Sleep Flashcards
1
Q
Is sleep a passive activity?
A
No
2
Q
Homeostatic activity of sleep is thought to be triggered by this molecule
A
Adenosine
“fatigue factor”
3
Q
Adenosine release in pontine tegmentum and basal forebrain acts on these neurons
A
Ventral lateral preoptic nucleus (VLPO)
4
Q
Adenosine is derived from the breakdown of this
A
Glycogen
5
Q
What are the two main functions of sleep?
A
Homeostatic and Circadian functions
6
Q
This is released in pontine tegmentum and basal forebrain, and acts on ventro lateral preoptic nucleus (VLPO) nucleus
A
Adenosine
7
Q
Summed electrical activity across sleep
Desynchronized discharge that can be separated by frequency (speed) and amplitude (power)
A
Electroencephalographic (EEG)
8
Q
What is the frequency of delta waves in an EEG?
A
Less than 4 Hz
9
Q
What is the frequency of theta waves in an EEG?
A
4-7 Hz
10
Q
What is the frequency of alpha waves in an EEG?
A
8-15 Hz
11
Q
What is the frequency of beta waves in an EEG?
A
16-31 Hz
12
Q
What is the frequency of gamma waves in an EEG?
A
> 32 Hz
13
Q
EEG waveform that is <4 Hz
A
Delta
14
Q
EEG waveform that is 4-7 Hz
A
Theta
15
Q
EEG waveform that is 8-15 Hz
A
Alpha
16
Q
EEG waveform that is 16-31 Hz
A
Beta
17
Q
EEG waveform that is >32 Hz
A
Gamma
18
Q
What is the primary EEG waveform when awake with eyes open?
A
Beta (16-31 Hz)
19
Q
What is the primary EEG waveform when awake with eyes closed?
A
Alpha (8-15 Hz)
20
Q
What is the primary EEG waveform in Stage 1 of sleep?
A
Theta (4-7 Hz)
21
Q
What is the primary EEG waveform in Stage 2 of sleep?
A
Theta (4-7 Hz), sleep spindles and K complexes
22
Q
Sleep spindles and K complexes are seen in this sleep stage
A
Stage 2
23
Q
What is the primary EEG waveform in stages 3 and 4 of sleep?
A
Delta (< 4Hz)
24
Q
What is the primary EEG waveform in REM?
A
Beta (16-31 Hz)
25
These are high amplitude, slow frequency waves followed by electropositive surge
K complexes
26
These are brief bursts of alpha waves
Sleep spindles
27
Sleep spindles are brief bursts of this waveform, seen in stage 2 of sleep
Alpha waves
28
Stage of sleep that is difficult to rouse with confusion upon waking
Stage 4
29
Stage of sleep that is associated with bet wetting, sleep walking and talking, and night terrors
Stage 4
30
Is muscle tone low or high in non-REM sleep?
Low
(low EMG and EOG activity)
31
Is heart rate reduced or increased in non-REM sleep?
Reduced
32
Is BP reduced or increased in non-REM sleep?
Reduced
33
Is respiration reduced or increased in non-REM sleep?
Reduced
34
In REM sleep, brain waves resemble this stage of sleep in that they are fast and low
Stage 1
35
Is muscle tone low or high in REM sleep?
Normal
Muscles of respiration, cardiac, and eye movement are normal tone
36
Is heart rate reduced or increased in REM sleep?
Increased
37
Is respiration reduced or increased in REM sleep?
Irregular
38
Is EMG activity low or high in REM sleep?
Low
39
This EOG component may protect sleep by reducing the effects of external stimuli
May also promote consolidation of memory and neuronal plasticity
Sleep spindles
40
What age do infants start to have REM and NREM becoming evident? (ultradian rhythm)
6 months
41
At this age, sleep moves towards a night activity (circadian rhythm)
3 years
42
At midlife, sleep efficiency and time start to decline, with notable loss of these stages
3 and 4
43
Cholinergic pathways involved in wakefulness are located in these two nuclei
Pedunculopontine and Laterodorsal tegmental
44
These pathways involved in wakefulness are located in pedunculopontine and laterodorsal tegmental nucleus
Cholinergic
45
Cholinergic pathways are inhibited by onset of this type of sleep
Non-REM
46
Neural system involved in wakefulness that is in the dorsal raphe nucleus
Serotonergic
47
Neural system involved in wakefulness that is in the locus coeruleus
Noradrenergic
48
Neural system involved in wakefulness that is in the ventral periaqueductal gray
Dopaminergic
49
Neural system involved in wakefulness that is in the tuberomammillary nucleus
Histaminergic
50
Neural system involved in wakefulness that is from the lateral hypothalamus
Orexin (formerly hypocretin)
51
VLPO activity may be triggered by accumulation of this molecule
Adenosine
52
VLPO releases this neurotransmitter
GABA
53
Does VLPO promote or inhibit sleep?
