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Neuropharmacology > Sleep Disorders and their treatment > Flashcards

Sleep Disorders and their treatment Flashcards

1
Q

what is stage 1 in the sleep cycle ?

A

light sleep, transition from alpha waves at 8-12 Hz to theta waves at 4-7Hz

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2
Q

what is stage 2 of the sleep cycle ?

A

this is unconscious sleep, sleep spindles occur at 12-16Hz

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3
Q

what are stages 3 and 4 of the sleep cycle ?

A

these are sometimes considered the same stage

deep sleep, slow wave sleep, delta waves of 0.5-4Hz

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4
Q

how many sleep cycles do you go through each night and describe the events in sleep cycles ?

A

4-5 cycles, each lasting about 1.5-2 hours
the cycles have more non-REM sleep earlier in the night
the time spent in stage 2 and REM increases through the night

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5
Q

how can sleep patterns be disturbed ?

A

disturbed by sleep disorders, medication and drugs of abuse

patterns also change with age

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6
Q

what NT are involved in maintaining wakefulness?

A 
noradrenaline
serotonin
dopamine
histamine
acetylcholine 
orexin
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7
Q

what NT are involved in promoting sleep ?

A

melatonin
GABA
adenosine

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8
Q

what happens with the release of orexin when your awake and when your asleep?

A

when your awake it is released at the TMN- tuberomamillary nucleus
when your asleep it is not released

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9
Q

what is happening when you are in the awake state ?

A

the ventrolateral preoptic nucleus has GABAergic neurons that are under tonic inhibition by noradrenaline

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10
Q

what happens in endogenous NREM sleep?

A

noradrenergic neurones in the locus coeruleus are inhibited by GABA
this in turn releases the tonic noradrenergic inhibition of the ventrolateral preoptic nucleus

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11
Q

what happens when the VLPO is released from inhibition ?

A

it enables the VLPO to release GABA onto the TMN
this inhibits the release of the arousal promoting histamine into the cortex
this induces loss of consciousness

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12
Q

what are the other pathways involved in NREM sleep ?

A

VLPO projects to all the monoaminergic cholinergic and orexinergic arousal nuclei such as tmn, LC, DR, PPTg, LDTg, PeF
these project to the cortex where they release arousal promoting neurotransmitters to promote wakefulness

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13
Q

what can be measuredd to assess sleep ?

A 
sleep onset latency 
total sleep time 
sleep efficiency 
wake time after sleep onset (WASO)
number of awakenings 
sleep quality
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14
Q

what is a subjective tool used to assess sleep measurements ?

A

sleep diary

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15
Q

what objective tools can be used to assess sleep measurements ?

A

MULTIPLE SLEEP LATENCY TEST
- assess daytime sleepiness by measuring the time it takes for patients to fall asleep (daytime nap)
POLYSOMNOGRAPHY
- typically used during an overnight sleep study
- electrodes continuouslu record eeg, REMs and muscle tone
WRIST ACTIGRAPHY
- used adjunctively with other objective data
- records movements of the wrist to determine time spent sleeping

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16
Q

what is important to record when carrying out a polysomnography ?

A

blood oxygen levels because some patients can stop breathing briefly during their sleep - this normally occurs in the elderly

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17
Q

what are some examples of sleep disorders ?

A 
insomnia 
circadian rhythm disorders 
narcolepsy 
parasomnias 
obstructive sleep apnoea syndrome
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18
Q

what are circadian rhythm disorders ?

A

jet-lag
shift-work disorder
advanced and delayed sleep phase syndromes

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19
Q

what are parasomnias ?

A 
sleep walking 
night terrors 
bruxism - grinding of teeth 
restless leg syndrome 
periodic leg movement disorder
20
Q

what happens to our circadian rhythm when we are placed in a cave or special apartment without clocks or time cues ?

A

people tended to go to bed an hour later and get up an hour later each day

21
Q

what does melatonin do ?

A

it promotes sleep

22
Q

how many people suffer from insomnia ?

