Sleep & Sleep Disorders Flashcards
1
Q
**Normal sleep **
What are the 2 sleep states?
What are the primary sleep neurotransmitters?
A
-
2 sleep states
- REM (rapid eye movement)
- Non-REM sleep
-
Primary sleep NTs
- REM: ACh
- NREM: serotonin
2
Q
Fill in the blanks
A
3
Q
Define:
- Human Circadian Cycle
- Awake EEG
- Sleep Latency
- Sleep Efficiency
A
- Human Circadian Cycle = 25 hrs
- Awake EEG = beta & alpha waves
- Sleep Latency = time it takes to fall asleep (<10 min)
- Sleep Efficiency = time sleeping/time spent trying to sleep (100%)
4
Q
Human Sleep Requirement
- Newborn
- Adolescent
- Adult
- Older adult
A
- Newborn = 16-18
- Adolescent = 9-10
- Adult = 8
- Older adult = **7-8 **
5
Q
REM Sleep
- What % of total sleep?
- How long?
- What happens physiologically?
A
- 25% of all sleep
- Every 90 min
- Each REM episode = 10-40 min
- Longer episodes – 2nd half of night
- BP, pulse rate, respirations – increase
- Penile & clitoral erection
- Skeletal muscle paralysis
- EEG – small, irregular brain waves
- **Dreaming occurs **
6
Q
What % of Stages 1, 2, 3 & 4 are Non-REM sleep?
A
- Stage 1 = 5% sleep
- Stage 2 = 45% sleep
- Stage 3 & 4 = 25% sleep
- Most deep sleep (1st half of night)
7
Q
Stage 1 NREM
- Length
- Breathing
- HR
- BP
- Temperature
- Blood flow to brain
- EEG
- Ability to wake sleeper
A
- Lasts about 10 min
- Breathing – slow & even
- HR – regular
- BP – decrease
- Temperature – decrease
- Blood flow to brain – decrease
- EEG – brain waves smaller, slower, irregular
- _Sleeper easily awoken _
8
Q
Stage 2 NREM
- Length
- Bodily functions
- EEG
- Ability to wake sleeper
A
- Lasts about 20 min
- Bodily functions continue to slow
- Even if eyes are opened, sleep cannot see
- EEG – larger brain waves, occasional quick bursts of activity
- _Sleeper can be awakened by sounds _
9
Q
Stage 3 NREM
- Length
- EEG
- Ability to wake sleeper
A
- Begins about 30-45 min after sleep is initiated
- EEG – brain waves are slow & large
- Up to 5X as large as in Stage 2
- _Sleeper is much less easy awake, requiring loud noise or active attempts to wake _
10
Q
Stage 4 NREM
- Bodily functions
- EEG
- Ability to wake sleeper
A
- Bodily functions decline in the deepest state of rest
- EEG – brain waves are large, slow & make a jagged pattern
- _Sleeper experiences oblivion – if awakened, very disoriented _
11
Q
How does sleep change with aging?
A
- Decreased REM
- Decreased Stage 3 & 4 sleep
- Increased night-time awakenings – decreased sleep efficiency
12
Q
How does sleep change with depression?
A
- Frequent awakenings – decreased sleep efficiency
- Early morning awakening
- Decreased REM latency – 1st REM within 45 min
- Increased total REM
- **Decreased Stage 3 & 4 sleep **
13
Q
Definitions
Dyssomnias
Parasomnias
A
- Dyssomnias – abnormal timing, quality, & amt of sleep
- Parasomnias – abnormal behaviors associated w/ sleep
14
Q
What are the different types if Dyssomnias?
A
-
Timing
- Narcolepsy
- Circadian rhythm sleep disorder
-
Quality
- Restless legs
- Sleep apnea
-
Amount
- Insominia
- Hypersomnia
15
Q
Key features of Narcolepsy
A
- Sleep attacks
- Hypnogogic/hypnopompic hallucinations
- Cataplexy
- Sleep paralysis
16
Q
Narcolepsy abnormalities in sleep architecture
A
- Decreased sleep latency
- Decreased REM latency (<10 min)
- Less REM overall
17
Q
Narcolepsy
Neurobiologic factors
Epidemiological factors
A
- Neurobiologic factors
- Associated w/ hypocretin (orexin) deficiency
- Epidemiologic factors
- Usually diagnosed in adolescence
- Significant genetic component
18
Q
How is narcolepsy treated?
