Sleep Disorders Flashcards
Physiology of sleep
Retinohypothalamic tract census light or darkness (even with eyes closed) → suprachiasmatic nucleus→ superior cervical ganglia→ pineal gland→ sends melatonin to the brain
(melatonin is not sedating what transmits information for sleep)
Chemicals involved in sleep and wake regulation
Adenosine: builds when we are awake and trigger sleepiness
Orexin signaling loss causes
Fragmented sleep and wakefulness
(decrease in people with narcolepsy)
What is wake propensity?
The balance between wake and sleep drive
What happens when you don’t sleep for a day?
There is a second wind & you tend to feel better as the Circadian wave drives increases
How does the suprachiasmatic nucleus work during the day?
Activate wake pathway and turns off sleep pathway
(vice versa at night via melatonin)
What are the stages of sleep in order of occurance?
- Stage 1
- Stage 2
- Stage 3 and 4
- REM
(least in REM)
How does sleep help to clear the mind?
Extracellular space increases→ allows faster clearance of metabolic waste
(good sleep May reduce the risk of neurocognitive disorders)
Sleep spindles are seen in which stage of sleep? What happens during this stage?
- Stage 2
- Transferring short-term memory to long-term memory
What stage of sleep do delta waves appear?
Stage 3
(brain waves start to fire in synchrony)
Which stage has mostly delta waves?
Stage 4
When are factual memories laid down?
- non-REM
- first half of night
When are procedural memories laid down?
Stage 2, 3, & 4
(the last half of sleep)
Which stage asleep is responsible for creativity?
REM
(capacity to measure time is absent- if woken up during this time and try to go back to sleep, when you wake you won’t know how long you were out)
What is the problem with napping?
If you get into deep stages of sleep it will disrupt your circadian rhythm and make it difficult to fall asleep at night
The older you get, what stage of sleep decreases?
Deep sleep
(also have more awakenings. Children get the best & the most sleep)
When babies kick, what stage of sleep are they in?
REM (we don’t develop paralysis during REM until we’re born)
Adjustment/transient insomnia
Related to a stressor (illness, work or relationship stress)
Chronic insomnia characteristics
- Long-term
- Waxes and wanes
- Primary or comorbid
Situational stressors related to transient / short-term insomnia
- Environmental Factors
- Emotional upset
- Major life events
- Systemic factors
- Rx
- Circadian Rhythm disruptions
Disorders associated with chronic insomnia
- Medical disorders and conditions
- Psychiatric disorders
- Primary Sleep disorders
(don’t memorize list, familiarize)
What percentage of people say that they have difficulty sleeping?
58%
Percentage of patients with sleep difficulty who actively seek treatment
(we accept not sleeping as a way of life)
Impact of insomnia
- Psychiatric disorders
- Neurocognitive functioning
- Absenteeism (physical and cognitive)
- Accidents
- Difficulties at work (get 25% less work done)
Insomnia increases the likelihood of accidents by ____
3-4 times
Insomnia increases the utilization of Health Care Services by how much?
Insomnia maybe one of the causes of _____
Psychiatric disorder
Define dyssomnia
Disturbance in the amount, quality or timing of sleep
Define insomnia disorder
Difficulty initiating or maintaining sleep or non restorative sleep (three nights per week for 3 months)
Causes significant distress
(does not occur with other sleep or mental or medical disorders)
The three p’s of insomnia
- Predisposing factors
- Precipitating factors
- Perpetuating factors
Approach to management of insomnia
Good sleep practices (aka sleep hygiene) (7)
- Regular waking up times
- limit time in bed not sleeping
- Limit napping (shift workers need it)
- No exercise before bed
- Avoid blue light
- Reduce or eliminate nicotine caffeine and alcohol
- Don’t look at a clock after you’re in bed (it takes a lot of mental capacity to evaluate the time and stresses them out if its late)
Cognitive behavioral therapy methods for sleep (5)
- Stimulus control therapy (sleep & sex only in bed)
- Sleep restriction therapy
- Relaxation training
- Cognitive therapy
- Sleep hygiene
Sleep restriction therapy
If a patient only sleeps 4 hours a night but wants seven → restrict naps → if they can do this & sleep the full 4 hours for 4 nights → add one more hour of sleep→ repeat
(repeat until they reach their goal; this re-conditions their perpetuating behaviors due to sleep)
If a patient can’t sleep what should they do?
Something productive or something they enjoy
(this is cognitive therapy)
Insomnia: pharmacologic agents (6)
- Sedating antidepressants
- Antipsychotic
- Benzodiazepines
- Non-benzodiazepine
- Melatonin
- Orexin Receptor Antagonist
(low-dose antidepressants and antipsychotics)