Sleep - Silvia Flashcards
Sleep Cycle:
Awake, NREM (N1, N2, N3 back to N2, then to ____) then back to N1.
During REM, loss of __ __, increased brain O2 usage, and increased ACH during dreaming.
Sleep Cycle:
- NREM (Non-REM)
- Stage W (Wake), N1, N2, N3 (back to N2, then back to REM, then back to N1)
During REM, loss of muscle tone, increased brain O2 usage, and increased ACH during dreaming.
Sleep Cycle in Adults:
- Stage W (Wakefulness)
- N1 (drowsiness) - EEG – brainwaves slow (___ waves), decreased eye blinking, slow eye movements
- N2 – characteristic EEG changes (___ waves)
- N3- “slow wave sleep” - Decrease eye movements, decrease in EMG (___ waves)
STAGE R (REM)
1) lower amplitude (___ waves)
2) Random Eye movements
3) low EMG activity
Sleep Cycle in Adults:
- Stage W (Wakefulness)
- N1 (drowsiness) - EEG – brainwaves slow (theta waves), decreased eye blinking, slow eye movements
- N2 – characteristic EEG changes (sleep spindles and K complexes)
- N3- “slow wave sleep” - Decrease eye movements, decrease in EMG (delta waves)
STAGE R (REM)
1) lower amplitude (beta waves)
2) Random Eye movements
3) low EMG activity
Sleep Cycling:
- ___ to ___ Cycles of NREM/REM
- __ - ___ minutes per cycle
Sleep Cycling
•3-5 Cycles of NREM/REM
•90-100 minutes per cycle
Stage REM – duration is ___ in each sleep cycle and ___ in second part of night
N3- mostly in the ____ part of night
Wake duration – ___ with age
Men– N3 ____ with age
Women– ___ does not decrease with age
Adults – Stage REM ____ with age
Stage REM – duration is longer in each sleep cycle and longer in second part of night
N3- mostly in the first part of night
Wake duration – increased with age
Men– N3 decreases with age
Women– N3 does not decrease with age
Adults – Stage REM decreases with age
Young adults:
- ____ - 5-10% of total sleep time
- ____ - 50-60%
- ____ - 15-20%
- ___ 20%
Babies:
Lighter, fragmented
Increase sleep latency
Pediatrics: % spent in REM
Infants ____% of the time are in REM
Toddlers ___%
Children ___%
•Young adults
•N1 - 5-10% of total sleep time
•N2 - 50-60%
•N3 - 15-20%
•REM - 20%
Babies:
Lighter, fragmented
Increase sleep latency
Pediatrics: % spent in REM
Infants 50% of the time are in REM
Toddlers 30%
Children 25%
The sleep stages are __. __, __, __, __, __, __ (one cycle)
Each cycle last between __ - -__ minutes. There are __ - ___ cycles per night, and you spend more time in REM at the end of the night. In normal adults, you spend the most time in ___, and as you age, you spend less time in REM and more in wake. Infants spend __% in REM. Toddlers, ___%, children __%, and adults __%.
Elderly spend less time in __ and ___. They spend more time in N1 and N2 (fewer dreams)
N1 - drowsiness or ___ state, and is accompanied by the feeling of falling and muscle jerks.
N2 - sleep___ and __ complexes
N3 - slow ___ waves (this is the stage where you sleep walk or sleep talk)
REM - mind is active but muscles are ___ (reduced muscle tone) and rapid eye movement.
For sleep deprivation, we have something called __ ____ This means that if you don’t sleep for one night, it will take __ nights of increased __ to recover.
The sleep stages are W, N1, N2, N3, N2, REM, N1 (one cycle)
Each cycle last between 90 - 100 minutes. There are 3 - 5 cycles per night, and you spend more time in REM at the end of the night. In normal adults, you spend the most time in N2, and as you age, you spend less time in REM and more in wake. Infants spend 50% in REM. Toddlers, 30%, children 25%, and adults 20%.
Elderly spend less time in REM and N3. They spend more time in N1 and N2 (fewer dreams)
N1 - drowsiness or hypnogogic state, and is accompanied by the feeling of falling and muscle jerks.
N2 - sleep spindles and K complexes
N3 - slow delta waves (this is the stage where you sleep walk or sleep talk)
REM - mind is active but muscles are paralyzed (reduced muscle tone) and rapid eye movement.
For sleep deprivation, we have something called REM rebound. This means that if you don’t sleep for one night, it will take three nights of increased REM to recover.
