Sleep Phys

Question 1

Sleep is a behavioral state:

Answer 1

Individual need genetically determined

Compensation following sleep loss i.e. sleep more after sleeping less = homeostatic drive likely due to adenosine buildup.

Question 2

Why do we sleep?

Answer 2

brain and body regeneration (NREM sleep, N3 SWS) and brain development/memory ** (REM sleep).

Performance of learned motor tasks improve after sleep, but not after similar period of wakefulness

Improved performance correlates with increases in focal delta over involved cortex during sleep
REM sleep essential for the developing mammalian brain, but functions of REM sleep in adults uncertain

Stage 3-4 (delta), now N3 sleep may be involved in synaptic “pruning” and “tuning

Question 3

We likely evolved to take advantage of:

Answer 3

morning blue-green light; the orange – red spectrum of late afternoon and evening does not have the same salutary effects

Question 4

NREM (N1, N2, N3 [SWS] sleep)

Answer 4

high amplitude slow brain waves, increased arousal threshold compared to wake, decreased muscle activity, slow rolling eye-movements, decreased heart rate, respirations and metabolism.

Question 5

rapid-eye movement sleep (REM) – every ~90 minutes

Answer 5

in adults - EEG looks awake but arousal threshold is higher than in SWS= an active brain in a paralyzed body. Eyes move, muscles paralyzed, except for eyes & diaphragm, temperature regulation suspended (like reptiles), brain temperature rises, engorgement of clitoris and penis; heart and respirations become irregular. When awakened, 85% report dreams though dreams also reported at a lower frequency in SWS

Question 6

(walking, terrors, confusional arousal, and night eating syndrome) usually arise early out of N3, SWS.

Answer 6

Disorders of arousal

Question 7

usually arises later, out of REM sleep

Answer 7

REM sleep behavior disorder

Question 8

~90 minutes. Short REM latency seen in depression, alcohol withdrawal, very short seen in narcolepsy.

Answer 8

Normal latency to REM

Question 9

Insufficient sleep opportunity – Poor sleep habits
Circadian rhythm disorders e.g. delayed sleep phase, shift-work, jet lag
Obstructive or central sleep apnea (CSA may be precipitated by opioid use). 70% of OSA patients are sleepy, 30% not **
Narcolepsy
Idiopathic hypersomnia
Head injury
Depression: especially seasonal, atypical, bipolar
Drug use or withdrawal
RLS
Medical illness e.g. renal or hepatic failure, brain tumors, neurodegenerative disorders

Answer 9

High Epworth: Excessive daytime sleepiness (EDS)

Question 10

driven by cholinergic pedunculo-pontine and laterodorsal tegmental (PPT/LDT) neurons

Answer 10

REM sleep

Question 11

Sleep Diagnoses through the life-cycle Kids:

Answer 11

Disorders of arousal: walking, night terrors, confusional arousals. Worry about safety.

Question 12

Sleep Diagnoses through the life-cycle Kids and adolescents

Answer 12

OSA. Circadian mismatch- delayed sleep phase syndrome (night owl). Worry about school

Question 13

Sleep Diagnoses through the life-cycle Adolescents & young adults:

Answer 13

poor sleep hygiene & sleep deprivation. Narcolepsy. Worry about driving & accidents. Sleep during pregnancy.

Question 14

Sleep Diagnoses through the life-cycle On-call:

Answer 14

Deprivation and circadian mismatch- shift-work sleep disorder.

Question 15

Sleep Diagnoses through the life-cycle Older:

Answer 15

learned or “conditioned” insomnia, obstructive sleep apnea, restless legs syndrome & periodic limb movement disorder (all can be in kids, too). Safety?

Question 16

Sleep Diagnoses through the life-cycle 50+

Answer 16

REM Sleep Behavior Disorder. Again, safety?

Question 17

Anxiety and depression

Conditioned / learned insomnia

Answer 17

Low Epworth: Fatigue

Question 18

waking discomfort. Urge to move legs and/or arms, with onset or worsened by rest, usually at night, and somewhat relieved by movement. ? Associated with HTN

Potentially “iatrogenic” along with REM sleep behavior disorder, sleep walking and OSA - precipitated or worsened by psychotropic medications.

Get serum ferritin and undergo fe replacement if 55 or less (will be reported as “normal”)

Fe = cofactor in dopamine metabolism

Answer 18

Restless Legs Syndrome  insomnia or EDS or both

Question 19

Both can be precipitated by psychotropic medications Both have been associated with serious injury to the patient and to those patients may encounter.

Answer 19

Walking & REM Sleep Behavior disorder

Question 20

genetic propensity, usually in children, out of slow wave sleep usually in first part of sleep period, partially or totally amnestic for event. Look for causes of increased sleep pressure and sleep disruption e.g. sleep schedule, deprivation, medications, drugs, obstructive sleep apnea, RLS, etc.

Answer 20

Disorders of Arousal (sleep walking, night terrors):

Question 21

(loss of muscle paralysis during sleep –> acting out dreams. Men > 50, can be prodrome to neurodegenerative disease, may be ppated by antidepressants and psychotropic medications. If seen in young, may be due to meds. Occurs in latter part of night when REM sleep is more prevalent; patient totally alert and easily wakened.

Answer 21

REM Sleep Behavior Disorder