Sleep cycle & insomnia

Question 1

Define the term sleep regulation

Answer 1

Where different brain structures are responsible for controlling and regulating sleep & wakefulness.
Inhibition of arousal and sleep-promoting centres affects sleep
We flip between sleep and wakefulness these are influenced by internal & external factors

Question 2

What neurotransmitters are released during from arousal centre?

Answer 2

Histamine. orexin & acetylcholine
All excitatory neurotransmitters

Question 3

Where is the arousal Centre located?

Answer 3

This area is found in the hypothalamus and stimulates the cerebral cortex which causes the release of neurotransmitters

Question 4

Where is the sleep promoting centre found?

Answer 4

This is found in the VLPO
Ventrolateral preoptic nucleus found in the hypothalamus
VLPO produces GABA & galanin which are inhibitory neurotransmitters. Inhibit the wake cycle, causes the arousal centre to shut down and prompts NREM sleep

Question 5

Describe the meaning of the ‘sleep switch’

Answer 5

It refers to the inhibition made by both neurotransmitters in different cycles, to promote sleep & wakefulness
E.g., when the cerebral cortex is stimulated histamine is released which inhibts the VLPO

Question 6

What are the 2 components of the sleep wake cycle proposed by borbely?

Answer 6

Process C: circadian rhythm
Process S: body’ internal timer
These processes affect the duration, timing and structure of sleep

Question 7

Describe process C

Answer 7

SCN communicates the CR to the body by stimulating melatonin production from the pineal gland, melatonin production peaks at night
Melatonin DOES NOT induce sleep, but starts the sleep process
CR controls: level of alertness, sleep tendencies, melatonin, hormone production, cardio/resp function & glucose levels

Question 8

Describe process S

Answer 8

This is a homeostatic mechanism that counts how long we have been awake/asleep for
As the day goes on a sleep pressure build whilst we are awake
As you sleep the sleep pressure decreases & likelihood of waking increases

Question 9

Define sleep pressure

Answer 9

The accumulation of adenosine in the cerebral spinal fluid whilst we are awake. Adenosine is released from ATP during R/s from glycogen
Adenosine drops during the night as glycogen stores are replenished

Question 10

What are the effects of stimulants on sleep e.g., caffeine?

Answer 10

Stimulants act as adenosine receptor antagonists, adenosine is inhibited but levels continue to rise. prevents adenosine from inducing sleep

Question 11

List external factors that affect sleep (give at least 5 examples)

Answer 11

-Light
- Medication
- medical conditions
- Caffeine
- Alcohol
- Drugs

Question 12

How does the presence of light effect sleep

Answer 12

Light affects the SCN which is responsible for regulating circadian rhythms. Light stimulates photosensitive areas in the retina which signal the SCN via retinohypothalamic tract. Light exposure therefore directly affects sleep as it is able to reset the body clock

Question 13

How can medical conditions affect sleep?

Answer 13

Some medical conditions may cause pain which causes difficulty sleeping, also affecting the quality of sleep (depth & length)
Mental disorders e.g., depression can create a sleep delay & reduce quality of sleep, increase in REM sleep

Question 14

Define insomnia

Answer 14

This is defined as difficulty getting to sleep, staying asleep & waking up earlier than intended to.
15% of adults suffer from chronic insomnia
40% of adults will suffer from insomnia
Insomnia can be induced by lifestyle factors e.g., alcohol & medication
Insomnia is linked to increased risk of depression, heart disease & stroke

Question 14

How can medications affect sleep?

Answer 14

E.g., Beta blockers can reduce NREM & REM sleep. This can increase daytime sleepiness
Some antidepressants may cause insomnia
Some medication contains caffeine which acts as a adenosine receptor antagonist

Question 14

What is the effect of alcohol on sleep?