Neurobiology of Sleep
•Awake Promoting Neurotransmitters come from the
___ and ___ HYPOTHALAMUS. Narcolepsy can result from loss of neuropeptides ___ and ___ (aka hypocretin-1 and hypocretin-2) produced in the ___ hypothalamus. These peptides normally promote ____
Neurobiology of Sleep:
•Awake Promoting Neurotransmitters come from the LATERAL AND POSTERIOR HYPOTHALAMUS. Narcolepsy can result from loss of neuropeptides orexin-A and orexin-B (aka hypocretin-1 and hypocretin-2) produced in the lateral hypothalamus. These peptides normally promote wakefulness.
If you are trying to promote arousal, you have to send signals to and from the ___ nuclei as well as the ___ nuclei, but you also have to have projections to the cerebral cortex. When you are awake, you want your cortex to be awake!
If you are trying to promote arousal, you have to send signals to and from the brainstem nuclei as well as the hypothalamic nuclei, but you also have to have projections to the cerebral cortex. When you are awake, you want your cortex to be awake!
We start with Orexin A and B. They send excitatory projections to
- __ __ nucleus (Hcrt 1, 2)
- ___ ____(Hcrt 1)
- ____ nucleus (Hcrt 2)
All of these send ___ projections to Hcrt neurons
Note: Hcrt neurons excitatory effect on cholinergic neurons in basal forebrain contribute to ___
We start with Orexin A and B. They send excitatory projections to
- Dorsal raphe nucleus (Hcrt 1, 2)
- Locus coeruleus (Hcrt 1)
- Tuberomammillary nucleus (Hcrt 2)
All of these send inhibitory projections to Hcrt neurons
Note: Hcrt neurons excitatory effect on cholinergic neurons in basal forebrain contribute to arousal
•Hcrt Neurons are activated during sensory ____. They have maximal firing in ____ behavior. Possible issue in ___ (a medical condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.)
- Hcrt Neurons are activated during sensory stimulation. They have maximal firing in exploratory behavior
- Possible issue in cataplexy (a medical condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious)
During REM, you have loss of muscle tone, increased O2 brain use, increase __ (from the lateral dorsal tegmentum and the pedunculopontine tegmentum) while dreaming, nightmares and penile/clitoal tumescence ocur. May serve memory processing function.
During REM sleep you are hypotonic. How does this work?
Orexin A and B project to the locus coreulus, raphe nucleus and the tuberomammilaries.
•The ubcoeruleus, sublateral dorsal tegmentum projects excitatory signals to the brainstem (medulla) but also produces inhibitory ___ neurons to motor neurons in the __ __.
Orexin A and B stimulate the tuberomamillary nucleus and this causes the nucleus to produce:
- ___
- H1— associated with ____
- H1 blockers (_____) associated with drowsiness
- H3—associated with ___ because it decrease histamine release
- Many projections (cortex, amygdala, SN, DRN, LC)
During REM, you have loss of muscle tone, increased O2 brain use, increase ACh while dreaming, nightmares and penile/clitoal tumescence ocur. May serve memory processing function.
During REM sleep you are hypotonic. How does this work?
•Subcoeruleus, sublateral dorsal tegmentum projects excitatory singals to brainstem (medulla) but also produces inhibitory GABA neurons to motor neurons in spinal cord.
Tuberommillary Nucleus
•HISTAMINE
- H1—associated with wakefulness.
- H1 blockers (Benadryl) associated with drowsiness
- H3—associated with sleep –> because it decreases histamine release.
- Many projections (cortex, amygdala, SN, DRN, LC)
Obstructive Sleep Apnea and Hypopnea
OSA
- Diagnosed on Polysomnogram
- Apnea – absent ___ at nose/mouth for __ seconds. Caused by an obstruction (usually in the __ area).
To be diagnosed:
- >__/hr abnormal if symptoms present
- >or __/hr with or without symptoms
- ___ terminates apnea
Sleep apnea is a sleep disorder characterized by repetitive cycles of ___ leading to gasping and possibly awakening from sleep.
Obstructive sleep apnea is defined as a transient obstruction of the upper airway leading to hypoxemia and arousal from sleep.
Risk factors for obstructive sleep apnea include:
Obesity (weight of neck may cause airway compression) (70%)
Anatomical abnormalities (e.g. enlarged tonsils or uvula)
The first line treatment for obstructive sleep apnea includes both ___ loss and continuous positive airway pressure (CPAP).
Hypopneas
– reduced ___, not complete ___.
- ___% reduction in flow from baseline
- 4% or greater oxygen desaturation
- After testing oxygen levels during sleep, you refer to the AHI- __-___ Index
- RDI-Respiratory Disturbance Index
- RERA-respiratory effort related arousals
- IN order to diagnose, you must have evidence that the rest of the body is trying to breath, but can’t because of ___ restriction.
