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Sleep Flashcards

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1
Q

How many stages of sleep is there?

A

4 stages in non-REM sleep
REM sleep - rapid eye movement (5-30mins)

Deepest sleep is at stage 4
Length of sleep cycle decreases as sleep goes on

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2
Q

Which neurotransmitter promotes REM sleep?

A

Melanin- concentrating hormone

This comes of the lateral hypothalamus

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3
Q

What is the role of orexin?

A

Orexin is produced from the lateral hypothalamus and promotes wakefulness. Orexin neurones also stimulate and reinforce locus coeruleus, raphe nuclei and the tuberomamillary nucleus which produces NA, 5-HT and H respectively that also promotes wakefulness

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4
Q

What drives sleep?

A

Ventrolateral preoptic area (VLPO) have neurones that inhibit neuronal activity of nuclei involved in arousal and wakefulness ie: LC, RN, RMN and orexin

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5
Q

Why do we transition into sleep?

A

Wakefulness is maintain by a positive feedback loop of the ARAS
BUT
1. overtime, homeostatic (accumulation of adenosine) and circadian drives build
2. Positive feedbacks fades, sleep promoting areas start to dominate

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6
Q

What is the role of melatonin?

A

Is a physiological signal for darkness

Facilitates onset of sleep and maintenance of sleep

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7
Q

Why do we need sleep?

A
  1. To restore normal balance to neuronal areas
  2. Neurodevelopment
  3. Memory consolidation
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8
Q

What are some types of dyssomnias and parasomnias?

A

Dyssomnia: Insomnia disorder, hypersomnolence disorder, narcolepsy

Parasomnia: Nightmare disorder, sleep terror, sleepwalking disorder

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9
Q

What are some extrinsic and intrinsic causes of dyssomnias?

A

Extrinsic: stress, hygiene
Intrinsic: restless leg syndrome, sleep apnoea

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10
Q

What are 4 types of primary insomnias?

A
  1. Acute transient insomnia (identifiable stressor)
  2. Psychophysiological insomnia (learned or conditioned insomnia, persistent even after stressor is removed)
  3. Idiopathic
  4. Paradoxical insomnia (sleep state misinterpretation)
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11
Q

What can secondary insomnia be due to?

A
  1. Inadequate sleep hygiene
  2. Psychiatric disorder
  3. Medical condition such as restless leg syndrome, pain, hotflushes
  4. Drugs or substance
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12
Q

What management options are there for insomnia?

A

Non pharmacological: mainstay

Pharmacological: short term, intermittent use of sedative/ hypnotics

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13
Q

What type of behavioural therapies are available?

A
  1. Stimulus
  2. Sleep restriction
  3. Sleep hygiene
  4. Relaxation training
  5. Cognitive therapy
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14
Q

When should hypnotics not be used?

A
  1. Sleep apnoea

2. Alcohol abuse (respiratory depression)

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15
Q

How long should BZD be used for to treat insomnia?

A 
not more than 7-14 days of continuous use
use intermittently (every 2nd to 3rd night)
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16
Q

How can pharmacist play a role in managing insomnia?

A
  1. Provide information
  2. Identify potential cause of insomnia
  3. Check duration
  4. Discourage inappropriate use of OTC medication
17
Q

What is restless leg syndrome?

A
  • The urge to move legs, usually accompanied by unpleasant sensation
  • The urge begins and is worse during periods of rest or inactivity
  • Partially relieved by moving such as walking or stretching
  • worse during early evening or night
18
Q

Pathophysiology behind restless leg syndrome?

A

Associated with dopaminergic dysfunction and abnormal brain iron metabolism

19
Q

Non pharmacological treatments for restless leg syndrome?

A
  1. Improve sleep wake cycle
  2. Regular moderate cycle
  3. Relaxation therapy, thermal baths, massage
  4. Correcting iron deficiency
20
Q

Pharmacological treatment for restless leg syndrome?

A
  1. Dopaminergic agonist: levodopa
  2. Dopaminergic agonist (non ergot derived): rotigotine, pramipexole
  3. Augmentations: gabapentin, clonazepam
21
Q

What is sleep apnoea?

A

Results from loss of respiratory effort during sleep

presents:
- frequent night awakening
- depression
- insomnia
- sleep disruption
- snoring

May required nasal oxygen or CPAP

22
Q

What is narcolepsy?

A

Irresistible urge to sleep

23
Q

What treatment is available for narcolepsy?

A
  • Schedule naps
  • Central nervous system stimulants: methylphenidate or dexaphetamine, clomipramine, modafinil, TCA, SSRIs
  • Modafinil usually started first
24
Q

What pharmacological treatments for sleep disorders?

A
  1. BZD
  2. Z drugs
  3. Antihistamines
25
Q

What is generalised anxiety disorder?

A

Excessive anxiety and worry that is difficult to control
Associated with restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.
For more days than not ≥6 months

26
Q

What are some risk factors for generalised anxiety disorder?

A
  1. Temperamental: behavioural inhibition, harm avoidance
  2. Environmental: Parental overprotection
  3. Genetic and physiological
27
Q

What is the pathophysiology behind GAD?

A

Impaired inhibitory circuits ie: hypoactive GABA and 5-HT

- Overactivity in excitatory NA pathways

28
Q

What is a panic or anxiety attack?

A

Brief episode of unbearable intense fear with marked somatic symptoms (eg: sweating, chills, tachycardia)
Occur repeatedly and unexpectedly in the absence of external threats

29
Q

Pathophysiology behind OCD?

A

Abnormal activity in:

  1. Caduate (linked with stereotyped behaviour and preservation)
  2. Basal ganglia, prefrontal and orbitofrontal lobes (correlated with severity of disorder and increased further with patient is exposed to fear stimuli)
  3. Anterior cingulate cortex (compulsions)

Species typical behaviour not adequately suppressed by cerebral cortex

30
Q

What pharmacological treatments for anxiety?

A

For acute attack

  1. BZD
  2. Z drugs

Treatment
First line: Antidepressants (SSRI/SNRI)
Refractory: clomipramine, imipramine

31
Q

How do BZD treat insomnia?

What are 3 examples of BZD?

A

Promotes action of ventrolateral preoptic area (VLPO) neurones to promote NREM
This increases total sleep time and quality and decreases number and duration of sleep awakenings

  1. Flurazepam
  2. Temazepam
  3. Triazolam

BZD help stay asleep

32
Q

What are 2 examples of Z drugs?

A
  1. Zolpidem
  2. Zoplicone

These help initiate sleep

33
Q

How do BZD treat anxiety?

A

Suppress the limbic system generally eg: amygdala
And inhibits neuronal firing in the LC, reducing NA activity

Diazepman, lorazepam, clonazepam and alprazolam used

34
Q

Should pharmacotherapy be first line treatment for anxiety?

A

No

Psychotherapy should be first line. Cognitive behavioural therapy is particularly useful in panic disorder and social phobia
Stress management, sharing problems, meditation can also help

35
Q

What antihistamines are available for insomnia?

A

H1 receptor inverse agonists

  1. Doxylamine
  2. Promethazine
36
Q

How does panic attacks worsen by itself?

A

Cycle of panic attack, fear, worry and consequence

37
Q

OCD therapies?

A
  1. Psychotherapy: Behavioural, cognitive or both
  2. SSRIs/SNRIs
  3. Clomipramine
  4. Adjunctive treatment: mood stabiliser/neuroleptic or antipsychotic
38
Q

What treatments for PTSD?

A

Psychotic- counselling, CBT
Hypnotics may be useful for short term use
Drugs: paroxetine, mirtazapine, amitriptyline

Psych (7 decks)

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