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Neurology > Sleep Phys and Disorders > Flashcards

Sleep Phys and Disorders Flashcards

1
Q

What part of the brain, in very general terms, regulates sleep?

A

diencephalic nuclei

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2
Q

See slide 5 for ambient light summary

A

ok

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3
Q

Body temperature does what during sleep periods?

A

Falls

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4
Q

Growth hormone is released most when?

A

Just after we fall asleep

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5
Q

Cortisol is released most when

A

Just before we wake up

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6
Q

Method of measuring sleep is known as

A

polysomnography

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7
Q

How many stages of sleep are there

A

5

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8
Q

What are the different divisions of EEG frequency

A

Beta- Over 13 hz
Alpha- 8-13 hz
Theta- 4-7 hz
D- less than 4

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9
Q

Beta frequency EEG

A

Over 13 hz. Most commonly seen in normal awake human beings

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10
Q

As frequency falls, what happens to ampltude>

A

It rises

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11
Q

So, basically as you progress from “Awake” through stage 4, the frequency of the EEG falls while the amplitude of the waves rise.

A

ok

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12
Q

What is unique about the EEG in REM sleep?

A

It is appears to be very similar to that of the awake sleep

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13
Q

Stages I-IV together are called

A

Non- REM sleep

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14
Q

Stage I is the lightest sleep and stage 4 is the…

A

deepest

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15
Q

Sleep spindles and K complexes are characteristics of what stage of sleep

A

2

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16
Q

What type of EEG activity characterizes stage I and II of sleep?

A

Theta

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17
Q

Stage 3 and 4 sleep are characterized by what kinds of EEG waves

A

Delta

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18
Q

The duration of sleep in stages 3 and 4 is longest when?

A

Early in a sleep cycle

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19
Q

The duration of REM sleep is longest when>

A

Late in the sleep cycle

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20
Q

Compare Non-REM with REM. Physiologically

A

NREM- Eye movements are slow, movement occurs but muscle tone is decreased

  • Decreased BP, HR, RR, metabolic rate
  • Dreams less vivid, low emotional content
  • Sleep walking and night terrors occur during slow wave
  • All reach a maximum during Stage IV sleep

REM-

  • Rapid eye movements
  • muscle paralysis
  • HR, BP, RR, temp and metabolism approach awake level
  • Dreams Vivid, high emotional content
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21
Q

Penile and clitoral erection occur when?

A

During REM sleep

22
Q

Brain activity is increased where during REM sleep?

A

_ Amygdala, parahippocampal gyrus, anterior cingulate cortex

23
Q

What brain areas are inhibited during REM

A
  • Frontal Cortex and posterior Cingulate cortex.
24
Q

What is the significance of these active and inactive brain regions

A
  • The activity explains the vivid, emotional dreams that occur during REM.
  • The inhibition of the certain brain regions may explain the bizarre nature of some dreams due to reduced executive reasoning and ratinal thought
25
Q

Make a chart for the Neural sleep circuits

A

ok

26
Q

The Neural sleep Circuit that is Cholinergic in nature is

A
  • Cholinergic neurons from the pedunculopontine (PPT) and Lateral Dorsal Tegmental (LDT) project to the thalamus and other brainstem areas.
  • Triggers thalamic cortical signaling that produces high frequency, low voltage EEG activity consistent with arousal.
  • Also active during REM sleep
27
Q

Noradrenergic sleep circuit?

A

Noradrenergic input comes from the locus ceruleus to the neocortex

Highly activated during wakefullness, none during REM

28
Q

Dopaminergic wakefullness cicuits originate where?

A

Substantia Nigra

This circuit is most important for full wakefullness

29
Q

Serotonergic circuits originate where?

A

dorsal and medial raphe nuclei

30
Q

Histaminergic output during wakefulness comes from

A

tuberomammillary nucleus

31
Q

What is important about the Orexin pathway

A

90% of pts with narcolepsy have significantly decreased or undetectable levels of orexin

32
Q

Ventrolateral preoptic nucleus

A

Significant because it harbors GABAergic and Galanin neurons both of which innervate and inhibit all of the nuclei that activate arousal. Thus, activation of the VLPO causes decreased forebrain arousal and the onset of NREM sleep

33
Q

Lesions of the VLPO would lead to

A

insomnia

34
Q

What are somnogens

A

endogenous sleep- promoting chemicals that may accumulate during wakefulness and promote sleep onset.

35
Q

Adenosine

A

a somnogen that builds up in the CNS during wakefullness and declines during sleep

36
Q

Cytokines IL-1B and TNF

A

promote sleep

37
Q

Melatonin

A

synthesis turned on by decreasing light

38
Q

Multiple sleep latency test

A

EEG defined sleep latency, i.e, the time required to fall asleep during 4-5 daytime naps

39
Q

Epworth sleepiness sclae

A

self-reported tendency to fall asleep in 8 diff situations

40
Q

Obstructive Sleep Apnea

A

Repetitive blockage of the resp pathway during sleep causing apneic periods lasting

  • Longer than 10 senconds
  • and causing oxyhemoglobin desaturations of more than 4%
41
Q

Strong association b/w OSA and

A

heart disease and HTN

42
Q

Check out OSA phys findings and symptoms slide

A 
- May have:
Nasal obstruction
Tonsillary hypertrophy
HTN
CHF
Pitting Edema with large hands and feet

Snoring, heartburn, memory loss, depression, nocturia, impotnece

43
Q

Narcolepsy

A

Excessive daytime sleepiness associated with one or more of the following tetrad:

  • sleep attacks/ intrusions
  • cataplexy- abrupt loss of muscle tone
  • sleep paralysis- persistent REM sleep atonia after waking
  • hypnagogic hallucinations
44
Q

90% of ppl with narcolepsy develop it when

A

by 2nd or 3rd decade

45
Q

Pathogenesis of Narcolepsy

A

loss of hypocretin/orexin secreting neurons in the posterior lateral hypothalamus

  • related to HLA genes DQ1 and DQB1 that may predispose to autoimmune attack on orexin secreting neurons
46
Q

Dx of narcolepsy

A
  • clinical pres

- Low CSF hypocretin level

47
Q

REM sleep behavior disorder

A
  • Loss of atonia/paralysis during REM sleep.
  • Very rare, most common in adult males over 50

See slide for pathogenesis info

48
Q

Melatonin produced where

A

Pineal Gland

49
Q

Sleep Cycle Stage Progression

A

Awake- stage 1 - stage 2- stage 3- stage 4

Back to 3, 2, 1 etcc… periodically moving into REM

50
Q

one sleep cycle =

A

begins at stage one and ends with a period of REM….takes about 90 minutes

Neurology (38 decks)

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