Sleep Flashcards

1
Q

What is sleep? What does it involve?

A
  • Stereotypic or species-specific posture
  • Minimal movement
  • Reduced responsiveness to external stimuli
  • Reversible with stimulation – unlike coma, anaesthesia or death
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2
Q

What measurements are used to evaluate sleep / sleep patterns?

A

EEG (brain waves)
EOG (eye movements)
EMG (muscle movements -> jaw)

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3
Q

What are the stages of sleep?

A
  • awake
  • Stage 1&2 (NREM)
  • Stage 3&4 (NREM)
  • Stage 5 (REM)
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4
Q

What does REM stand for?

A

Rapid Eye Movement

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5
Q

What is a common characteristic of stage 2 sleep on the EEG?

A

sleep spindle

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6
Q

How is sleep structured?

A
  • divided into 5 stages

- multiple sleep cycles

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7
Q

When are you most likely to dream?

A
  • during REM sleep but not exclusively
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8
Q

What are lucid dreams?

A

In the dream you are aware that you are dreaming

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9
Q

How is sleep controlled?

A
  • the RAS is important for enabling conciousness
  • Lateral hypothalamus: promotes wakefulness, suppresses RAS
  • ventrolateral preoptic nucleus: promotes sleep, suppresses RAS
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10
Q

RAS

A
  • Reticular activating system
  • projections from brainstem to thalamus and cortex
  • it is not the center of conciseness. It enables conciseness, without it consciousness would not be possible.
  • > stimulated by lateral hypothalamus
  • > suppressed by ventrolateral preoptic nucleus.
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11
Q

What do different sleep phases look like on EEG, EMG, EOG?

A
  • rapid eye movement in Stage 5, looks like in awake
  • higher heart rate and breathing rate in REM
  • overall slowing EEG in the sleep stages until REM sleep is reached and increased EEG speed
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12
Q

SCN

A

= suprachiasmatic nucleus

  • tracks level of ambient light (“clock”)
  • has connections to LH, VLP, RAS and the pineal gland (melatonin release)
  • synchronises sleep with falling light level
  • regulates the circadian rhythm
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13
Q

Pineal gland

A
  • responsible for melatonin release

- stimulated by the SCN

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14
Q

Lateral Hypothalamus

A
  • promotes wakefulness (orexin, hypocretin)
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15
Q

Ventrolateral preoptic Nucleus

A
  • (in anterior hypothalamus)

- promotes sleep

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16
Q

What are indices that sleep is necessary?

A
  • Most/all animals sleep
  • Sleep deprivation is detrimental
  • Sleep is regulated accurately
17
Q

What are the psychiatric and neurological consequences of sleep deprivation?

A

– Sleepiness

  • irritability
  • stress
  • mood fluctuations
  • depression
  • impulsivity
  • hallucinations
  • psychosis
  • seizures (especially in epilepsy but also in healthy poeple)
18
Q

What are the neurological consequences of sleep deprivation?

A

– Impaired attention, memory, executive function
– Risk of errors and accidents (e.g. shift work, doctors)
– Neurodegeneration (?)

19
Q

What are the somatic complications of sleep deprivation?

A
– Glucose intolerance
– Reduced leptin/increased appetite
– Impaired immunity
– Increased risk of cardiovascular disease and cancer 
– Death
20
Q

What is sleep important for?

A
  • normal brain funciton
  • memory consolidation
  • e.g. affected brain activation when solving math problems in a sleep deprived state.
21
Q

How is sleep regulated? I.e. what happens after sleep deprivation?

A

After sleep loss:
• Reduced latency to sleep onset
• Increase of slow wave sleep (NREM)
• Increase of REM sleep (after selective REM sleep deprivation)

22
Q

What are the functions of sleep?

A
  • Restoration and recovery – but active individuals do not sleep more
  • Energy conservation – 10% drop in BMR – but lying still is just as effective
  • Predator avoidance – but why is sleep so complex?
  • Specific brain functions – memory consolidation, …
23
Q

What are dreams? When do they occur?

A
  • Can occur in REM and NREM sleep
  • Most frequent in REM sleep
  • More easily recalled in REM sleep
  • Contents of dreams are more emotional than ‘real life’
  • Brain activity in limbic system higher than in frontal lobe during dreams
24
Q

What is the function of dreams?

A
  • Safety valve for antisocial emotions
  • Disposal of unwanted memories
  • Memory consolidation

(Freud? - dealing with problems, anxiety)

25
Insomnia
* High prevalence | * Most cases transient
26
Causes of chronic cases of Insomnia?
– physiological e.g. sleep apnea, chronic pain – Brain dysfunction eg. depression, fatal familial insomnia, night working - Anxiety and other psychological issues?
27
How do you treat insomnia?
– sleep hygiene – hypnotics (most enhance GABAergic circuits) – sleep CBT - medications - now GPs are more careful when prescribing these.
28
Obstructive sleep aponoea
- people feel tired during the day - they usually don't remember waking up at night - very common cause of Insomnia - interrupted sleep
29
Improving sleep quality - sleep hygiene
* establishing fixed times for going to bed/waking up * creating a relaxing bedtime routine * only going to bed when you feel tired * maintaining a comfortable sleeping environment * not napping during the day * avoiding caffeine, nicotine and alcohol late at night * avoiding eating a heavy meal late at night * don't use back-lit devices shortly before going to bed
30
Hypersomnia
excessive daytime sleepiness or excessive time spent sleeping, is a condition in which a person has trouble staying awake during the day.
31
What are some common and some primary causes of Hypersomnia?
Primary: Narcolepsy, post traumatic brain injury, idiopathic hypersomnolescence Common: - obstructive sleep apnoea - restless leg syndrome - nocturnal pain - neurodegenerative disease - medication - environmental factors such as noise - anxiety - oesophageal acid reflux - severe bruxism
32
What is a subjective test to assess sleepiness?
The Epworth Sleepiness Scale | rate the likelihood of dozing in the following situations
33
Epworth Scale
- Epworth Sleepiness Scale -> likelihood of falling asleep in certain sitations - likelyhood between 0-3 - scala goes up to 24 points
34
Narcolepsy
* Falling asleep repeatedly during the day and disturbed sleep during the night * Cataplexy (sudden, brief loss of voluntary muscle tone, often triggered by strong emotions e.g. laughter) * Dysfunction of control of REM sleep * Orexin/hypocretin deficiency
35
Cataplexy
sudden, brief loss of voluntary muscle tone, often triggered by strong emotions e.g. laughter
36
Effects of shift work on sleep
* Night working causes physiological processes to become desynchronised * This can lead to sleep disorders, fatigue and an increased risk for some conditions such as obesity, diabetes and cancer
37
Sleep and Neurodegenerative disease
- cause or consequence? | - sometimes sleep issues happen before but it could also be an early manifestation of dementia
38
Lewy-Body dementia
often preceded by REM problems (e.g. hitting, shouting, falling out of bed during sleep)