Sleep Flashcards
Percentage of sleep NREM?
75%
NREM: hypo or hyperactive state?
HYPO
NREM blood flow to brain?
DECREASED
Beta
NREM
16-25 Hz
Vigilent
Eyes open
Alpha
NREM
8-12 Hz
Drowsy
Eyes closed
Theta
NREM
3-7 Hz
Stage 1 (5%) = rolling eyes, hypnogogic hallucinations Stage 2 (45%) = COMPLEX K, SPINDLES
Delta
NREM
0.5-3Hz
Stage 3/4 (12%+ 13%) = SLOW WAVE SLEEP
Most stage 4 in 1/3 of night.
Percentage of sleep REM (adults)?
25%
REM: hypo or hyperactive state?
HYPER
REM blood flow to brain?
INCREASED
REM muscle tone?
ATONIA
What is paradoxical about REM sleep?
EEG activity more closely resembles awake than slow sleep
REM waves?
SAWTOOTH
Last 1/3 of sleep
Percentage of sleep REM (neonates)?
up to 50%
Fall asleep directly into REM
16H / day with brief periods of wakefulness
Aging sleep changes?
(According to K&S summary):
DECREASED TOTAL SLEEP TIME vs. TOTAL REM SLEEP (see below)
Lower efficiency
Higher fragmentation
INCREASED SLEEP LATENCY
Less slow wave AND REM sleep so % stays the same
Need for sleep doesn’t change
(From K&S text…not helpful)
“Changes in sleep structure among persons over 65 years of age involve both REM sleep and nonrapid eye movement (NREM) sleep. The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and LESS TOTAL REM SLEEP. The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.”
Children sleep differences?
DECREASED SLEEP LATENCY (5-10 minutes)
Highly efficient sleep
Easy awakening
Dream quality in NREM?
LUCID
PURPOSEFUL
Dream quality in REM?
ABSTRACT
SURREAL
More REM eye movements associated with vividness of dreaming)
NE in sleep?
Firing = wakefulness and NREM
Which neurotransmitter is REM promoting?
Acetylcholine
Which is the primary neurotransmitter in reticular activating system?
Acetylcholine
Glutamate as well
Where is melatonin produced?
Pineal gland
Where is the circadian clock in brain?
Suprachiasmatic nucleus
Antidepressants and REM?
Serotonin is anti-REM
Antidepressants increase serotonin
Antidepressants DECREASE REM
Process S
Accumulates during wakefulness
Process C
Think CIRCADIAN
In hypothalamus
Regulates temperature and sleep duration
Histamine and sleep
In posterior hypothalamus
Fire while AWAKE but not during REM and NREM
(ANTI-histaminics cause sedation)
Long sleepers how many hours?
> 9 hours
Short sleepers how many hours?
< 6 hours
General timing of sleep disorders?
3 nights per week for at least 3 months
Strongest risk factor for insomnia disorder?
Past episode of primary insomnia
Normal REM latency?
90 minutes
Nocturnal myoclonus often affects which muscle?
Anterior tibialis
rare side effect of SSRI
Hypersomnolence
At least 7 hour main sleep period \+ ONE of: - recurrent periods of sleep in same day - non-restorative main sleep > 9 hours - difficulty being fully awake after abrupt awakening
3x / week x 3 months
Tx with Modafinil (1st line)
What is a sign of daytime somnolence in kids?
HYPERACTIVITY
being “wired”
What is highly specific to hyper somnolence?
SLEEP INERTIA = drunkenness at sleep-wake transition
Who is at his for non-24-hour sleep-wake type?
Up to 50% in BLIND people
TBI
Most common circadian rhythm sleep disorder?
Delayed phase
Impact of Lithium on circadian period?
LENGTHENS
Most common single symptom of insomnia disorder?
MAINTENANCE
awake for total 20-30 minutes in the night
Most common presentation of insomnia disorder?
COMBINATION of initiation/maintenance/early awakening
Gene associated with advanced sleep phase type?
PER2 gene
Autosomal DOMINANT
Percentage of night workers with shift work type?
5-10%
Reverses after 2 weeks of normal schedule
Irregular sleep-wake type associated with?
Neurodegenerative disorders
Narcolepsy criteria
3x / week x. months
ONE OF:
- cataplexy a few times per month
- HYPOCRETIN deficiency using CSF
- polysomnography showing REM LATENCY < 15 minutes or MULTIPLE SLEEP LATENCY TEST showing mean sleep latency < 8 minutes + at least 2 sleep-onset REM periods
Hypocretin
Excitatory hormone in hypothalamus (stimulates appetite and alertness)
With cataplexy but no hypocretin rare (< 5%)
Cerebellar ataxia + deadness + narcolepsy?
EXON 21 DNA mutation
Autosomal dominant
Narcolepsy + obesity + DM2?
Mutation in the myelin oligodendrocyte glycoprotein gene
Autosomal dominant
Genetic marker narcolepsy?
HLA-DR2 positive in 90-100%
What percentage of narcolepsy have cataplexy?
50%
How to differentiate cataplexy from conversion?
ABOLISHED REFLEXES during cataplexy
What percentage have hypnagogic/hypnopompic hallucinations?
20-60%
What percentage have sleep paralysis?
20-60%
Narcolepsy treatment for daytime somnolence?
Modafinil
Sodium oxybate
Narcolepsy treatment for cataplexy/sleep paralysis/hallucinations?
SSRIs/TCA
Sodium oxybate
Apnea criteria in OSA?
> 5/hr + symptoms
OR
15/hr
Apnea definition?
At least 10 seconds of O2 sat decrease by 3%
Central sleep apnea criteria?
At least 5/hr
Congenital hypoventilation gene?
PHOX2B gene
REM parasomnias?
Nightmares
REM sleep behaviour disorder
NON-REM sleep arousal disorders?
Sleepwalking
Sleep terrors
No memory usually
Nightmares
SECOND HALF OF THE NIGHT (because REM)
No movement or vocalization
Can be caused by:
L-dopa
B-blockers
REM sleep behaviour disorder
END OF NIGHT
PRECURSOR OF LBD/PARKINSON (synuclein)
Can be unmasked by antidepressants
Dreams acted out, no paralysis
Injury to partner
Alert, not confused on waking
Tx with CLONAZEPAM (80-90% respond)
What is a black box warning on some sedatives?
SLEEPWALKING
Sleep terror
Occurs during FIRST 3RD OF NIGHT (because NON-REM)
What to rule out medically with sleep terror?
Temporal lobe epilepsy
Other name for restless leg syndrome?
WILLIS-EKBOM
Restless leg syndrome criteria?
Urge to move legs
Need all 3
- Worse during rest
- Relieved by movement
- Worst at evening
What can you give to test if restless leg syndrome?
Dopamine agonist
Levo-dopa (+ if 50% improvement in sx)
Treat with dopamine agonist, benzos, opiates, anti-epileptics
What is not a recognized ethology of restless leg syndrome?
Menopause