Sleep and Hypnotics

Question 1

What is sleep?

Answer 1

A readily reversible state of reduced responsiveness to, and interaction with, the environment

Question 2

What are the two stages of the sleep cycle?

Answer 2

Rapid eye movement (REM) and non rapid eye movement (NREM)

Question 3

Rapid eye movement (REM) stage lasts for how long?

Answer 3

Around 20 mins and dreaming

Question 4

Non rapid eye moment (NREM) involves how many stages?

Answer 4

4

Question 5

Non rapid eye moment (NREM) lasts for how long?

Answer 5

60-90 minutes

Question 6

Non rapid eye moment (NREM) is repeated how many times per night?

Answer 6

4-6 times

Question 7

How do you record brain waves?

Answer 7

EEG (Electoencephalogram)

Question 8

What does an EEG do?

Answer 8

Records the activity of populations of neurones

Question 9

Synchronous activity gives rise to LARGE/SMALL EEG signals

Answer 9

Large

Question 10

Each cycle has ‘_______’ non-REM periods and ‘_______’ REM periods

Answer 10

Shorter non-REM

Longer REM

Question 11

Changes in REM sleep

Answer 11

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

Question 12

Changes in NREM sleep

Answer 12

A rest period
Muscle tension reduced
Body temp lowered
Energy consumption lowered
Increase in Parasympathetic activity
Brain rhythms slow

Question 13

Ascending reticular activating system:

Locus Coeruleus is related to?

Answer 13

NA

Question 14

Ascending reticular activating system:

Raphe Nuclei is related to which chemical?

Answer 14

5-HT

Question 15

Ascending reticular activating system:

Brainstem/forebrain is related to which chemical?

Answer 15

Ach

Question 16

Ascending reticular activating system:

Midbrain is related to which chemical?

Answer 16

Histamine

Question 17

What substances regulate sleep?

Answer 17

Interleukins
Melatonin
Hypocretin-orexin
Stimulants

Question 18

Transient insomnia is caused by what?

Answer 18

Noise, shift work, jet lag etc

Question 19

Short-term insomnia (Primary insomnia) is caused by what?

Answer 19

Emotional, stress, anxiety etc

Question 20

Chronic insomnia (Secondary insomnia) is caused by what?

Answer 20

Pain, depression, anxiety, alcohol etc

Question 21

What are hypnotics used for?

Answer 21

To induce and maintain sleep

Question 22

The use of hypnotics should be….

Answer 22

Intermittent (occuring at irregular intervals)
Limited to 1-3 weeks (tolerance may develop)
Withdrawal syndrome can occur

Question 23

Benzodiazepine hypnotics can be…

Answer 23

Long and short acting

Question 24

Examples of long-lasting benzodiazepines include:

Answer 24

Nitrazepam and flurazepam

Question 25

Examples of short-lasting benzodiazepines include:

Answer 25

Loprazelam and Temazepam

Question 26

Which (long or short acting) give rise to the ‘hangover effect’

Answer 26

Long acting

Question 27

Non-benzodiazepine hypnotics include

Answer 27

Zaleplon, Zolpidem and Zopliclone

Question 28

How do the 3 Z’s work?

Answer 28

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