Sleep Flashcards
Which stages of sleep become longer in adults? Which become shorter? Which stay about the same?
N1-2 get longer, N3 gets shorter, REM is slightly smaller but not much (about the same) .
CBT-I vs short term sleep meds. How does it do in short term? How does it do in long term?
Short term: CBT-I vs meds equally effective
Long-term: CBT more effective because CBT-I gains are maintained 2, 12, 24 months later.
How are z drugs and benzos different?
z drugs are selective towards Gaba(a1) unit only. Only hypnotic effect is prominent.
Benzos hit (a1, a2, a3, a5) .
How does suvorexant work?
Dual orexine receptor antagonist (ORA) blocks 2 receptors: OX1R and OX2R (for sleep onset and sleep maintenance) .
This ANTAGONIZES wakefulness.
Which gland secretes melatonin ?
Pineal gland
Timeline for sleep disorders
Occurs 3x/week for at least 3 months . True for insomnia, restless leg
What is the narcolepsy prevalence?
0.5% of the population. Genetically linked
Hypocretin levels
If low, suggestive of narcolepsy. However, high or normal hypocretin levels does not exclude narcolepsy.
What does sodium oxybate do?
Increases N3 sleep . Activates GABA-B receptor. Suppresses inappropriate relaese of night time dopamine and norepi in narcolepsy. Then allows their release during the day, increasing alertness.
What is Cheyne-stoke breathing?
Hypoventilation followed by compensatory hyperventilation.
In what stage of sleep do sleep walking and sleep terrors occur?
N3, will occur in the first third of sleep episode.
What are the two types of Non-REM Sleep Arousal Disorder?
Sleepwalking Type and Sleep Terror type
In what sleep phase does dreaming occur?
In REM. Therefore, Nightmare Disorder is a REM sleep dysfunction.
REM Sleep Behavior Disorder is associated with what?
Synucleinopathy diagnosis (parkinson’s). Reduced striatal presynaptic dopamine transporters. Could be a prodrome for parkinsons or lewy body.
Treatment for REM Sleep Behavior Disorder ?
Clonazepam (90% benefit) , melatonin, levodopa
FDA approved for Sleep onset insomnia ONLY?
eszopliclone , ramelteon
Stimulation of what cranial nerve will worsen OSA?
Vagus nerve
Only drug with FDA approval for both onset insomnia and maintenance insomnia?
eszopliclone
Non 24 hour sleep disorder
Give tasimelteonHistory of excessive daytime sleepiness, insomnia, or both, which alternate with asymptomatic episodes, due to misalignment between the 24 hour light-dark cycle and endogenous circadian rhythm; Symptoms persisting over the course of at least 3 months,
Theta rhythm occurs during what stage of sleep?
Stage I. EEG reveals rhythmic activity ranging between 5 and 8 Hz and occasional positive occipital sharp transients (POSTs) of sleep. Slow rolling eye movements are also noted
Long term sedative/hypnotic use can do what to the sleep cycle?
Increased stages 1 and 2 sleep, reduced stages 3 and 4 sleep, and sleep fragmentation
When does sleepwalking happen?
Sleepwalking disorder, or somnambulism, usually occurs in the first third of the night in deep NREM (stages III and IV) sleep and frequently progresses to leaving bed and walking about without full consciousness or later memory. It usually begins between 4 and 8 years of age, has peak prevalence at 12 years of age, is more common in boys, tends to run in families, and happens at least occasionally to 15% of children.
in REM sleep behavior disorder, what is actually happening on polysomnography?
Loss of muscle atonia during REM sleep. alpha synucleinopthay
What sleep changes happen to the elderly?
- Increased fragmentation of sleep
- Increased latency for the onset of sleep
- Decreased sleep efficiency
- Decreased total sleep time
- Decreased slow-wave
Delta waves happen during what stage of sleep?
Stage III
Mixed waves happen during what stage of sleep?
REM
Sawtooth waves on EEG happen during which phase of sleep ?
REM
Nocturnal panic attacks typically appear during which phase of sleep?
between stage 2 and 3
POSTS and slow rolling eye movements - which sleep stage?
Stage I