Promotes
(inhibits wakefulness pathways via release of GABA)
54
REM sleep is related to activation of these two nuclei
Pedunculopontine and laterodorsal tegmental nucleus
(which have cholinergic pathways)
55
Cholinergic projections from pons to these two structures regulate atony during REM
Medulla and spinal cord
56
Cholinergic projections to these two structures trigger phasic eye and cardiac/respiratory activity during REM
Hypothalamus and Thalamus
57
Sleep is promoted by activity of this nucleus
Ventrolateral preoptic nucleus (VLPO)
58
Wakefulness is associated with activity of this nucleus
Histaminergic tuberomammillary nucleus (TMN)
59
Wakefulness-sleep switch may be triggered by this compound located in key nuclei of sleep/wakefulness
Orexin
60
Neurons of this nuclei fire in a circadian pattern with a 24 hour period
Suprachiasmatic
(may be regulated by light input and melatonin secretion)
61
Melatonin is secreted by this gland
Pineal gland
62
Melatonin acts on this nucleus
Suprachiasmatic nucleus ("master clock")
63
Orexin is a neurotransmitter that maintains sleep or wakefulness?
Wakefulness
64
This neurotransmitter system activates REM during sleep
Acetylcholine
65
Excessive daytime sleeping
Hypersomnia
66
Sudden and uncontrollable onset of REM sleep during wake state
Narcolepsy
67
Parasomnia where person acts out dream during sleep and muscles may not be atonic
REM sleep disorder
68
Sleep walking and sleep terrors are associated with this parasomnia
Non-REM sleep arousal disorders
69
These are effective for short-term treatment of insomnia
Sedating antihistamines
70
Sedating antihistamines MOA in sleep involves central blockage of these 2 receptors
Histamine-1 and cholinergic
71
Treatment for insomnia with sedation MOA related to central blockage of histamine-1 and cholinergic receptors
Sedating antihistamines
72
Are sedating antihistamines safe for use during breastfeeding?
Probably
73
Insomnia drug type that is contraindicated with alcohol or any CNS depressant, anticholinergics, or monoamine oxidase inhibitors
Sedating antihistamines
74
This type of drug is considered alternative drug option for patients needing restorative sleep but cannot be treated with a depressant
Antidepressants
75
Trazodone and Doxepin are this type of drug for insomnia
Antidepressants
76
What is the MOA of Valerian for insomnia?
unknown, may prolong GABA activity
77
Valerian is an alternative medication used to treat this
Insomnia
78
Valerian can treat insomnia, potentially by prolonging this activity
GABA
79
This drug is indicated to promote the onset of sleep
Not a controlled substance so may be a viable sleep aid for patients with history of substance abuse
Ramelteon
80
Type of melatonin receptor that regulates sleepiness
Meltonin-1
81
Type of melatonin receptor that helps body shift from day and night
Melatonin-2
82
This drug with a non-sedation MOA is an agonist at the melatonin-1 and melatonin-2 receptors believed to be involved in regulation of circadian sleep rhythms
Ramelteon
83
Ramelteon is an agonist of these two receptors
Melatonin-1 and -2
84
What is the MOA of Ramelteon in insomnia?
Indicated to promote the onset of sleep
Agonist at the melatonin-1 and -2 receptors
85
What effect do sedating antihistamines have on REM?
REM is decreased
(sleep time increased)
86
What effect does Ramelteon have on REM?
May suppress REM
87
Ambien is this drug
Zolpidem
88
Z-drug used for short-term sleep induction
Zolpidem (Ambien)
89
Controlled release of this Z-drug is used for short-term sleep maintenance
Zolpidem (Ambien)
90
Z drug used for short-term sleep induction
Zaleplon
91
Z drug used for sleep induction and maintenance
Eszopiclone
92
What is the MOA of Z drugs (Zolpidem, Zaleplon, Eszopiclone) in insomnia?
Enhancement of GABA-benzodiazepine receptor complex
("non benzodiazepine GABA-A agonist")
93
Type of drug for insomnia with minimal to no antianxiety, muscle relaxant or anticonvulsant activity
Little disruption of the sleep stage pattern
Z drugs (Zolpidem, Zaleplon, Eszopiclone)
94
What is the half life of Zolpidem?
3 hours
95
What is the half life of Zaleplon?
1 hour
96
What is the half life of Eszopiclone?
6 hours
97
Z drug with half life of 3 hours
Zolpidem
98
Z drug with half life of 1 hour
Zaleplon
99
Z drug with half life of 6 hours
Eszopiclone
100
This is an antagonist to Z drugs
Flumazenil
101
Triazolam has a half life of 2 hours and is this type of drug used to treat insomnia
Benzodiazepine
102
This drug's allosteric binding site activation results in enhancement of GABA-associated hyperpolarization
Benzodiazepine
103
What effect do benzodiazepines have on the sleep stages?
Increase stage 2
Decrease stages 3, 4, and REM
104
Do Z drugs or Benzodiazepines have Sedation, antianxiety, muscle relaxant and anticonvulsant activity?
Benzodiazepines
(Z drugs have minimal activity)
105
Insomnia drug type that increases stage 2 sleep while decreasing stages 3, 4, and REM
Benzodiazepines
106
Are benzodiazepines safe during pregnancy?
