sleep Flashcards
sleep is
a) a rapid reversible state of altered consciousness.
b) rapid irreversible state of altered consciousness.
c) state unconsciousness
d) none of the above
A
@wakefulness, brain stem’s arousal centres project to the _________
thalamus+ CX
@night, ___________ signals for the arousal systems to stop
ventralateral preoptical area
The homeostatic sleep load _________ throughout the day and peaks at________
increases; 9pm ish to signal sleepiness
the circadian process promotes__________ . After peaking it produces________
wakefulness; melatonin
Stage 3+ 4 sleep were combined to being labelled_________
SWS
Sleep disorders can be diagnosed with___________
DSM or ICD
The broad categories of sleep disorders are__________
Insomnia disorder
nightmare disorder
REM sleep behaviour disorder
Diagnostic features of insomnia disorder
o early morning awakening o Sleep Initiation problems o Poor sleep quality o Daytime impairment Clinically significant distress/impairment Occur DESPITE opportunities for sleep
Insomnia disorder symptoms must be present for ___________
3+ times a week for 3+ months
The INCORRECT statement is;
a) Insomnia may be caused by offset body clock which causes hyperarousal
b) may be caused by Extrinsic factors i.e. noise
c) Insomnia is underdiagnosed
d) none of the above
D - all true
Insomnia is more common in females, why might this be
Different lifestyle factors i.e. waking children for school BUT may just be bc seek help more
Sleep is most likely to occur when core body temperature is_________
at its lowest
NORMAL sleep efficiency is__________
85-95%
Sleep efficiency refers to_______
the amount of time SPENT IN BED that is actually used for sleep i.e. in bed @9 but sleeping @11:30
The MOST common type of insomnia is________ and is caused by
Psychophysiological insomnia; hyperarousal-person gets preoccupied with sleep, anx means even less sleep
Paradoxical insomnia refers to________
self reported insomnia in the absence of objective markers of insomnia, inv day time disturbances
The ICD-10 outlines ______ types of insomnias
6
Idiopathic insomnia refers to
Insomnia with no real cause, most common in childhood. Long lasting
Sleep hygeine refers to
irregularities in sleep/wake cycles because they don’t have routines i.e. on phone/ caffeine,
Behavioural insomnia is associated with _______ stage of development and caused by_________
Childhood;
wrongly learns incorrect indicators of sleep. i.e. only falls asleep when being rocked, gets used to such sleep cues
Spielman (1987) model of insomnia dictates that we have 3 pillars influencing insomnia expression
Predisposing- female, anxiety, hyperarousal,
Precipitating - medical psychological enviro events that triggers insomnia
Perpetuating -caffeine, naps etc., other factors that exacerbateing insomnia
What was the 2015 change in insomnia classification
BEFORE
•Primary insomnia – insomnia that is not associated with a known physical Or psychological disorder
•Secondary insomnia – where insomnia is considered second to another disorder i.e. MDD, where primary one is treated first
AFTER
insomnia considered as standalone illness
Some CBTi treatments for insomnia are____________
- Sleep restriction
- Stimulus control
- Relaxation techniques
- Cognitive therapy
- Improve sleep hygiene
Sleep restriction refers to____________
strengthen relationship between being in bed and ‘sleeping’ i.e. only use bed for SLEEPING not studying etc.,
the difference between relaxation and cognitive therapy is
a) shift attention away from conscious sleep
b) ease anxiety associated with sleep, reduce stress
Are meds recommended for insomnia? why?
Only for SHORT term, because get dependent, tolerant.
