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Neuro 2 > Sleep > Flashcards

Sleep Flashcards

1
Q

Sleep

A
  • reversible behavioral state of perceptual disengagement from, and unresponsiveness to the environment
  • essential for heath in all mammals (sleep deprivation can be fatal)
  • not absence of all brain activity, but series o complex, precisely regulated brain states that are activated & deactivated by multiple sets of diencephalic & brainstem nuclei
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2
Q

Sleep Demographics

A
  • normal adults average 7.5 +/- 2 hrs per night
  • sleep occupies approximately 1/3 of lifespan
  • normal sleep duration dec. with inc. age
  • sleep deprivation leads to decreased mental & physical performance & eventually death
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3
Q

Biological Clock

A
  • group of cellular/molecular cycles inherent in a variety of body organs that drive a host of circadian rhythms
  • contain + & - feedback loops that allow the mechanism to cycle with a regular time constant
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4
Q

Suprachiasmatic Nucleus

A
  • anatomical pathway by which ambient light regulates melatonin synthesis and secretion
  • rise of melatonin beginning in early evening as daylight wanes & peaking around 2-4 am
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5
Q

Polysomnography

A

-method of measuring sleep

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6
Q

Sleep Lab

A
  • sleep room with wall mounts for connecting physiological monitors to the patient
  • monitors air flow of nose
  • scalp to monitor EEG, face sensors to monitor eyelid movement, monitor respiration, monitor blood ox
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7
Q

Sleep frequencies

A
  • 5 stages (changes of EEG)
  • Beta > 13 Hz
  • Alpha 8-13 Hz
  • Theta 4-7 Hz (stage I & II)
  • Delta <4 Hz (stage III & IV)

-alpha & beta normal awake humans

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8
Q

REM stage

A
  • 5th
  • Rapid Eye Movement
  • associated eye movements, physiological changes
  • EEG characteristics: fast frequency, low voltage, close to awake state
  • theta and beta
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9
Q

Sleep Stages (Cycle)

A

Stage I - IV Non Rapid Eye Movement Sleep or NREM sleep & stage V is rapid eye movement REM

  • Frequency (hertz, cps) and voltage
  • Stage I sleep is lightest sleep and stage IV is deep sleep
  • Stage II is characterized by bursts of activity called sleep spindles and K complexes
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10
Q

Stage II Sleep

A

-unique “spindle” and “K-complex” patterns

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11
Q

Sleep Cycle

A
  • starts with Stage I and ends with REM sleep (90 min)
  • during duration of stages 3 & 4 sleep lasts longer early in the sleep cycle while REM sleep duration & frequency increase toward the morning or waking hours
  • tend to be 5-6 cycles of NREM and REM sleep during a 7-8 hr sleep period
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12
Q

Physiologic Changes in Sleep Cycle: NREM sleep

A
  • few eye movements, when they occur they are slow, rolling
  • decreased muscle tone but movement still occurs
  • decreased HR, BP, RR, temp, metabolic rate
  • dreams occur but they are less vivid with low emotional content
  • sleep walking and night terrors occur during slow wave sleep
  • all changes reach a maximum during stage IV sleep
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13
Q

Physiologic Changes in Sleep Cycle: REM sleep

A
  • rapid, ballistic eye movements
  • muscle paralysis
  • HR, BP, RR, temp., metabolic rate approach awake level
  • dreams are vivid with strong emotional content, bizarre
  • penile and clitoral erection in REM
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14
Q

Neural Sleep Circuits

A

-awake state: activation of the following nuclei promote wakefulness
Brainstem Nuclei:
-cholinergic neurons in pedunculopontine (PPT) and lateral-dorsal tegmental (LDT) areas
-noradrenergic neurons in the locus ceruleus
-dopaminergic neurons in substantia nigra
-serotonergic neurons in raphe nuclei
Hypothalamic Nuclei:
-histaminergic neurons in tuberomammillary nucleus
-orexin/hypocretin neurons in the lateral hypothalamus

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15
Q

Cholinergic Neurons

A
  • from pedunculopontine (PPT) & lateral dorsal tegmental (LDT) areas project to the thalamus and other brainstem areas
  • activation signals thalamic-cortical signaling with high frequency, low voltage EEG consistent with arousal and alertness
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16
Q

Noradrenergic Circuits

A

-imput from locus ceruleus to the neocortex is highly activated during wakefulness, less so during NREM sleep, and nearly silent during REM sleep

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17
Q

Serotonergic Circuits

A
  • from dorsal and medial raphe nuclei are highly active during wakefulness, less during NREM sleep, and nearly silent during REM sleep
  • variety of drugs influence sleep (tricyclic antidepressants & selective serotonin reuptake inhibitors (SSRIs)
18
Q

Histaminergic Circuits

A
  • out put from tuberomammillary nucleus is high during wakefulness, lower during NREM sleep, and still lower during REM sleep
  • drugs that block histamine H1 reeceptors, such as diphenhydramine inc. NREM and REM sleep
19
Q

Hypothalamic Nuclei

A

-suprachiasmatic & paraventricular nuclei involved in the light/dark regulation of pineal gland production of Melatonin

