Sleep Flashcards

1
Q

Uses of EEG

A

. Diagnosis of disease
. Determination of brain death
. Distinguish stages fo sleep

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2
Q

Alpha wave

A

. Rhythmic waves w/ freq. of 8-13 Hz and moderately low voltage
. Characteristic of awake patients resting quietly

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3
Q

Beta waves

A

. Lower voltage at higher frequency (14-50 Hz)
. During activation of cortex in awake patient
. Observed primarily when actively concentrating

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4
Q

Theta waves

A

. Higher voltage w/ freq. of 4-7 Hz
. Mostly recorded in children in parietal and temporal lobes
. Can be seen in adults experiencing frustration and disappointment
. Recorded during stages 2-4 of slow-wave sleep and in bursts during REM

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5
Q

Delta waves

A

. Very slow (less than 4 Hz) high voltage waves
. Recorded in stage 3 slow-wave sleep and stage 4 slow wave sleep
. Also characteristic of coma

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6
Q

Waking state

A

. Alpha when relaxed

. Beta when concentrating (beta replaces alpha)

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7
Q

Types fo sleep

A

Slow-wave sleep

. REM

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8
Q

Stage 1 sleep

A

. Alpha waves disappear and replaced by low voltage mixed freq. waves
. Thoughts become dissociated but subjects easily aroused by low-intensity stimulation
. Transitional stage btw drowsy but awake and light sleep

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9
Q

Stage 2 sleep

A

. Light creep
. Low voltage mixed freq. waves
. Occurrence of sleep spindles (short bursts alpha waves) and K complexes (single large biphasic deflections)

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10
Q

Stage 3 sleep

A

. Deep sleep w/ delta waves w/ freq. less than 2Hz observed 20-50% of time

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11
Q

Stage 4 sleep

A

. Deep sleep w/ delta waves more than 50% of the time

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12
Q

Eye movement in slow wave deep sleep stages

A

. Stage 1: slow rolling movement
. 2-4 motionless
. Other skeletal mm. Are active during stages 1-4

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13
Q

REM sleep

A

. At end of each slaw wave sleep cycle
. Short period where EEG pattern looks similar to wide awake pattern (beta) even through person is dreaming and not awake
. Difficult to arouse person, but a person is more likely to spontaneously wake up in REM that’s other stages
. Rapid eye movements
. Irregular HR and respiration
. Story-like dreaming

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14
Q

New sleep classification system

A

. Stage W: wakefulness
. Stage N1 and N2: light sleep
. Stage N3: (combines stages 3 and 4): deep sleep
. Stage R: active/REM sleep
. Pattern of cycles called sleep architecture

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15
Q

When are stages 3 and 4 more likely to occur opposed to REM

A

. 3 and 4 more likely in first few hrs of sleep
. REM more frequent and period is longer late in sleep period (morning hrs)
. If total sleep time is shortened then REM sleep is disproportionately reduced

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16
Q

Age in relation to sleep cycle

A

. Sleep time dec. w/ age

. Relative percentage of REM vs slow wave dec. from infancy to adulthood

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17
Q

Skeletal mm. Changes during sleep

A

. activity declines during slow wave sleep
. During REM there is tonic inhibition of skeletal m. Except eye mm. And primary mm. Of respiration
. Period twitches and muscular tremors of face and limbs occur in REM when periodic bursts of excitatory activity break through generalized tonic inhibition

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18
Q

Cardiovascular and respiratory system during sleep cycle

A

. Slow wave sleep has steady dec. in bp, HR, and RR
. REM has inc. and large oscillations in bp, HR, and RR
. Very high phasic bps in REM assoc. w/ strokes and heart attacks
. Fatal heart attacks most common from 5-6am when most people are in REM sleep

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19
Q

Growth hormone in children sleep cycle

A

. Secreted exclusively during sleep
. Peaks during early portion of sleep period (non-REM stages 3 and 4)
. In adolescence and puberty it is still mostly at night but there are also peaks throughout the day

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20
Q

Prolactin in sleep

A

. Secretion occurs almost entirely during sleep

. Maximal in morning hours

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21
Q

Cortisol during sleep

A

. Reaches its minimum early in sleep and peaks at end of sleep period

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22
Q

TSH secretion during sleep

A

. Peaks prior to onset of sleep and then declines during sleep

23
Q

Luteinizing hormone during sleep

A

. Drives testosterone production
. Inc. during sleep responsible for meal puberty
. LH secretion in adult males is less related to sleep

24
Q

Follicle stimulating hormone in sleep

A

. Follows similar pattern to LH

. During female puberty it peaks during sleep

25
Q

Body temp during sleep

A

. As night progresses core Body temp drops reaching minimum during slow wave sleep. In early morning hrs
. During REM body temp. Inc. slightly

26
Q

Renal function changes during sleep

A

. Dec. urine volume

. Inc. osmolality

27
Q

Functions of slow wave sleep

A

. May serve as time for body rest and metabolic restoration

28
Q

REM sleep functions

A

. Needed for physical changed necessary for long-term memory and learning

29
Q

Circadian rhythm cycle

A

8 hr sleep

16 hr awake

30
Q

Suprachiasmatic nucleus of hypothalamus

A

. Basic circadian rhythm
. Inputs from retina modulate it
. Jet lag and sleep problems assoc. W/ working alternating shifts dur to confusion of visual cues
. Interacting pos. And neg. feedback loops that regulate gene expression are central to setting basic circadian rhythm

