 yrs

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