Sleep Physiology, Hypersomnolence, Parasomnias

Question 1

what is sleep?

Answer 1

normal, recurring, reversible state where there is loss of ability to respond to external environment

Question 2

what makes sleep not a conscious state?

Answer 2

not fully aware of self and environment

Question 3

what makes sleep not an unconscious state?

Answer 3

can respond when stimulated

Question 4

when do you have more non REM sleep?

Answer 4

start of night (3/4 of sleep for young adults is NREM)

Question 5

what occurs to the body during non REM sleep?

Answer 5

synchronised, rhythmic EEG activity

partial muscle relaxation

reduced cerebral blood flow

Question 6

what is heart rate during non REM sleep?

Answer 6

reduced heart rate

Question 7

do you dream during non REM sleep?

Answer 7

yes - get some non-narrative images

Question 8

when do you have more REM sleep?

Answer 8

end of night

Question 9

what happens to body during REM sleep?

Answer 9

EEG shows fast activity

fMRI shows increased brain activity - similar to awake

atonic muscles (except diaphragm and extraocular muscles)

increased cerebral blood flow
impaired thermal regulation

Question 10

do you dream during REM sleep?

Answer 10

yes - narrative dreaming

Question 11

what type of sleep is more important?

Answer 11

non REM sleep (deep sleep)

Question 12

why is non REM sleep more important?

Answer 12

allows cortex to recover after a busy day

Question 13

what is the main role of REM sleep?

Answer 13

early brain development in children

Question 14

what type of drugs suppress REM sleep?

Answer 14

tricyclics

Question 15

how many hours per day do neonates spend seeping?

what kind of sleep?

Answer 15

16

50% REM sleep, shorter cycles

Question 16

what is the trend of REM sleep during 1st decade?

Answer 16

percentage REM sleep falls

REM latency increases

Question 17

what kind of sleep habits do elderly experience?

Answer 17

increased awakenings

reduced REM latency and total sleep time

daytime napping

Question 18

what are the three critical processes of sleep onset?

Answer 18

homeostatic response - regulated need for sleep

emotional response - brain has to be ready to go to bed

circadian rhythm - body clock

Question 19

do adolescents have an advanced or delayed sleep pattern?

Answer 19

delayed

Question 20

do elderly have advanced or delayed sleep pattern?

Answer 20

advanced

Question 21

how long does normal circadian rhythm last?

Answer 21

25 hours

Question 22

how does light entrain body clock?

Answer 22

using retinal ganglion cells (non-rod and non-cone cells) projecting to suprachiasmatic nucleus

(why dark room = cant get up in morning)

Question 23

can the cortex rest when awake?

Answer 23

no - only during sleep

when awake it stays in “quiet readiness”

Question 24

most effects of sleep deprivation and prefrontal - what are these?

Answer 24

no psychoses but become irritable and suspicious

visual illusions

microsleeps and concentration lapses

Question 25

what time is the two peaks of drowsiness?

what also occurs at this time?

Answer 25

4am and 2pm

peak of number of sleep related crashes

Question 26

about 10% of RTAs attended by police are sleep related (most acutely deprived), in what kind of road is this number doubled?

Answer 26

non-urban roads

Question 27

what is most likely cause of accidental death at work in UK just now?

Answer 27

truck driver falling asleep at wheel

Question 28

what do most studies suggest is an acceptable amount of sleep?

Answer 28

7 - 7.5 hours

Question 29

donald trump thinks he only needs 3 hours sleep a night - why is he wrong about this? (and everything else he does)

Answer 29

he has lost perception of how sleepy they are - homeostatic response is dysfunctioning

Question 30

a mid afternoon nap of 15 minutes is equivalent to how many minutes of overnight sleep?

Answer 30

90 mins

Question 31

what occurs during REM parasomnia?

Answer 31

dreaming, much simpler behaviour, usually latter third of night

Question 32

what disease does REM parasomnias often precede?

Answer 32

parkinsons (about 38% of those with REM parasomnias get parkinsons)

Question 33

what occurs during non-REM sleep parasomnias?

Answer 33

non dreaming 
confusional arousals 
sleep walking 
sleep terrors (crying or screaming)
bruxism 
restless legs and PLMS
possible dissociation

Question 34

what is the incidence of narcolepsy in UK?

Answer 34

0.04%

Question 35

where are the two peaks of age of narcolepsy onset?

Answer 35

15 and 36

Question 36

what 5 things characterise narcolepsy?

Answer 36

daytime sleepiness - inappropriate times, during eating / talking

cataplexy - loss of muscle tone, triggered by emotion

hypnagogic hallucinations - hallucinations at sleep onset

sleep paralyses - unable to move on falling sleep or awakening with retained consciousness

RBD

Question 37

what investigations take place in narcolepsy?

Answer 37

overnight polysomnography

multiple sleep latency test

lumbar puncture

Question 38

how is a multiple sleep latency test carried out?

Answer 38

4 twenty five minute naps are scheduled about 2 hours apart

record of EEG, muscle activity and eye movement recorded

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

patients falls asleep faster if they are sleepier

Question 39

what is checked during a lumbar puncture for narcolepsy?

Answer 39

CSF hypocretin levels

low (<110pg/ml or 1/3 of mean control value) = narcolepsy

Question 40

are you able to drive with narcolepsy?

Answer 40

yes but cease driving on diagnosis until control is achieved

permanent exclusion from group 2

Question 41

what is REM sleep behaviour disorder?

Answer 41

paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to act out dreams dreams

characterized by the acting out of dreams that are vivid, intense, and violent

Question 42

what is example of REM parasomnia?

Answer 42

nightmares
sleep paralysis
REM sleep behaviour disorder