Sleep

Question 1

• Homeostatic drive to sleep? What blocks it?
• SWS when? Dream sleep?
• Sleep walking/ terrors = what off? what on?
• Narcolepsy due to? Why?
• REM sleep behavior disorder? Treat with? (2)
• Melatonin produced where? By?
• N-REM: Brain waves? Adults enter in?
• REM Sleep: How often? EEG? Not paralyzed muscles? (3) Brain temp? Infants enter in?
• NT’s of NREM? (2)
• NT’s of REM? (5)

Answer 1

• Adenosine in hypothalmus; caffeine
• early in sleep; late
• Frontal lobe; cingulate gyrus
• Not enough hypocretin; stabilizes awake
• LMN not inhibited; Melatonin/clonazipam
• Pineal gland in dark
• slow delta; this stage
• 90 min; like awake; eye, mid ear; diaphragm; increases; this stage
• Gaba; Galanine
• ACH, low GABA, Galanine, DA, some hypocretin

Question 2

• Interaction of Circadian (process C) and Homeostatic System (process S): Circiadian linked to? Homeo to?Process C ossilates? Process S through day? Process C?
• CNS increasing effects of GABA? (6)
• GABA receptor: Gaba binds? ethanol? z drugs? BDZ? Flumazenil?
• a1 location? effects? (4)
• a2-5 location? (2) Effects? (2)
• Combined lead to? (3)
• Normal sleep: REM? Phase 2? Phase 4-5 (SWS)?
• Insomnia: Latency? Mostly stage what? SWS? REM?
• BDZ do what? (5)
• Z drugs do what? (5)

Answer 2

• Core body temp; adenosine build up; regardless of external cues such as sunshine; increase; increase until right before bed
• Anxiolysis, sedation, hypnosis, anesthesia, med depression, coma
• ab, non specific, a1, a1/a2-5, anatagonist
• cortex; sleep, anti conv., amnesia, additive CNS depression
• Limbic/brainstem; anxiolytic, myorelaxant
• Tolerance, dependence, less REM
• 20%; 50%; 25%
• Higher; 2; down, down
• Less latency, more stage 2/duration; less REM/SWS
• Less latency, more stage 2/duration; no effect REM/SWS

Question 3

BDZ’s: Adverse? (3)
1.) Triazolam: Onset? 1/2 life? SE?
2.) Temazepam: Absorption? Half life? Effect on latency?
3.) Flurazepam: 1/2 life? Metabolite? Not for who?
Z drugs: Adverse? (4)
1.) Zolpidem/Zalepon: Onset? Half life? Difference in usage?
2.) Eszopicoline: Structurally different than? 1/2 life? Good for? Why?
- BDZ and Z with pregnancy?
- Treatment order? (3)

Answer 3

• Daytime sedation (flu accum); antero amne (Tria>Tem); rebound insomnia with short half lives
  1. ) Quick; Short; Rebound insomnia
  2. ) slow; intermediate; none
  3. ) Long; active; ELDERLY
• Drowsy, amnesia, HA, behavioral
  1. ) Quick; short (zol = 2.5/ zal = 1); Zal no decr. awakenings
  2. ) Z drugs; longer; sleep maintenance; safe long term
• Fine
• Non drug; z drugs/ramelteon; short acting BDZ (Tem)