A

it is a significant problem which is being increasingly recognised
10-30% of the population suffer from it
50% of insomnia patients have reduced daytime fucntioning - inability to concentrate, reduced energy, memory problems, work hazard

23
Q

what is primary insomnia ?

A

symptoms present for greater than 1 month
no associated mental or physical disorder
it is also known as chronic insomnia

24
Q

what is transient insomnia ?

A

associated with specific events- acute periods of stress or anxiety

25
Q

how is insomnia associated with depression and anxiety ?

A

insomnia is one of a number of symptoms caused due to depression and anxiety disorders
therefore do you treat the mental disorder or the symptoms

26
Q

what are non-pharmacological treatments for sleep disorders ?

A

SLEEP HYGIENE- be active during the day to try and tire yourself out

COGNITIVE BEHAVIOURAL THERAPY- therapy involves training people into good habits

27
Q

what pharmacological treatments can be used to treat sleep disorders ?

A

for insomnia

  • benzodiazepines and z drugs ( zolpidem, zaleplon, zopiclone)
  • chloral hydrate, chlromethiazole, antihistamines and melatonin

for narcolepsy
- sodium oxybate (GHB), modafinil

28
Q

how can REM sleep be dtermined ?

A

by putting an electrode net to the your eye- it is when you are dreaming

29
Q

what agents are involved in promoting sleep ?

A

GABA agonists and GABA allosteric modulators
melatonin agonists
5-HT2 antagonists
orexin anatgonists

30
Q

what agents are involved in promoting wakefulness ?

A

adenosine antagonists - caffeine

dopamine stimulants

31
Q

what agents cause sedation ?

A

GABA agonists and allosteric modulators
noradrenergic alpha-1 antagonists
histamine H-1 antagonists
muscarinic antagonists

32
Q

what do all classical benzodiazepines have ?

A

all have hypnotic action

33
Q

what dictates the usefulness of benzodiazepines ?

A

their duration of action
- do not want daytime sleepiness
short half life benzodiazepines are recommended such as temazepam - 9hrs

34
Q

what are the concerns associated with dependence of benzodiazepines?

A

there is more chance with short half life- this datta is limited with respect to hypnotic actions
have to limit use to short term use
PRN- pro re nata- taken when needed

35
Q

what effects were seen on sleep quality when benzodiazepines were taken ?

A

improvements were seen during the 24 week test period but it was followed by a rebound worsening of sleep

36
Q

what are z drugs ?

A

theses are non-benzodiazepines that act at specific subset of GABAa receptors

37
Q

what are some examples of Z drugs ?

A

zolpidem
zopiclone
zalepton
eszopiclones

38
Q

what receptors do zolpidem, zopiclone and zaleplon primarily act at ?

A

alpha1/beta2/gamma2 subunit GABAa receptors

39
Q

what does eszopiclone primarily act at ?

A

GABAa receptors made up of alpha2/beta2/gamma2, alpha3/beta2/gamma2 subunits

act to a lesser extent at alpha1/beta2/gamma2

40
Q

what is more recommended BZs or Z drugs ?

A

BZs is recommeneded by nice

41
Q

what are the pharmacokinetics of BZs and Z drugs ?

A

generally they have similar times to reach tmax, becayse 1-2hours

he half life of the BZs is longer copared to the z drugs

42
Q

what does chloral hydrate and chlormethiazole do ?

A

they are older drugs and are no longer recommended
GABAa receptor modulators
activate GABAa receptors at high doses and therefore they are not safe

43
Q

what do antihistamines do ?

A

e.g. promethazine
over the counter medication
little hypnotic effects, mainly sedative
tolerance and next day sedation are issues

44
Q

what does melatonin do ?

A

it is used in short term insomnia for people over 55 yrs

45
Q

what does sodium oxybate do ?

A

(gamma-hydroxybutyrae- GHB)
GABA analogue but has an unknown mechanism of action
street drug (GHB, liquid ecstasy)
useful in narcolepsy with cataplexy

46
Q

what does modafinil do ?

A

useful for daytime sleepiness associated with narcolepsy

unknown mechanism of action

Neuropharmacology (15 decks)

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