Sleep physiology, hyper somnolence, parasomnias

Question 1

Describe non-REM sleep

Answer 1

More at start of night
Synchronised, rhythmic EEG activity, partial relaxation of muscles, reduced cerebral blood flow
Reduced HR, blood pressure and tidal volumes
Some non-narrative images

Question 2

Describe REM sleep

Answer 2

Mostly at end of night
EEG shows fast activity, similar to wakefulness
Atonic muscles (except diaphragm and extra ocular muscles
Cerebral blood flow increased, impaired thermoregulation
Narrative dreaming

Question 3

Which part of sleep is essential?

Answer 3

Non-REM

Question 4

What is REM sleep thought to be for?

Answer 4

Early brain development- substitute for wakefulness

Question 5

Which drugs suppress REM

Answer 5

Tricyclic

Question 6

What is non-REM sleep for?

Answer 6

Protein synthesis, cell division and growth

Question 7

What does circadian rhythm regulate?

Answer 7

Sleep-wake, appetite, body temperature, hormone secretion, alertness

Question 8

How long is a normal circadian rhythm?

Answer 8

25 hours

Question 9

How does light entrain body clock?

Answer 9

Uses retinal ganglion cells projecting to suprachiasmatic nucleus. Non-rod, non-cone cell/

Question 10

When does cell division peak?

Answer 10

Skin mitosis peaks during sleep, however time of day effect- also increases after meals

Question 11

What are the side effects of sleep deprivation?

Answer 11

Irritable and suspicious
Visual illusions
Microsleeps and concentration lapses

Question 12

About __% of RTAs attended by police are sleep related

Answer 12

10%

Question 13

What is an appropriate amount of sleep?

Answer 13

7-7.5 hours

Question 14

A mid afternoon nap is equivalent to __ minutes of sleep overnight

Answer 14

90

Question 15

What are the non- REM parasomnias?

Answer 15

Non-dreaming
Confusional arousals
sleep walking
Sleep terrors and paralysis
Bruxism
Restless legs and PMLS

Question 16

When are REM parasomias often seen?

Answer 16

Preceding PD

Question 17

Which type of sleep disorders show simpler behaviour?

Answer 17

REM parasomnias

Question 18

What are the peaks of onset of narcolepsy?

Answer 18

age 15 and 36

Question 19

What is the clinical presentation of narcolepsy?

Answer 19

Characterised by;

• Daytime sleepiness
• Cataplexy
• Hynagogic hallucinations
• Sleep paralysis
• RBD

Question 20

What is daytime sleepiness?

Answer 20

Involuntary somnolence during eating/talking

May be severe, and impossible to resist

Question 21

What is cataplexy?

Answer 21

Loss of muscle tone triggered by emotion

Question 22

What are hypnagogic hallucinations?

Answer 22

Hallucinations occurring at sleep onset

Question 23

What is sleep paralysis?

Answer 23

Unable to move upon falling asleep or awakening with retained consciousness

Question 24

What is RBD

Answer 24

Sleep behaviour disorder -present in 7-36% of patients with narcolepsy

Question 25

What are the investogations for narcolepsy?

Answer 25

Overnight polysomnography

Multiple sleep latency test

Lumbar puncture

Question 26

What is involved in a multiple sleep latency test?

Answer 26

4 twenty five minute maps are scheduled out two hours apart

Record of EEG, muscle activity and eye movement recorded

Measures time from start of a daytime nap to the first signs of sleep (sleep latency)

Faster patient falls asleep the more tired they are

Question 27

What is checked in lumbar puncture for narcolepsy?

Answer 27

CSF hypocretin levels, Low levels (less than 110pg/ml or 1/3 of the mean control value) are consistent with narcolepsy