No
107
This benzodiazepine has an active metabolite
Flurazepam
108
Is Temazepam safe during breastfeeding?
Probably
109
Is dependence seen with use of benzodiazepines?
Yes
Withdrawal symptoms following abrupt discontinuation
110
This is a Benzodiazepine binding site blocker
Antidote for overdose
Flumazenil
111
Insomnia drug with sedative effects related to active metabolite trichloroethanol
Chloral Hydrate
112
Chloral Hydrate sedative effects are related to this active metabolite
Trichloroethanol
113
Drug that is an Orexin (hypocretin) antagonist used to promote and maintain sleep
Suvorexant
114
Suvorexant is an antogonist to this, and is used to promote and maintain sleep
Orexin (hypocretin)
115
What is the half life of Suvorexant?
12 hours
(is associated with considerable grogginess and hangover)
116
Is dependence seen with use of Suvorexant?
yes
117
Insomnia drug that is also used in Alzheimer's
As with any sleep aid in elderly or cognitive-impaired patients, increased risk of falls is still a concern
Suvorexant
118
What is the MOA of Suvorexant for insomnia?
Orexin (hypocretin) antagonist
Used to promote and maintain sleep
119
MOA of this insomnia drug is central anticholinergic and antihistaminic
Sedating antihistamines
120
This is the drug of choice for patients with history of drug abuse needing sleep aids
Trazodone
121
As a Complementary and Alternative Med, this drug may be ideal for patients on the cusp of needing pharmacotherapy for sleep
Valerian
122
This drug has some value in treating sleep problems related to circadian (shift) problems, some reports of memory disruption and reduced libido, some risk of physical dependence
Ramelteon (and Tasimelteon)
123
What insomnia drug should be used for patients with sleep problems related to circadian (shift) problems?
Ramelteon
(and Tasimelteon)
124
Do Z drugs affect the quality of sleep?
Very good sleep
125
Lower dose of this insomnia drug should be given in women due to slower metabolism
Zolpidem
126
This type of drug for insomnia can cause powerful amnesia
Z drugs
127
This type of drug should be given when stage 4 and REM suppression is desired
Benzodiazepines
128
Sleep paralysis is a side effect of this insomnia drug
Suvorexant
129
Narcolepsy may be caused by a deficiency in this
Hypocretin
130
What is the tetrad of symptoms of narcolepsy?
Sleep attacks
Cataplexy
Hypnagogic and Hypnopompic hallucinations
Sleep paralysis
131
Sleep attacks, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis are a tetrad of symptoms seen in this condition
Narcolepsy
132
Narcolepsy pharmacological treatment is with these
Mixed catecholamine agonists ("stimulants")
133
Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, modafinil, armodafinil treat this part of narcolepsy
Excessive daytime sleepiness
134
Fluoxetine, imipramine, nortriptyline, protriptyline, venlafaxine, selegiline treat this part of nacrolepsy
Cataplexy
135
Benefit of these 2 drugs for naroclepsy is lost when combined with alpha-antgonists (e.g. prazosin)
Modafinil and Armodafinil
136
Modafinil and Armodafinil benefit is lost when combined with this type of drug
Alpha-antagonists (such as Prazosin)
137
Cardiac arrhythmias, Visual changes, Hypertension and Dependence are serious adverse reactions to these 2 drugs for narcolepsy
Modafinil and Armodafinil
138
MOA of this type of drug for narcolepsy is indirect stimulation of norepinephrine (low dose) and dopamine (higher dose) activity
Direct stimulation of norepinephrine and dopamine receptors
Mixed monoaminergic agonists
139
Low doses of mixed monoaminergic agonists results in indirect stimulation of this activity
Norepinephrine
140
Higher doses of mixed monoaminergic agonists results in indirect stimulation of this activity
Dopamine
141
Mixed monoaminergic agonists directly stimulate these 2 types of receptors
Norepinephrine and Dopamine
142
Growth suppression when used long-term, Psychosis and depression, Hypertension, Cardiac arrhythmias (black box warning) and Seizures are serious adverse effects of this type of drug for narcolepsy
Mixed monoaminergic agonists
143
Mixed monoaminergic agonists should not be given with either of these 2 types of drugs
Monoamine oxidase inhibitors
CNS drugs
144
Mixed monoaminergic agonists are contraindicated in patients with either of these two conditions
Epilepsy
Cardiovascular or cerebrovascular disease
145
Disorder characterized by repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors
Upon awakening from these episodes, individual is completely awake, alert, and not confused/disoriented
REM sleep behavior disorder
146
Benzodiazepine that is the preferred treatment for REM sleep behavior disorder
Clonazepam
(melatonin may be a second drug)
147
This is a comorbidity associated with sleep walking
Obsessive-compulsive disorder
148
This is a comorbidity associated with sleep terrors
Depression or anxiety
149
What is the pharmacological treatment for both REM and non-REM sleep disorders?
Benzodiazepines
150
What is the pharmacotherapy used to treat restless leg syndrome?
Usually the dopamine agonist therapies used in Parkinson's
(direct agonists appear superior to indirect agonists)
