Sleep Flashcards
Ways to define sleep?
Duration
Timing
Quality
Having a sleep disorder increases mortality by how much?
1.5 x
What is the body’s master circadian clock?
ie control center for sleep and arousal
Where is it located?
Suprachiasmatic nucleus (SCN)
in the hypothalamus
oscillator and pacemaker
What are ‘zeitgebers’?
internal and external stimuli
- that entrain the master clock
Most potent –>Light
Melatonin is produced by what?
What does it do?
Pineal gland
- night hormone
Promotes night time things and sleep
Melatonin peaks when?
30 mins before anticipated bedtime
Plateaus for rest of night
Rapidly decreases close to subjective day
Melatonin ceases at first light exposure, approx 30 min after wake
What does melatonin inhibit?
SERT
- sodium dependent serotonin transporter
Physiologic changes induced by healthy sleep?
Lower cortisol
Lower glucose
Greater insulin sensitivity
Higher daytime leptin
- reduced food seeking behav
Healthy sleep impact on CV disorders
Lower sympathetic tone
Low BP
Greater night peripheral perfusion
Core body temp cooling (night)
Increased stamina
Faster CV recovery time
Appropriate duration and timing of REM is associated with…?
- enhanced learning and memory
- faster cognitive processing
- greater extinguishment of anxiety and fear
When should you order a PSG study?
ie for which disorders?
Breathing-related sleep disorder
Narcolepsy
Nocturnal seizures
Periodic limb movement disorder
REM sleep behaviour disorder
For what conditions is a PSG not required?
Circiadian rhythm disorder
Insomnia disorder
NREM partial arousal parasomnia
Nightmare disorder
Restless legs syndrome
NREM stages
Stage 1.
- slow brain waves
- 2% of night
- enter sleep
Stage 2.
- 50% of night
- logical dreams
Stage 3.
- 20-25% of night
- deep sleep (good for memory)
- delta waves
- first half of the night
- restorative
Features of NREM sleep?
- sensation/perception
- thoughts
- movement
sensation and perception
- dulled/absent
thoughts
- logical and perseverative
movement
- episodic and involuntary
Features of REM sleep?
- sensation/perception
- thoughts
- movement
sensation and perception
- vivid
- internally generated
thoughts
- illogical and bizarre
movement
- inhibited
How long in REM?
First episode how long after sleep?
Most of REM occurs when?
REM important for?
Dreaming?
20-25% of night
90-120 min
2nd half
memory, brain dev, emotional consolidation
Most dreaming occurs here
Sleep assessment tools?
Sleep diary
Retrospective mini sleep ass’t
SQS (single item sleep quality scale)
Pittsburgh Sleep Quality Index
STOP-BANG
ESS
ASHS (adolescent sl hygeine survey)
STOP-BANG
Snoring
Tired, often
Observed apnoea
Pressure, elevated
BMI > 35
Age > 50
Neck size > 43cm
Gender, male
How to manage:
Delayed sleep onset or
Difficulty with sleep initiation
Enviro: bed only for sleep and sex, min noise and light , warm extremeties at bedtime
Light exp: early morning sun, afternoon activity, less light at night
Diet: reduce caffeine, etoh, sodium at night, carb rich bf and low carb dinner
Exercise: morning or afternoon
Stress: start winding down > 1 hr before bed; bath, meditation
How to manage:
Sleep fragmentation or
Difficulty maintaining sleep
Enviro: darken bedroom, cool room during night, keep glass of cool water at bedside
Light exp: imcrease morning and mid-afternoon sunlight exposure, activity outdoors, avoid turning on light for middle of night wakings
Diet: increase late afternoon hydration, avoid evening diuretics (soda, caffeine, alcohol)
Exercise: without pain
Stress: mitigate worrying, planing, ruminatin
How to manage:
Sleep deficiency from waking too early
Enviro: sufficient bedcovers to be warm in early morning
Light exp: avoid bright light until ideal wake time, increase late afternoon / evening sunlight (to increase melatonin prod); use blue spectrum lights until 1hr before bedtime
Diet: avoid caffeineuntil 30-60 mins after ideal wake time; have more carbs at dinner (not bf)
Exercise: increase evening physical activity
How to manage:
Jetlag traveling east
Light exp: exposure to bright light (pref outside) close to new ideal wake time; only dim light starting 1 hour before new bedtime
Diet: hearty bf within 30-45 min of new ideal wake time
Melatonin may assist
How to manage:
Jetlag traveling east
Enviro: darken bedroom, cool room during night, keep glass of cool water at bedside
Light exp: imcrease morning and mid-afternoon sunlight exposure, activity outdoors, avoid turning on light for middle of night wakings
Diet: increase late afternoon hydration, avoid evening diuretics (soda, caffeine, alcohol)
Exercise: without pain
Stress: mitigate worrying, planing, ruminating
How to manage:
Sleep deficiency from waking too early
Enviro: sufficient bedcovers to be warm in early morning
Light exp: avoid bright light until ideal wake time, increase late afternoon / evening sunlight (to increase melatonin prod); use blue spectrum lights until 1hr before bedtime
Diet: avoid caffeineuntil 30-60 mins after ideal wake time; have more carbs at dinner (not bf)
Exercise: increase evening physical activity
How to manage:
Jetlag traveling east
Light exp: exposure to bright light (pref outside) close to new ideal wake time; only dim light starting 1 hour before new bedtime
Diet: hearty bf within 30-45 min of new ideal wake time
Melatonin may assist
How to manage:
Jetlag traveling west
Light exp: late afternoon and early evening bright light, pref outside; avoid dim light until 1 hour before ideal sleep time
Diet: hearty bf within 30-45 min of new ideal wake time; complex carb rich dinner 2-3 hrs before new ideal sleep time
Melatonin may assist
OSA severity (AHI)
Mild
Mod
Severe
Mild 5 < 15
Mod 15 < 30
Severe 30+
Indications for a sleep specialist referral
Requires PSG
RLS
Narcolepsy
Periodic limb movement
CBT-i
when?
If doesn’t need PSG
If non adherent to CPAP
Methods of CBT-i
- Behavioural therapies (SCT)
- Sleep restriction therapy
- Relaxation training therapy
Stimulus control therapy
Limit bed to sleep and sex
If unable to sleep in 15-20 min, get out of bed and do low-key activity until feeling sleepy
Return to bed to attempt sleep
Repeat until sleep occurs
Sleep Restriction therapy
Stable bedtime / wake time
- strengthen circadian rhythm