31
Q

Arousal systems in brain

A

. Cholinergic neurons in upper pons activate thalamic nuclei and adrenergic neurons in upper brainstem to stimulate cerebral cortex
. Peptidergic neurons in hypothalamus contain orexins and melanin concentrating hormone to stimulate cerebral cortex and brainstem arousal areas

32
Q

Arousal system in brainstem

A

. Raphe nuclei
. Part of reticular activating system that sets general level of arousal
. Amphetamines act here to promote arousal and dec. sleep
. Excitatory neurons in reticular activating system are active during working state and lead to arousal and enhanced attention to outside word

33
Q

Sleep systems in hypothalamus

A

. Inhibitory GABA-containing neurons in preoptic nucleus of hypothalamus inhibit arousal areas of brainstem
. Orexin-containing neurons in lat. hypothalamus activate arousal areas
. His-containing neurons in post. Hypothalamus project to reticular activating system and promote wakefulness
. Drowsiness assoc. w/ anti-histamines due to inhibition of histaminergic neurons

34
Q

REM-promoting areas of brain

A

. Pontine tegmentum

. Ventrolat. Periaqueductal gray matter

35
Q

Sleep-promoting peptides

A

. VIP and delta sleep inducing peptide (DSIP) inducing delta waves
. DSIP does not initiate sleep but keep sleep/wake cycle in proper order

36
Q

Sleep-inhibiting peptides

A

Orexins/hypocretins
. Released from neurons whose cell bodies are in lat. hypothalamus but axons project throughout brain
. Similar to GI hormone secretin
. Activate thalamic nuclei and stimulate cerebral cortex and brainstem around areas

37
Q

Cytokines and sleep

A

.lipopolysaccharide
. IL-1
. Interferon-alpha-2
. TNF

38
Q

Cholecystokinin (CCK) and sleep

A

. Contributes to drowsiness assoc. w/ large meal

39
Q

ADH and sleep

A

May promote REM sleep

40
Q

Melatonin

A

. Secreted by pineal gland
. Acts on suprachiasmatic nucleus via specific receptors that lead to gene transcription of proteins involved in circadian rhythm
. Useful treatment of jet lag and insomnia in elderly but not as general sleeping pill

41
Q

Insomnia

A

, difficulty falling asleep, awakening frequently, waking up early and not being able to get back to sleep
. Waking up feeling unrefreshed
. Caused by stress, anxiety, caffeine

42
Q

Disorders of excessive somnolence (DOES)

A

. Most common is narcolepsy
. Chronically sleepy during day
. Often have abnormal tendency to progress suddenly from being awake to REM sleep in response to emotional stimulus
. Abnormal REM sleep accompanied by cataplexy (loss of mm. Tone/paralysis)
. Assoc. w/ loss of hypocretin producing cells in hypothalamus

43
Q

Dysomnias

A

. Disturbances of normal circadian rhythmicity of sleep

. Jet lag is reduced after a 16 hr fast

44
Q

Parasomnias

A

. Normally undesirable behaviors that occur exclusively during sleep or are exaggerated by sleep

45
Q

Night terrors

A

. Certain types of dreams occurring during slow wave sleep characterized by feelings as opposed to specific images
. Most common in kids 3-5
. Child will waken abruptly, scream and run about disoriented unable to speak coherently, then go back to sleep after 3-4 minutes

46
Q

Sleepwalking

A

. Complex motor behaviors while person is in slow wave sleep
. Eyes are open and person appears awake

47
Q

REM sleep disorder

A

. Person acts out dreams during sleep when they are normal paralyzed
. Dreams usually frightening and are. Accompanied by violent behavior

48
Q

Pseudoinsomnia (sleep state misperception)

A

. Person sleeps adequately but dreams about not being asleep
. Wake up tired w/ dark eye circles

49
Q

Obstructive sleep apnea

A

. Physical blockage of airway due to collapse of soft tissue in rear of through
. Assoc. w/ obesity and snoring

50
Q

Central sleep apnea

A

. Rare
. Skeletal m. Inhibition during REM extends to inhibition of respiratory mm.
. Lead to inc. risk of high bp, stroke, and heart attack
. Can be turreted w/ CPAP or surgery
. Weight loss can be effective long-term solution

51
Q

Restless leg syndrome and periodic limb movement disorder

A

. Pins and needles, itchiness, or creeping crawling sensations leading to vigorous movement of legs esp. around bedtime
. Awakens sleeper during sleep
. PLMD consists of repetitive movement of toe, foot, knee, or hip during sleep that can also lead to awakening
. Treatment if severe: dopaminergic agonists, benzos, or opioids

52
Q

Effects of sleep deprivation

A

. Inc. incidence of hypertension, weight gain, periodontal disease, and suicide
. Acute deprivation leads to cognitive decline, mood swings, and depression

53
Q

Sleep promoting pharmacology

A

. Alcohol due to relaxation
. Hypnotics
. Anti-histamines
. DSIP

54
Q

Sleep inhibiting drugs

A

. Caffeine
. Meds (steroids, opiates can cause sleep apnea, vit. B)
. Cocaine: suppresses REM sleep
. Newer narcolepsy drugs: stimulants modafinil and armodafinil