Sleep & CT Flashcards
What frequency are Beta waves and what sleep/wake stage are they associated with?
13-20 Hz. Wakefulness.
What frequency are Alpha waves and what sleep/wake stage are they associated with?
8-12Hz. Drowsiness or relaxed states.
What frequency are Theta waves and what sleep/wake stage are they associated with?
3.5-7.5Hz. Stage 1. Light sleep.
What stage of sleep are sleep spindles and k-complexes associated with?
Stage 2.
What frequency do sleep spindles occur at? What stage of sleep are they associated with?
12-14Hz. Stage 2.
What frequency are Delta waves and what sleep/wake stage(s) are they associated with?
Less than 4Hz. Stages 3 and 4. 20-50% of activity in Stage 3. More than 50% of activity in Stage 4.
For the first full sleep cycle, list the order of sleep stages you progress through.
1-2-3-4-3-2-REM (then back down: REM-2-3-4-3-2-REM and repeat).
Are the longest periods of REM at the start or end of the night?
End.
Which brain area controls REM sleep?
Pontine reticular formation.
Describe which brain areas are more and less active during REM sleep.
More active: limbic system and motor cortices (although signals blocked).
Less active: prefrontal cortex.
Which of these sensory responses remains active for the longest at sleep onset? Visual/Auditory/Olfactory
Olfactory. But meaningful auditory stimuli are also very powerful throughout night.
Briefly describe the evolutionary model of sleep.
Humans are not well adapted to operating at night (poor night vision, would be very vulnerable). Sleep is an adaptive mechanism to get around this. Suggested that changes in circadian rhythm with age ensure someone is on guard at all points throughout night.
Which is the main area of the brain that dictates circadian rhythm?
Suprachiastmatic nucleus.
Describe the effect of sleep dreprivation on the retention of positive, negative and neutral stimuli. What effects could this have on well-being?
When sleep deprived (compared to rested) you retain fewer positive and neutral memories, but about the same amount of negative memories. Will likely add to negative affect.
Describe the Restoration model of sleep. What evidence is there for it?
Body breaks down over the day. Need to repair at night. Evidence includes longer sleep after exercise
Where is melatonin secreted from?
Pineal gland.
Is the correlation between SCN activity and melatonin secretion positive or negative?
Negative. SCN active during day which suppresses melatonin secretion.
What does SOL stand for and what does it mean?
Sleep Onset Latency. Time between ‘lights out’ and falling asleep.
What does WASO stand for and what does it mean?
Wake After Sleep Onset. Total amount of time spent awake after initially falling asleep (may be multiple awakenings; high in insomnia).
What does TST stand for and what does it mean?
Total Sleep Time. Can be referring to self-report or measurement.
What does TIB stand for and what does it mean?
Time In Bed. Important for insomnia to estimate sleep efficiency.
CITE Diathesis-Stress Model/3P model of insomnia (Predisposing, Precipitating, Perpetuating factors).
Spielman 1987
CITE Stimulus control model of insomnia
Bootzin & Nicasio 1978
CITE Neurocognitive model of insomnia based on the Hyperarousal Model
Perlis et al 1997
CITE Psychophysiological model of insomnia
Espie et al 2006
CITE RCT showing effectiveness of one-off dose of CBT-I
Ellis et al 2015
CITE Consensus Sleep Diary
Carney et al 2012
CITE Pittsburgh Sleep Quality Index
Buysse et al 1989
CITE Insomnia Severity Index
Morin et al 2011
CITE Sleep Condition Indicator
Espie et al 2014
CITE First night effect and reverse first night effect. FNE more common than RFNE. RFNE can occur because home environment may not be conducive to good sleep.
Byun et al 2019
CITE Family history of dream enactment increases OR of having RBD
Dauvilliers et al 2013
CITE Nighttime seizures may be confused for some symptoms of RBD
Nguyen-Michel et al 2018
CITE Restless Leg Syndrome may be confused for some symptoms of RBD
Gaig et al 2017
CITE Main impact of RBD is self-injury
Schenck et al 2019
CITE Example of RBD leading to criminal proceedings due to injury to bed partner
Ingravallo et al 2010
CITE Best practice guidelines for RBD treatment
Aurora et al 2010 and ICSD-3 2014
Pharmacological interventions for RBD?