A
- Scheduled daytime naps
- Psychostimulants
- Methylphenidate (Ritalin)
- Modafinil (Provigil)
19
Q
What are the features of circadian rhythm sleep disorder?
A
- Inability to sleep at appropriate or desired times
- 2 types: delayed & advanced
- Causes: intrinsic & extrinsic (shift work, jet lag)
20
Q
How is circadian rhythm sleep disorder treated?
A
-
Delayed sleep phase
- Melatonin 5-10 mg/hr before bedtime
- Light at desired waking time
-
Advanced sleep phase
- Light in the evening
-
Shift work
- Modafinil 100-200 mg or caffeine for alertness
- Melatonin or other hypnotic at bedtime
21
Q
What are the features of restless legs?
A
- Uncomfortable sensation in legs
- Repetitive limb jerking
- Frequent night-time awakenings
22
Q
Restless Legs
Epidemiology
Treatment
A
- Epidemiology
- Older adults
- Treatment
- Anti-Parkinsonian agents
- Levodopa
- Carbidopa/levodopa (Sinemet)
- Ropinirole (Requip)
23
Q
What are the features of sleep apnea?
A
- Cessation of breathing
- CO2 increases
- Frequent awakenings
- Increased rate of sudden death
24
Q
Sleep apnea
Associated features
Laboratory
A
- Associated features include:
- Snoring (if obstructive variant)
- Daytime sleepiness
- Morning headache
- Laboratory: _respiratory acidosis _
25
Q
What are the two types of sleep apnea?
A
-
Central Sleep Apnea
- Decreased respiratory effort
-
Obstructive Sleep Apnea
- Normal respiratory effort
- Airway obstruction
26
Q
Sleep apnea
Epidemiology
Treatment
A
- Epidemiology
- Central Sleep Apnea (older adults)
- Obstructive Sleep Apnea
- Middle-aged adults
- Men >>> Women
- Associated w/ obesity
- Treatment
- Weight loss (if obesity present)
- Continuous positive airway pressure (CPAP)
- Medroxyprogesterone acetate
- Uvulopalatoplasty/Tracheostomy
27
Q
What are the features of insomnia?
A
- Difficulty falling asleep or staying asleep
- 3X/wk or more
- Duration at least 1 mo
- Daytime sleepiness
28
Q
Insomnia
Epidemiology
Treatment
A
- Epidemiology
- At least 30% of population
- Associated w/ cognitive impairment & accidents
- Treatment
- Avoid caffeine, especially in evenings
- AM exercise
- Develop sleep routine
- Relaxation techniques
- Hypnotic medication
- May, however, decrease REM & delta sleep
29
Q
What are the different types of Parasomnias?
A
- Bruxism (tooth grinding)
- Night terror
- Sleep walking
- REM sleep behavior disorder
30
Q
Bruxism
Features
Stage of Sleep
Treatment
A
- Features
- Tooth-grinding
- Tooth damage & jaw pain
- Occurs during Stage 2 sleep
- Treatment: dental appliance worn at night
31
Q
Night terror
Features
Stage of Sleep
Population
A
- Features
- Repetitive experiences of fright
- Not easily awakened
- No memory upon awakening
- Occurs in Stage 3 & 4 sleep
- Usually occurs in children
32
Q
Sleep walking
Features
Stage of Sleep
Treatment
A
- Features
- Repetitive walking
- Can be injured
- Eyes open
- No memory upon wakening
- Occurs in Stage 3 & 4 sleep (usually 1st half of night)
- Usually occurs in children
- Treatment
- Manipulate environment (safety)
33
Q
**REM sleep behavior disorder **
Features
Stage of Sleep
Treatment
A
- Features
- Motor activity while dreaming
- Eyes closed
- Awakens fully alert & able to recount their dream
- Occurs in REM (usually 2nd half of night)
- Associated w/ Parkinson disease & Lewy Body Dementia
- Treatment
- Environmental manipulation: safety
- Melatonin or low-dose benzodiazepines
