Sleep Flashcards
Consequences of short term stress
Headache Fatigue Difficulty Sleeping Upset Stomach Irritability
Consequences of Long Term Stress
Depression High Blood Pressure Abnormal Heart Rhythm hardening of Arteries Heart disease/attack Ulcers Irritable Bowel syndrome Cramps Constipation Weight gain/loss Change in sex drive Change in sex performance Fertility problems Asthma flare up Arthritiz flare-up Acne eczema Psoriasis
Physiology of Stress
- CRH AVP expressed in hypothalamus
- Stimulate ACTH secretion
- Corticosterone and noradrenaline release from adrenal gland
Counteracted by inhibitory effects from glucocorticoid receptors expressed n the hippocampus, hypothalmus, and anterior pituitary
Sleep Stages
Rapid Eye Movement (REM)
Where recallable dreams from
Stage 1: Light Sleep
Stage 2: First stage of real sleep
Stage 3 and 4: Deep, restful sleep
How much sleep do younger adults need?
7-9 hours
Stress and Sleep
Blocks that cascade of chemical and hormonal cascades that lead to activation of the stress pathway
Adenosine signals to the pituitary to reduce ACTH
Adenosine
Builds up from hydrolysis of ATP
Amount of Adenosine produces relative to amount of neural and glial processing
Sleep
Regulates hormone levels
Refreshes the mind
Promotes clearer thinking
Gives the body a chance to repair and restore itself
Reduces an individuals perception of stress
Light Exposure and Suprachiasmatic Nucleus
Body internal clock for sleep- suprachiasmatic nucleus
Receives light directly from eye to regulate clock
Light exposure and melatonin
Increase in light exposure causes decrease in melatonin
Melatonin controls sleep and wake cycles- reduction in melatonin is increased feelings of sleepiness
Also increases risk for cancer, impairs immune system, cardiometabolic consequences
Drugs that Promote Wakefulness
CNS Stimulants Anphetamine (Adderall) Methylphenidate (Ritalin) Pemoline (Cylert) Modafinil (Provigil, sparlon) OTC Pseudophedirine (Sudafed) Phenylpropanolamine Caffeine Nicotine Cocaine
Ideal Hypnotic
No withdrawal or tolerance Short duraction of action Rapid onset of symptoms No impairment of post sleep function Increase of recuperative sleep time
Sedative/ Hypnotics (Barbiturates)
Phenobarbital Pentobarbital Secobarbital Amobarbital Thiopental
Sedative/ Hypnotics (Benzodiazepine)
Flurazepam (Dalmane) Quazepam (Doral) Estazolam (Prosom) Temazepam (Restoril) Triazolam (Halcion)
Sedative/ Hypnotic (Other prescription)
Tricyclic antidepressant amitriptyline nortriptyline imipramine doxepin Antidepressant trazodone
Sedative/ Hypnotic (Other OTC, non benzo)
Zolpidem (Ambien)
Zopiclone (Imovane)
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Zolpidem(Ambien)
Unrelated to benzodiazepine
Selectively binds to BZ1 receptor
Devoid of muscle relaxant or anticonvulsant behavior
Preserves stage 3 and 4
Ramelteon (Rozerem)
New class of sleep agents
Selectively binds to MT1 and MT2* receptors in the suprachiasmatic nucleus and not GABAa
Differs from zolpidem, eszopiclone, zalepone
MT- melatonin
Suvorexant (Belsomra)
New class of medication to treat insomnia Selective orexin (Hypocretin) receptor antagonist Blocks endogenous alertness modulating molecule hypercretin
Drug Withdrawal
Becoming drug dependent on hypnotics means that the body has achieved a homeostasis that is dependent on this drug
During withdrawal, homeostasis is disrupted, causing both insomnia and stress
- Drugs not the best way to maintain sleep
Cognitive Behavioral Therapy
Bad sleep habits develop during chronic insomnia
Bedroom has cues for stress, anxiety, frustration
Strengthen association between bedtime stimuli and sleep only