Melatonin. Benzodiazpines (muscle relaxant). Off-label clonazepam. Mixed reports of rivastigmine (Brunetti,2014; can also induce it Yeh 2010)
ICSD-3 criteria for RBD
A. Repeated motor or vocalisation events. B. PSG or clinical history shows it’s associated with REM sleep . C. PSG used to demonstrate lack of muscle atonia. D. Not better explained by another sleep disorder, mental disorder, medication, or substance use.
Treatment for RBD
Environmental changes to avoid self-injury. Pharmacological treatments include clonazepam, benzodiazpines, melatonin, rivastigmine. See neurologist to detect onset of Parksinsons, LBD dementias or similar.
Main impacts of RBD
Self-injury. Injury to bed partner. Long term it may be Parkinson’s. Fatigue due to poor sleep for self and partner. Long term this can have negative effects on mood and sociability.
CITE Negative daytime effects of insomnia disorder (DSM5)
Espie et al 2012
What are the diagnostic criteria for Chronic Insomnia in adults in ICSD3?
A) Difficulty going to sleep, remaining asleep or problematically early waking. B) Dissatisfaction with sleep or negative effects on daytime functioning in any aspect of daily life from work/study through to socialising or hobbies. C) Can’t be explained by failure to allot an appropriate amount of time for sleep. D) Three times per week E) Three months F) Not better explained by something else.
A) Difficulty B) Dissatisfaction C) Duration D + E) 3x3 F) Due to something else
CITE Links between improved sleep at mental health
Freeman et al 2017
CITE Effectiveness of CBT improving various aspects of sleep
Friedrich and Schlarb 2017, Espie et al 2018
CITE Exercise is somewhat effective for insomnia treatment but needs more research.
Lowe 2019
CITE European guideline for treatment of chronic insomnia disorder
Riemann et al 2017
CITE Genetic factors in insomnia
Palagini et al 2014
CITE Insomnia: microarousals being perceived as awakenings
Feige et al 2013
CITE Insomnia sufferers twice as likely to be depressed
Baglioni 2011
CITE Sleep hygiene
Hauri, 1991
What are the three generic criteria for ICSD3 sleep-wake phase disorders?
A) Chronic disturbance to sleep habits which are disruptive. Arise from change to endogenous CR or misalignment between endogenous CR and societal demands (work, school, social etc). B) Must cause symptoms of insomnia or excessive sleepiness. C) Must be disruptive, distressing or otherwise problematic.
What are the five criteria for delayed SWPD?
A) Major delay in timing of major sleep episode. Difficulties falling asleep and waking at desired time. B) Chronic - three months C) If a person is allowed to sleep freely, sleep quality and wellbeing is substantially improved. D) Delay must be evidenced by sleep logs or actigraphy for at least a week and must include free and work days. E) Not better explained by another sleep disorder, physical of mental health disorder, medication side effects or substance use.
CITE Adolescents engage with social media immediately before bed leads to poorer quality and lower volume of sleep.
Levenson et al 2017
CITE Evening chronotype (owl) associated with increased moribidity of every UK Biobank measure
Knutson and Schantz 2018
CITE Links between health/immune function and sleep
Besedovsky 2019
CITE Negative memories more remembered when sleep deprived
Stickgold & Walker 2006
CITE Insomnia general review, effectiveness of CBTi
Kyle et al 2010
CITE Improving sleep improves mental health symptoms
Freeman et al 2017
CITE Circadian rhythms affect pharmacological timing
Ballesta 2015
CITE Chronotype changes with age
Randler 2017
CITE European insomnia guidelines
Riemann et al 2017
CITE Women understudied in CR disorders
Ashby 2019
General criteria for NREM parasomnias
A) Incomplete awakenings B) Low function and low imagery C) Unresponsive to interaction D) No recall E) Not better…
CITE Chronotherapeutics
Ballesta 2015
CITE Nightmare recommendations
Morganthaler 2018
CITE RBD to Parkinson
Lin 2018
CITE Owls poorer outcomes for a range of measures UK Biobank
Knutson and Schantz 2018
CITE Local brain sleep
Tononi 2011
