Sleep

Question 1

When does non REM sleep tend to occur?

Answer 1

Towards the end of the night

Question 2

What age group have mainly non-REM sleep?

Answer 2

Teenagers (3/4 of their sleep is non rem)

Question 3

What physiological changes occur during non-REM sleep?

Answer 3

Partial muscle relaxation
Reduced cerebral blood flow
Reduced HR, blood pressure and tidal volume

Question 4

Does REM sleep have narrative or non narrative images?

Answer 4

Narrative

Question 5

What type of images are seen in non-REM sleep?

Answer 5

Non narrative

Question 6

What physiological changes occur in REM sleep?

Answer 6

Increased cerebral blood flow
Impaired thermal regulation
Atonic muscles

Question 7

In non- REM sleep what is seen on an EEG?

Answer 7

Synchronised rhythmic EEG activity

Question 8

In REM sleep what is seen on an EEG?

Answer 8

Fast activity and increased brain wakefulness

Question 9

What muscles are not atonic during REM sleep?`

Answer 9

Diaphragm

Extra-ocular muscles

Question 10

What is the purpose of REM sleep?

Answer 10

Early brain development
Maintains immunocompetence
Consolidates memories and potentially deletes unnecessary memory files

Question 11

What animals do not have a REM cycle?

Answer 11

Dolphins

Question 12

What medication suppresses REM sleep?

Answer 12

Tricyclics

Question 13

Deep sleep allows for what part of the brain to recover?

Answer 13

The cortex

Question 14

What age group has roughly 50% REM sleep?

Answer 14

Neonates

Question 15

What is the typical sleeping pattern of elderly patients?

Answer 15

Increased awakenings
Reduced REM latency
Reduced total sleep time
Daytime napping

Question 16

What does non-REM sleep allow for?

Answer 16

Protein synthesis

Cell division and growth

Question 17

What cells are responsible for using light to train the body clock?

Answer 17

Retinal ganglionic cells

non rod and non cone cells

Question 18

Where do the retinal ganglionic cells transmit to?

Answer 18

Suprachiasmatic nucleus

Question 19

If you have been sleep deprived, how much sleep can be made up?

Answer 19

1/3rd

All non-REM

Question 20

What process peaks during sleep?

Answer 20

Cell division

Question 21

Lack of sleep affects which region of the brain most?

Answer 21

Prefrontal cortex

Question 22

What are some of the prefrontal effects of sleep deprivation?

Answer 22

Irritable and suspicious
Visual illusions
Microsleeps and lapses n concentration

Question 23

An afternoon nap of ____ minutes is equivalent to ____ minutes overnight?

Answer 23

15 mins = 90 mins

Question 24

Give some symptoms of non-REM parasomnias:

Answer 24

Confusion arousals
Sleep walking
Sleep terrors / paralysis
Bruxism
Restless legs and PLMS

Question 25

What are the common characteristics of Narcolepsy?

Answer 25

• Daytime sleepiness
  - involuntary
• Cataplexy (loss of muscle tone)
• Hypnagogic hallucinations
• Sleep paralysis
• RBD

Question 26

What investigations can be done for Narcolepsy?

Answer 26

Actigraphy and sleep diary
Overnight polysomnography
Multiple sleep latency test

Question 27

How is a multiple sleep latency test carried out?

Answer 27

4 twenty five min naps scheduled 2 hours apart
Record of EEG, muscle activity and eye movement
Measures time from start of a daytime nap to the first signs of sleep

Question 28

Why might you do a lumbar puncture in a patient with potential Narcolepsy?

Answer 28

CSF hypocretin levels which are low (< 110pg/ml) are consistent with narcolepsy

Question 29

How is Narcolepsy managed?

Answer 29

Sleep hygiene, lifestyle changes and CNS stimulants

Question 30

List some examples of CNS stimulants used 1st line in Narcolepsy?

Answer 30

Modafinil

Armodafinil

Question 31

List some CNS stimulates used 2nd line in Narcolepsy?

Answer 31

Dexamphetamine

Methylphenidate

Question 32

What scale is used to measure the level of residual sleepiness / monitor patients with Narcolepsy?

Answer 32

Epworth Sleepiness Scale