Sleep and Hypnotics Flashcards
What is sleep?
A readily reversible state of reduced responsiveness to, and interaction with, the environment
What are the two stages of the sleep cycle?
Rapid eye movement (REM) and non rapid eye movement (NREM)
Rapid eye movement (REM) stage lasts for how long?
Around 20 mins and dreaming
Non rapid eye moment (NREM) involves how many stages?
4
Non rapid eye moment (NREM) lasts for how long?
60-90 minutes
Non rapid eye moment (NREM) is repeated how many times per night?
4-6 times
How do you record brain waves?
EEG (Electoencephalogram)
What does an EEG do?
Records the activity of populations of neurones
Synchronous activity gives rise to LARGE/SMALL EEG signals
Large
Each cycle has ‘_______’ non-REM periods and ‘_______’ REM periods
Shorter non-REM
Longer REM
Changes in REM sleep
EEG like that of the active/waking brain (paradoxical sleep) Oxygen consumption of brain is high Vivid dreaming Loss of skeletal muscle tone (atonia) Sympathetic activity predominates
Changes in NREM sleep
A rest period Muscle tension reduced Body temp lowered Energy consumption lowered Increase in Parasympathetic activity Brain rhythms slow
Ascending reticular activating system:
Locus Coeruleus is related to?
NA
Ascending reticular activating system:
Raphe Nuclei is related to which chemical?
5-HT
Ascending reticular activating system:
Brainstem/forebrain is related to which chemical?
Ach
Ascending reticular activating system:
Midbrain is related to which chemical?
Histamine
What substances regulate sleep?
Interleukins
Melatonin
Hypocretin-orexin
Stimulants
Transient insomnia is caused by what?
Noise, shift work, jet lag etc
Short-term insomnia (Primary insomnia) is caused by what?
Emotional, stress, anxiety etc
Chronic insomnia (Secondary insomnia) is caused by what?
Pain, depression, anxiety, alcohol etc
What are hypnotics used for?
To induce and maintain sleep
The use of hypnotics should be….
Intermittent (occuring at irregular intervals)
Limited to 1-3 weeks (tolerance may develop)
Withdrawal syndrome can occur
Benzodiazepine hypnotics can be…
Long and short acting
Examples of long-lasting benzodiazepines include:
Nitrazepam and flurazepam
Examples of short-lasting benzodiazepines include:
Loprazelam and Temazepam
Which (long or short acting) give rise to the ‘hangover effect’
Long acting
Non-benzodiazepine hypnotics include
Zaleplon, Zolpidem and Zopliclone
How do the 3 Z’s work?
Bind to GABA(A) receptors
Have a short duration of action and are less likely to cause rebound insomnia (like BZs)
Dependence may be a problem