Obstructive Sleep Apnea
- Diagnosed on Polysomnogram
- Apnea – absent airflow at nose/mouth for 10 seconds. Caused by an obstruction (usually the supraglottal area).
To be diagnosed:
- >5/hr abnormal if symptoms present
- >or have 15/hr with or without symptoms
- Arousal terminates apnea
Sleep apnea is a sleep disorder characterized by repetitive cycles of hypoxia leading to gasping and possibly awakening from sleep.
Obstructive sleep apnea is defined as a transient obstruction of the upper airway leading to hypoxemia and arousal from sleep.
Risk factors for obstructive sleep apnea include:
Obesity (weight of neck may cause airway compression) (70%)
Anatomical abnormalities (e.g. enlarged tonsils or uvula)
The first line treatment for obstructive sleep apnea includes both weight loss and continuous positive airway pressure (CPAP).
Hypopneas
– reduced airflow not complete cessation
- 30% reduction in flow from baseline
- 4% or greater oxygen desaturation
- After testing, you refer to the AHI- Apnea-Hypopnea Index
- RDI-Respiratory Disturbance Index
- RERA-respiratory effort related arousals
- Evidence that the rest of the body is trying to breath, but they can’t because of supraglottic restriction.
___ symptoms
- EDS (excessive daytime sleepiness)
- Frequent nocturnal arousals
- AM Headaches
- Loud ____
- Choking, gasping in sleep
- Witnessed breathing pauses
- Restless ___ movements in sleep
- Depression, fatigue
Physical Examination
- BMI
- Mallampati score
- High ___
- Retrognathia
- Increase neck circumference (17”M, 16”F)
- Evidence of heart failure
OSA symptoms:
- EDS (excessive daytime sleepiness)
- Frequent nocturnal arousals
- AM Headaches
- Loud snoring
- Choking, gasping in sleep
- Witnessed breathing pauses
- Restless ___ movements in sleep
- Depression, fatigue
Physical Examination
- BMI
- Mallampati score
- High palate
- Retrognathia
- Increase neck circumference (17”M, 16”F)
- Evidence of heart failure
Pediatric OSA:
- Different risk factors and symptoms
- Hyperactivity, developmental delay, behavior
- Usually affects __-___ yr olds
- Obesity
- Age of tonsillar/adenoid hypertrophy max
- Don’t report ___ (excessive day time sleepiness)
- PSG-OHI>1hr, or OAHI>2/hr
- Treatment ____ or ___ not always helpful
Pediatric OSA
- Different risk factors and symptoms
- Hyperactivity, developmental delay, behavior
- Usually affects 4-6 yr olds
- Obesity
- Age of tonsillar/adenoid hypertrophy max
- Don’t report EDS
- PSG-OHI>1hr, or OAHI>2/hr
- Treatment T&A, not always helpful
Central Sleep Apnea
- ___ to ___ %of patients with sleep apnea
- Adults – __ seconds, absence of ___
- Divided into __ vs. ___
- Mostly due to pre-existing medical problems like: neuromuscular, medication induced, cardiac
Caused by:
- __ __ Syndrome
- “___ curse”
- Respiratory arrest/insufficiency with sleep
- __ or acquired
•10-15%of patients with sleep apnea
- Adults – 10 seconds, absence of effort
- Divided into hypocapnic vs. hypercapnic
- Mostly due to pre-existing medical problems
- Neuromuscular, medication induced, cardiac
Caused by:
•Congenital Hypoventilation Syndrome
•“Ondine’s curse”
•Respiratory arrest/insufficiency with sleep
•Congenital or acquired
Central Sleep Apnea
__ to ___% of patients with sleep apnea
Adults - 10 seconds, absence of effort
Brain ain’t telling body to breathe
Divided into hypo___ vs hyper___
Mostly due to pre-existing medical problems
Like ALS
Neuromuscular, medication induced, cardiac
Diagram: during apnea, there is no ___ effort or chest movement
Congenital hypoventilation syndrome
“Ondine’s curse”
___ arrest/insufficiency with sleep
Congenital or acquired
Central Sleep Apnea
10-15% of patients with sleep apnea
Adults - 10 seconds, absence of effort
Brain ain’t telling body to breathe
Divided into hypocapnic vs hypercapnic
Mostly due to pre-existing medical problems
Like ALS
Neuromuscular, medication induced, cardiac
Diagram: during apnea, there is no respiratory effort or chest movement
Congenital hypoventilation syndrome
“Ondine’s curse”
Respiratory arrest/insufficiency with sleep
Congenital or acquired