Answer 14

Alcohol may cause us to drift off easier to sleep, but the overall quality of sleep is reduced. You are more likely to suffer with broken sleep

Question 15

Name daytime symptoms of insomnia (give min 5)

Answer 15

• Lack of concentration
• Irritability
• Accident prone
• Daytime sleepiness
• Depression
• Forgetfulness
• Lack of energy
• Decreased performance in tasks

Question 16

What are the 4 types of insomnia

Answer 16

1. Chronic insomnia
2. short-term insomnia
3. other insomnia
4. normal variants & isolated symptoms

Question 17

Describe and explain chronic insomnia

Answer 17

Chronic insomnia diagnosis is given when insomnia has occurred minimum 3 times a week for more than 3 months.
This can be further broken down into 3 catergories of paradoxical insomnia, idiopathic insomnia & psychological insomnia
symptoms include:
- accident prone
- irritability
- lack of attention/ concentration
- difficulty maintaining & initiating sleep
- daytime sleepiness

Question 18

Define psychological insomnia

Answer 18

A form of chronic insomnia in which it is a learned response. A person is unable to sleep when they plan to, difficulty getting to sleep or napping. Can sleep when it is unplanned, this creates anxiety for a person of when & where they will fall asleep next. Creating a vicious cycle of wanting sleep, but not getting it

Question 19

Define idiopathic insomnia

Answer 19

A form of chronic insomnia in which is detrimental to health. It is lifelong insomnia. It appears in infancy & childhood, no known cause or cure

Question 20

Define paradoxical insomnia

Answer 20

A form of chronic insomnia in which there is a lack of evidence. Patients will complain of restlessness & fatigue, however there EEG shows evidence of restful sleep
A sleep diary is recommended to keep an eye on sleep habits & hygiene

Question 21

Define short-term insomia

Answer 21

This is where an individual suffers with insomnia episodes for less than 3 months. A change to lifestyle or a stressful event normally causes it. e.g., a new baby, the death of a friend/family member, or a career change.
This type of insomnia is normally resolved once problem or new lifestyle is adapted to.

Question 22

Define other insomnia

Answer 22

This is a form of insomnia that does not fit into other categories. Patients may have some aspects of the disorder, but do not show all the symptoms and therefore a proper diagnosis is not given as they do not reach full criteria for short-term or chronic insomnia

Question 23

Define normal variants & isolated symptoms

Answer 23

This is defined as excessive time spent in bed, patients have no daytime problems, but struggle to get to sleep
Shorter sleepers tend to spend 6 hrs in bed
Longer sleepers tend to spend 9hrs+
No sleep/daytime symptoms
Diagnosed by lack of daytime symptoms

Question 24

What are the causes of insomnia?

Answer 24

• Hyperarousal state preventing falling & maintenance of sleep
• Medical conditions: pain, frequent urination, sleep apnea
• poor sleep hygiene (technology before bed)
• Mental health conditions e.g., depression/anxiety
• Eating or drinking large amounts before bed

Question 25

How is insomnia treated?

Answer 25

To treat insomnia it is proposed that underlying condition must be addressed first before treatment. e.g., identifying depression and treating that
Non-drug therapies should always be given first before medication
Drugs to only be used in serious cases and for a short period of time

Question 26

What are the 5 types of treatment for insomnia?

Answer 26

Antihistamines
Benzodiazepines
Antidepressants
Melatonin
Talking therapies

Question 27

Describe the use of antihistamines in treatment of insomnia

Answer 27

Antihistamines prevent the release of histamine, an excitatory neurotransmitter, preventing inhibition of VLPO. Therefore, they may aid in sleep and are widely available over the counter.
However, they become less effective the more you use them & they may leave you feeling groggy the morning after

Question 28

Describe the use of benzodiazepines in treatment of insomnia

Answer 28

These are prescription-required drugs as they can cause over-dependency and addiction. e.g., valium/xanax
They provide a sedative & hypnotic sleep-inducing effect. Sleep aid, 10+ million prescriptions given annually. They enhance the effect of GABA an inhibitory neurotransmitter, prevents inhibition of VLPO
e.g., diazepam

Question 29

Describe the use of antidepressants in treatment of insomnia

Answer 29

Some antidepressants can provide a drowsy & relaxant effect.
However, some antidepressants may induce insomnia
Antidepressants need more research in to treatment for insomnia, should be carefully prescribed

Question 30

Describe the treatment of melatonin in treatment of insomnia

Answer 30

There is less risk associated with dependence on melatonin. Melatonin is released by the pineal gland naturally to induce sleep. It is available over the counter. Is a useful supplement as melatonin production decreases with age, allows more restful sleep

Question 31

Describe use of non-drug therapies in treatment of insomnia

Answer 31

These therapies should always be the first recommendation in the treatment of insomnia
These therapies involve improving sleep hygiene, reducing stimulus, relaxation therapy as well as CBT. CBT is used to change someone’s mindset around sleep as anxiety around sleep could be creating insomnia. Changes dysfunctional attitudes