Insomnia is most often comorbid with___________
MDD
Narcolepsy requires recurrent periods of irrepressible need to sleep ______a week, for ______period
3+; 3+ months
Cataplexy refers to____________
losing all muscle tone
Narcolepsy is associated with deficiency of;
a) orexin
b) serotonin
c) hypocretin
d) both A and C
D
Narcolepsy requires patients have sleep latency _________ minutes or 2 REM periods in under__________ minutes
15; 8
Multiple sleep latency test (MSLT) measures day time sleepiness by_______________
electrodes on scalp, measure ‘fall asleep as fast as you can’ The longer it takes to fall asleep=more awake you are. Narcoleptics need LESS than 15mins
Orexin is a neuropeptide that is important for______________
feeding + capacity to stay awake = low in narcolepsy
Narcoleptic episode may be induced by_________ and
strong emotions
due to orexin loss there is _________stimulation to areas that_______sleep
LESS; INHIBIT
Possible biological causes for narcolepsy are
Swine flu injection, HLA gene presence.
Both NOT causal but strong links
The 2 types of narcolepsy are
Orexin depletion WITH cataplexy
Orexin depletion WITHOUT cataplexy
hypnagogic hallucinations are
vivid DREAMS
Which class of drugs can be used for narcolepsy
STIMULANTS -for day time sleepiness. Ritalin, modafinil/nuvigil ,
or sleeping meds to increase sleep regularity. Xyrem - highly controlled drug.
Parasomnia refers to______________
abnormal behavioural, experiential or physiological events associated with sleep specific sleep stages, or sleep-wake transitions
Parasomnia is more common in __________whereas insomnia is more common in____________
MALES; FEMALES
Parasomnia is likely to occur in____________ part of the night and includes __________ symptoms of which the client __________ aware of
first THIRD of the night
sleep walking/ terrors
is NOT aware of
Sleep terrors are associated with _________ age and linked with __________of the CNS
3-8; IMMATURITY
Which is INCORRECT of sleep terrors;
a) you should wake someone out of one
b) they occur in SWS and so can be recalled
c) has an onset of 4-12 yo
d) associated with increased autonomic arousal
B - DOES occur in SWS but child does NOT recall the dream
Sleep terror is different to nightmare because____________
Sleep Terror- typically in kids, ND – chronic + wider age gap;
Sleep Terror-NREM, ND-REM,
Sleep Terror-no arousal, ND- wake up and recall dream.
Which is INCORRECT regarding sleep terror tmt;
a) involves counselling parents as they are mostly traumatised
b) proposes scheduled awakenings
c) recommends excessive play / excess heat to wear child down
d) recommends harm reduction in the room
C - excessive tiredness NOT recommended
Sleep walking is triggered by _____________. TMT’s include
Excessive sleep deprivation;
harm reduction, scheduled awakenings
REM disorders ____________
Nightmare disorder REM sleep behaviour disorder Sleep paralysis Child head banging Restless leg syndrome Confusional arousal Bruxism – teeth grinding Enuresis – bedwetting
Nightmare disorder typically occurs _____________ of the night and is ____________ remembered
second half of night or after 90 mins of sleep; WELL
Nightmares are often caused by____________ and occur in ________ of the population annually
stress, anxiety, PTSD, meds ; 85%
Nightmares may begin in childhood and are likely to go away by _______ age or otherwise persist. Treatment invovles__________
10; therapy changing the end of the dream
REM sleep behaviour disorder is diagnosed with_________ and associated with_____________muscle tone
PSG; abnormally preserved muscle tone in REM sleep
REM sleep behaviour disorder is present in _____________ population
middle aged / elderly / those with a neurological disorder. Onset age 52-62
REM sleep behaviour disorder may be a prodromal stage of ___________ as it has an onset 5-10 years before disease onset
AD/PD
Treatment of REM sleep BD is __________ which controls symptoms but does NOT control______
diazepines; likelyhood of later developing neurodegenerative diseases
Sleep paralysis is when___________ is inhibited but ___________are intact
voluntary muscle tone; ocular +respiratory
Sleep paralysis is associated with________sleeping position and is likely to occur ___________time
Lying flat on back; sleep onset or offset
Hypnagogic ___________ whereas hypnopompic___________
sleep ONSET; sleep OFFSET
We used to think sleep disturbances were secondary to psychiatric illnesses, NOW we think_____________
that because they often co-occur with other shit, they may share similar aetiology
