Sleep Flashcards
What is slow wave sleep? Or deep sleep
Voluntary muscle paralysis
What happens during slow-wave sleep?
During this stage your blood pressure drops and your body begins to self-repair. Blood flows to muscles. Growth hormones are stimulated. It is difficult to wake up during this stage and 95% of your growth occurs
What is REM sleep?
Rapid eye movement sleep, it is the stage of sleep where most of your dreams happen
What does your brain activity look like during REM sleep?
Brain activity looks very similar to brains activity while you are awake
How much of your total sleep time does REM sleep make up?
25%, your first REM cycle of a sleep period is typically the shortest around 10 minutes. Each one that follow lasts up to about an hour (cleaveland clinic)
What is the one muscle that works during REM sleep?
Diaphragm, the rest of the muscles have limited movement (hypotonia) decreases muscles movement.
Describe the hours of sleep that you need as you age
You have decreased slow wave sleep, increased wakenings, slight decrease in total sleep time
What is the average sleep you need up >65 years?
6.5 hours
What is a compound that decreases as you age for sleep?
Melatonin
What are the two processes that govern sleep and wakefulness?
Homeostatic sleep drive and intrinsic circadian rhythm
What is the homeostatic sleep drive?
An increase in pressure with more time we are awake whic makes you want to sleep at the end of the day, which then decreases during sleep.
What is intrinsic circadian rhythm?
Clocks, we are alert in the day (with a midafternoon dip)
What is obstructive sleep apnea?
Decreases in saturation of haemoglobin (oxygen saturation decreases). The airways are partially or completely blocked. Breathing stops and carbon dioxide will accumulate
What is the ribcage movement like in obstructive sleep apnea?
There is a period of activity in the ribcage but has become irregular, as there is no airflow
What is central sleep apnea?
Where there is something going on in the brain. There is no effort to breath with a cessation of airflow
What happens to the ribcage in central sleep apnea?
The ribcage doesn’t move as it isn’t getting the right signals from the brain - so there is no drive to breathe. The condition is rare
What is the pathophysiology for obstructive sleep apnea?
Increased surface forces acting on the upper airway. Complete or partial collapse of the upper airway
What are the symptoms for obstructive sleep apnea?
Snoring, witnessed apneas during sleep, excessive daytime sleepiness
What are the anatomic factors that promote the pharyngeal narrowing?
Large neck, soft tissue, bone and vessels
What are some additional factors that promote obstructive sleep apnea?
Alcohol use, smoking and using sedatives and hypnotics
What are associated medical disorders with obstructive sleep apnea?
Endocrine disorders, neurological disorders, prayer willi syndrome, Down syndrome, congestive heart failure, atrial fibrillation, obesity hypoventilation syndrome (slowik JM et al)
What muscles are required to maintain patency?
Pharyngeal muscles
What are some predisposing factors for OSA?
Neck size, calories, jaw shape, tonsils and retrognathia
What is AHI?
The number of apnea events divided by the number of hours of sleep
What is the normal AHI?
<5
What is considered mild apnea?
5<15
What is considered moderate sleep apnea?
15<30
what is considered severe sleep apnea?
> 30
How can help retrognathia causing obstructive sleep apnea?
Extensive teeth removal
What is the treatment for obstructive sleep apnea?
Weight loss, sleep hygiene (avoidance of sedatives, positional changes), mandibular advancement, nasal continuous positive airway pressure (CPAP)
What is CPAP?
Forcing the airway open - the collapsed airway is now open
What happens as you increase the pressure in CPAP?
The airway dilates
What can you get back once you have been treated from obstructive sleep apnea?
Your driving licence back
What are other sleep disorders?
Circardian rhythm disorders, insomnia, narcolepsy, REM sleep behaviour disorder
What is narcolepsy?
Excessive sleepiness due to neurological condition caused by failure of neurotransmission in a tiny subset of brain neurones - some people feel like they can’t move (sleep paralysis)
What is a REM sleep behaviour disorder?
Progressive, with loss of normal REM Antonia leading to acting out of dreams, change in dream content
What is REM sleep behaviour disorder treated with?
Clonazepan (or other long acting hypnotics)