20
Q

Somnogens

A
  • endogenous sleep-promoting chemicals that may accumulate during wakefulness and promote sleep onset
  • Adenosine: accumulates in CNS during wakefulness & declines during sleep
  • Cytoines: IL-1B and TNF promotes sleep
  • Melatonin: Synthesis turned on by dec. light
21
Q

Sleep Symptoms

A
  • Sleepiness
  • Insomnia
  • Snoring
  • Abnormal Behaviors
  • Nightmares
  • Abnormal Movements
22
Q

Multiple Sleep Latency Test

A

-EEG defined sleep latency, the time required to fall asleep measured during 4-5 daytime naps

23
Q

Epworth Sleepiness Scale

A

-self-reported tendency to fall asleep in 8 different situations differing in their soporific nature

24
Q

Obstructive Sleep Apnea (OSA)

A

-repetitive blockage of the respiratory pathway during sleep causing apneic periods lasting longer than 10 sec and causing oxyhemoglobin desaturations of more than 4%

25
Q

OSA epidemiology

A
  • 3-5% of population (4% men, 2% women age 30-60)
  • more common in men
  • incidence inc. with obesity but occurs also in the non-obese
  • strong association b/w OSA, heart disease, HTN
26
Q

OSA Pathogenesis

A

-complex interaction b/w pharyngeal muscles, tongue, and soft tissues leading to airway obstruction

27
Q

OSA Physical Findings

A
  • Nasal obstruction
  • Tonsillar/adenoid hypertrophy
  • macroglossia
  • reflux laryngitis
  • shirt collar size > 17 in
  • hypothyroidism with goiter
  • truncal obesity
  • HTN
  • congestive heart failure
  • pitting edema of lower extremities
  • enlargement of hands & feet (acromegaly)
28
Q

OSA Symptoms

A
  • excessive daytime fatigue
  • snoring
  • heartburn
  • memory loss
  • irritability
  • depression
  • morning headache
  • shortness of breath
  • nocturia
  • impotence
29
Q

Narcolepsy

A
  • excessive daytime sleepiness associated with one or more of the following tetrad
    • sleep attacks/intrusions, irresistible, daytime sleep onset
    • cataplexy (abrupt loss of muscle tone during waking hours
    • sleep paralysis - persistent REM sleep atonia after awakening
    • hypnagogic hallucinations - dream persistent after awakening
30
Q

Narcolepsy Epidemiology

A
  • 0.05-0.2% (200,000 in US)
  • symptom onset 90% develop symptoms by 2nd-3rd decade
  • symptoms persist throughout life
  • male = female
  • familial tendency: 1st deg. relatives have 1-2% inc. risk
31
Q

Secondary Narcolepsy

A

-associated with multiple sclerosis, pituitary tumors, vascular malformations, stroke

32
Q

Narcolepsy Pathogenesis

A
  • loss of hypocretin/orexin secreting neurons in the posterior lateral hypothalamus related to:
  • HLA genes DQ1, DQB1*0602 that may predispose to an autoimmune attack on orexin secreting neurons
  • secondary to tumor, stroke, to orexin secreting neurons
33
Q

Naracolepsy Lab

A
  • clinical presentation with components of tetrad
  • low CSF hypocretin-1 level (10% normal)
  • Polysomnography (mean sleep latency test - MSLT of < 8 min)
  • sleep onset REM period >2 episodes of SOREMPs
34
Q

Naracolepsy Treatment

A
  • Daytime sleepiness - methylphenidate, Modafinil, Gama-hydroxybutyrate
  • Cataplexy - tricyclic antidepressants, SSRIs
35
Q

Insomnia

A

-difficulty falling asleep or remaining asleep

36
Q

Epidemiology of Insomnia

A
  • Transient insomnia - days to weeks; affects 50% of adults during lifetime
  • Chronic insomnia - >6 weeks, affects 25% of adults
  • Female: Male 1.3:1
  • Strong association b/w insomnia & depression
37
Q

Insomnia Causes

A
  • delayed sleep onset
  • primary: idiopathic, psychophysiologic
  • secondary: anxiety, physical activity, jet lag, shift work, sedative withdrawal, stimulant drug use
  • Failure to maintain sleep: obstructive sleep apnea, aging, sedative wear-off, depression, REM disorder, medication effects, CNS degenerations
38
Q

REM sleep Behavior Disorder

A

-loss of atonia/paralysis during REM sleep leading to physical acting out of dream states including verbalization, punching, kicking, jumping from bed; this activity can cause physical injury to the bed partner or patient

39
Q

REM sleep Behavior Disorder: Epidemiology

A
  • RBD present in 0.5% of population

- most common in adult makes over 50

40
Q

REM sleep Behavior Disorder: Pathogenesis

A
  • primary RBD may be idiopathic or associated with alpha-synucleinopathies (parkinsons, multisystems atrophy, lewy body dementia, progressive supranuclear palsy)
  • secondary RBD can be caused by EtOH withdrawal, TCA, and SSRI use
41
Q

REM sleep Behavior Disorder: Treatment

A

-RBD responds well to Clonazepam

Neuro 2 (16 decks)

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