Sleep And Anxiety Flashcards
What is the difference between primary and secondary insomnia?
P: physiological, psychological, social factors
S: caused by an underlying disease- substance induced, leads to chronic insomnia.
What are the 3 anxiety models?
NA - autonomic overstimulated, 5HT - abnormal functioning, GABA models - dysregulation
What are 4 non-REM sleep stages?
Stage 1: slow eye movement, theta waves replace alpha waves
Stage 2: slightly deeper sleep, easily woken, no eye movement and dreaming is rare
Stages 3 and 4: metabolic activity slows, delta waves are slow, high amplitude waves. No eye movement.
How is REM sleep described?
Stage associated with dreaming (beta waves). Not a restful stages and skeletal muscles are atonic. Dopamine, noradrenaline and acetylcholine prefominate here.
What is insomnia?
Inability to sleep for 30 mins or more after trying to do so occuring on 3 or more nights per week lasting longer than 6 months.
What are 4 causes of insomnia?
Age: >65 altered sleep physiology
Mental: mood and anxiety disorders, substance abuse
Situational: work stress, financial stress, conflict
Medical: CV, respiratory, chronic pain, endocrine disorders
What is the noradrenaline model of anxiety?
ANS is hypersensitive and overreacts to stimuli, alpha 2 receptors are downregulated, hypersensitive. Increased glutamate produces anxious feelings and can induce panic attacks.
What is the GABA-Receptor model of anxiety?
GABAa - ligand gated ion channels cause receptor numbers in the CNS to change.
GABAb - metabotropic inhibit presynaptic GABA release
What is the Serotonin-Receptor model of anxiety?
5HT may be downregulated in GAD. Abnormal functioning and release and uptake at presynaptic autoreceptors. Increased 5HT may reduce noradrenaline in the locus ceruleus
What are the pathophysiological reasons for anxiety?
Various neurotransmitters, amygdala (assessment of fear stimuli and learned response to fear stimuli and learned response.
Locus ceruleus - implementation of fear responses
Hippocampus - consolidates traumatic memory
Hypothalamus - integrates neuroendocrine and autonomic responses to fear.
What is the difference between the two GABA receptors?
A: ligand-gated ion channel specific for Cl, activated by GABA
B: metabotropic ion, G-coupled receptors, decrease cyclic AMP and causes post-synaptic inhibition.
What are some drugs that bind to GABAa receptors?
GABA, BZDs, Barbiturates, Z-drugs, Alcohol
What are some cautions and contraindications of benzos?
COPD, severe hepatic disease, myasthenia gravis.
Geriatic patients: increased fat cells thus increased volume of distribution
Porphyric attacks
Pregnancy and lactation
What are examples of intermediate-acting benzos?
Alprazolam, bromazepam, lorazepam
What are examples of long-acting benzos?
Clobazepam, clonazepam, diazepam, flurazepam, prazepam,nitrazepam
