Sleep DO

Question 1

Sleep is divided into 2 stages:

Answer 1

nonrapid eye movement (NREM) and rapid eye movement (REM).

Question 2

________ is a state of sleep characterized by slowing of the EEG rhythms, high muscle tone, absence of eye movements, and thoughtlike mental activity.

The brain is inactive while the
body is active.

Answer 2

NREM

Question 3

Stages of NREM

Answer 3

Stage 1 Disappearance of alpha wave and appearance of theta wave 5%
Stage 2 k complexes and sleep spindles 45%
Stage 3 Appearance of delta wave 12%
Stage 4 Continuation of delta wave 13%

Question 4

________ is a stage of sleep characterized by aroused EEG patterns, sexual arousal, saccadic eye movements, generalized muscular atony (except middle-ear and eye muscles), and dreams. The
brain is active and the body is inactive.

Answer 4

REM

Question 5

EEG findings for REM

Answer 5

Bursts of sawtooth waves 25%

Question 6

Longest of all the sleep stages

Answer 6

Stage 2

Question 7

Also called slow wave or delta sleep
Hardest to arouse
Tends to vanish in the elderly

Answer 7

Stages 3 and 4

Question 8

Easiest to arouse
Lengthens in time as night progresses
Increased during the second half of the night

Answer 8

REM

Question 9

The time needed before you actually fall asleep. Typically less than 15 minutes
in most individuals

Answer 9

Sleep Latency

Question 10

The period lasting from the moment you fall asleep to the first REM period.
Lasts approximately 90 minutes in most individuals

Answer 10

REM Latency.

Question 11

However, several disorders will shorten

REM latency; these disorders include _______ and ______

Answer 11

depression and narcolepsy

Question 12

Characteristics of Sleep from Infancy to Old Age

Answer 12

• Total sleep time decreases.
• REM percentage decreases.
• Stages 3 and 4 tend to vanish.

Question 13

Neurotransmitters of Sleep
• ____: Increased during sleep; initiates sleep
• ______: Increased during sleep; linked to REM sleep
• _______ Decreased during sleep; linked to REM sleep
•_____: Increased toward end of sleep; linked to arousal and wakefulness

Answer 13

Serotonin

Acetylcholine

Norepinephrine:

Dopamine

Question 14

Chemical Effects on Sleep
• Tryptophan:_______
• Dopamine agonists: Produce arousal
• Dopamine antagonists: Decrease arousal, thus produce sleep
• _______: Suppress Stage 4 and, when used chronically, increase sleep latency

Answer 14

Increases total sleep time

Benzodiazepines

Question 15

Chemical Effects on Sleep

• Alcohol intoxication:_____
• Barbiturate intoxication:____
• Alcohol withdrawal: _____
• Barbiturate withdrawal: ______
• ______: Shortened REM latency, increased REM time, suppression of delta,
multiple awakenings, and early morning awakening

Answer 15

Suppresses REM

Suppresses REM

REM rebound

REM rebound

Major depression

Question 16

A disorder characterized by excessive daytime sleepiness and abnormalities of
REM sleep for a period of greater than 3 months. REM sleep occurs in less than 10 minutes. Patients feel refreshed upon awakening.

Answer 16

Narcolepsy

Question 17

MC sx Narcolepsy

Answer 17

Sleep attacks

Question 18

Narcolepsy

Pathognomonic sign, consisting of a sudden loss of muscle tone which
may have been precipitated by a loud noise or intense emotion. If short episode, the
patient remains awake

Answer 18

Cataplexy

Question 19

Narcolepsy

Hallucinations that occur as the
patient is going to sleep and is waking up from sleep, respectively.

Answer 19

Hypnagogic and hypnopompic hallucinations

Question 20

Narcolepsy

Most often occurs during awakening, when the patient is awake but unable to move.

Answer 20

Sleep paralysis

Question 21

Tx of Narcolepsy

Answer 21

Forced naps at a regular time of day is usually the treatment of choice.

Question 22

Medical TX of narcolepsy

Answer 22

When medications are given, psychostimulants are preferred.

If cataplexy is present, antidepressants
such as TCAs are preferred.

Question 23

_____ is also used for narcolepsy–

cataplexy by improving the quality of nighttime sleep.

Answer 23

Gamma-hydroxybutyrate (GHB)

Question 24

A disorder characterized by the cessation of airflow at the nose or mouth during
sleep.

These apneic episodes usually last longer than 10 seconds each. Characterized by
a loud snore followed by a heavy pause.

Answer 24

Sleep Apnea

Question 25

When is sleep apnea pathologic

Answer 25

Considered pathologic if the patient has more than `5 episodes an hour or more than 30 episodes during the night

Question 26

SSx of sleep apnea

Answer 26

• Complain of dry mouth in the morning
• May have headaches in the morning
• Complain of being tired during the day
• May develop arrhythmias, hypoxemia, pulmonary hypertension, and sudden death

Question 27

Types of sleep apnea

• _____ Muscle atonia in oropharynx; nasal, tongue, or tonsil obstruction
• ______ Lack of respiratory effort
• _____ Central at first, but prolonged due to collapse of the airway

Answer 27

Obstructive:

Central:

Mixed:

Question 28

A disorder characterized by difficulties in initiating or maintaining sleep

Answer 28

Insomnia

Question 29

RF for insomnia

Answer 29

Typically associated with some form of anxiety or anticipatory anxiety. Many patients have underlying psychiatric disorders, such as depression, etc. If due to
a psychiatric disorder, seen more frequently in women. Other conditions include PTSD, OCD,
and eating disorders.

Question 30

Meds for insomnia

Answer 30

If medications are to be used, consider

zolpidem, eszopiclone, or zaleplon.