Sleep Disorders

Question 1

origin and expression of circadian rhythms

Answer 1

hypothalamic nuclei

• suprachiasmatic
• subparaventricular
• dorsomedial

Question 2

diencephalic control of sleep onset

Answer 2

hypothalamic nuclei

• ventrolateral preoptic
• lateral
• tuberomamillary

basal forebrain

Question 3

Pontine control of the REM-NREM cycle

Answer 3

Mesopontine nuclei

• laterodorsl tegmental
• pedunculopontine
• dorsal raphe
• locus coerleus

Question 4

how many sleep cycles does the average adult have and how long do they last

Answer 4

5-6 sleep cycles

each lasts ~90minutes

Question 5

what stage of sleep do most adults spend most time in

Answer 5

Stage 2

it is also most common to wake from

Question 6

about how many sleep cycles do infants have and what accounts for half of the sleep time?

Answer 6

6-9 sleep cycles

half time is in REM

Question 7

how does sleep correlate with age

Answer 7

sleep decreases with age

Question 8

what are some functions of sleep

Answer 8

restoration

detox

preservation of energy

Question 9

which stage of sleep vanishes in the elderly

Answer 9

REM, then Stage 3

That’s why they tend not to feel as rested

Question 10

Describe Stage 0 sleep

Answer 10

period of wakefulness with eyes closed

Alpha waves (which decrease as drowsiness increases)

Question 11

Describe Stage 1 Sleep

Answer 11

sleep onset stage

provides brief transition from wakefulness to sleep

mainly Beta waves and slo theta waves

~5% of total sleep

Question 12

Describe Stage 2 sleep

Answer 12

dominated by Theta waves with K spindle complexes

teeth grinding (bruxism) occurs here

majority of sleep time (45-55%)

easiest to wake from

Question 13

Describe Stage 3 Sleep

Answer 13

slow wave/ deep sleep

high voltage Delta waves

increased muscle tone

absent eye movements

15-20% of total sleep time

Question 14

activities occurring during stage 3 sleep

Answer 14

sleep walking

eneuresis

night terrors

Question 15

Describe REM sleep

Answer 15

cardiac and respiratory rate fluctuations

penile and clitoral engorgement

20-25%of total sleep time

desynchronized sleep

rapid conjugate eye movements

reduced muscle tone

Question 16

what pathologic event occurs during REM sleep

Answer 16

Narcolepsy

Question 17

what stage does dreaming occur

Answer 17

REM

Question 18

treatment of Narcolepsy

Answer 18

Modafinil (weakly)

Question 19

what happens during REM deprivation

Answer 19

interferes with performance and learning of complicated tasks

decreased attention to details

Question 20

which substances are seen in deep sleep

Answer 20

ACH: more towards deep sleep (highest in REM)

Serotonin: more towards deep sleep

Less Norepi is seel during deep sleep

Question 21

what triggers REM

Answer 21

ratio of ACh and Norepi

Question 22

Things that could decrease REM

Answer 22

Benzodiazepines

High EtOH

Major Depressive Disorder (increased REM, but decreased latency)

Question 23

what could happen with high EtOH during REM sleep

Answer 23

REM rebound

night mares

Question 24

Describe REM sleep behavior disorder

Answer 24

dream enacting behaviors

content of action-filled or violent dreams of being attacked or trying to escape from a threatening situation

vocalizations are often loud, emotion-filled, and profane

Question 25

Describe Narcolepsy

Answer 25

recurrent episodes of an irrepressible need to sleep ## Footnote **must have occurred at least 3x/ week over the past 3 months**

Question 26

Describe nightmare disorder

Answer 26

repeated extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity. Typically occurring during the second half of sleep

Question 27

Describe NREM Sleep Arousal Disorder

Answer 27

**sleepwalking and sleep terrors—**represent variations of the simultaneous admixture of elements of both wakefulness and NREM sleep, thereby **resulting in the appearance of complex motor behavior without conscious awareness** usually amnesia after waking

Question 28

Describe RLS

Answer 28

sensorimotor, neurological sleep disorder characterized by a **desire to move the legs, usually associated with uncomfortable sensations** typically described as creeping, crawling, tingling, burning, or itching worse at rest and at night

Question 29

Describe Insomnia Disorder

Answer 29

difficulty initiating or maintaining sleep, or early morning awakening with an inability to return to sleep ## Footnote **occurs at least 3 nights a week for 3 months**

Question 30

how is insomnia typically treated

Answer 30

1. CBT 2. Benzos, Z drugs

Question 31

Describe hypersomnolence disorder

Answer 31

excessive sleepiness **occurs at least 3 times a week for 3 months,** as evidenced by prolonged sleep episodes, daytime sleep episodes, or difficulty being fully awake after abrupt awakening;

Question 32

treatment for hypersomnolence disorder

Answer 32

stimulant agents: **methylphenidate/ Adderall** Stimulant Antidepressants: **Fluoxetine**

Question 33

Describe Circadian Rhythm Sleep-Wake Disorder

Answer 33

persistent or recurring patterns of sleep disruption that result from an altered sleep-wake schedule, or occur when the sleep-wake cycle is **not correctly synchronized with a person’s daily schedule**

Question 34

Describe Obstructive Sleep Apnea Hypopnea

Answer 34

breathing repeatedly stops and starts during sleep **at least 5 episodes per hour of sleep** most common category of breathing-related sleep disorders **cannot breathe normally because of upper airway obstruction.**

Question 35

Describe central sleep apnea

Answer 35

repeated episodes of apneas and hypopneas during sleep caused by variability in respiratory effort. These occur because the **brain fails to send proper signals to the muscles that control breathing**

Question 36

Describe Sleep related hypoventilation

Answer 36

frequent episodes of shallow breathing lasting longer than 10 seconds during sleep **result of a decreased response to high carbon dioxide during sleep**

Question 37

Signs of Sleep deprivation

Answer 37

increased cortisol increased blood pressure inflammation amygdala activation transient psychotic symptoms confusion agitation