Sleep & Sleep Disorders - Tsao Flashcards
What are the two sleeps states?
Which neurotransmitters are dominant in each state?
Rapid eye movement (REM) sleep: acetylcholine
Non-REM sleep: Serotonin
In which state of sleep are the following EEG patterns seen?
Sleep spindles
Delta waves
Alpha waves
Theta waves
K complexes
Beta waves
Sleep spindles- Stage 2
Delta waves- Stages 3 & 4
Alpha waves- Awake
Theta waves- Stage 1
K complexes- Stage 2
Beta waves- Awake
How long is the typical circadian cycle?
What is sleep latency?
What is sleep efficiency?
25 hours
Time it takes to fall asleep
time sleeping/time spent trying to sleep
(should be close to 100%)
How much sleep is needed as
a newborn?
an adolescent?
an adult?
an older adult?
a newborn- 16-18 hours
an adolescent- 9-10 hours
an adult- 8 hours
an older adult- 7-8 hours
REM sleep
How frequently does it occur.
What physical changes occur?
How much of sleep does it comprise?
10-40 minutes every 90 minutes. REM sleep episodes get longer the longer you sleep.
Increased BP, pulse, respirations; skeletal muscle blockade; genital erections.
~25% of total sleep
How is sleep divided among stages 1-4 and REM?
Stage 1- 5% of total sleep
Stage 2- 45% of total sleep
Stage 3/4- 25% of total sleep (mostly occurs at beginning of the night)
REM- 25% of total sleep (mostly occurs towards the end of the night)
What general trends occur as a sleeper moves from stage 1 to stage 4 sleep?
quality of sleep
body function
EEG waves
Sleep becomes deeper and sleeper is much harder to awaken
Body functions slow down through stage 4 (lower temp, HR, RR, etc)
EEG waves become larger, more erratic.
What happens to sleep as we age?
How much sleep is needed as we age?
Decreased REM, decreased stages 3/4, and increased night-time awakenings.
Older adults need about as much sleep as young, middle aged adults! (~8 hours)
What sleep changes are seen in depression?
Frequent awakenings
Decreased REM latency (REM w/in 45 min)
Increased total REM
Decreased stages 3/4
What are dyssomnias?
What are parasomnias?
Dyssomnias-abnormal timing, quality, amount of sleep
Parasomnias- abnormal behaviors associated with sleep
What are some timing dyssomnias?
What are some quality dyssomnias?
What are some amount dyssomnias?
Timing
- Narcolepsy
- Circadian rhythm sleep disorder
Quality
- restless legs syndrome
- sleep apnea
Amount
- insomnia
- hypersomnia
What are four sleep disorders classified as parasomnias?
Bruxism
Night terrors
Sleepwalking
REM sleep behavior disorder
What the four core symptoms of narcolepsy?
How is a narcoleptic’s sleep architecture different?
Sleep attacks/daytime sleepiness
Hypnogogic/hypnopompic hallucinations
Cataplexy (50% of cases)
Sleep paralysis
Decreased latency, REM latency, and overall REM
What deficiency is narcolepsy typically associated with?
What treatments are most effective?
Hypocretin (AKA orexin)
scheduled daytime naps
psychostimulants (methylphenidate, modafinil)
What are the two varieties of circadian rhythm sleep disorder?
What are appropriate treatments?
Advanced- patients are driven to go to sleep early, get up early
Delayed- patients stay up late and wake up late
Light therapy (at night for advanced, in morning for delayed)
melatonin before bed
