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Behavioral Dynamics Exam 3 > Sleep/Wake disorders > Flashcards

Sleep/Wake disorders Flashcards

1
Q

Sleep vs Coma

A

● Sleep
○ When sleep-promoting neurons are stimulated and wake-promoting
regions are inhibited.
○ Controlled by the body’s “internal clock” and by external forces.
○ Reduced responsiveness, but can be interrupted by sensory or other
stimuli
○ Also defined by typical Electroencephalographic (EEG) Patterns
● Coma - Unresponsive to the environment and cannot be interrupted by
stimuli, including pain

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2
Q

Physiologic changes during sleep

A

● ↑ Parasympathetic tone
● ↓ Sympathetic tone
● Constant neuronal activity
● Reduced overall Metabolism

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3
Q

Regulatory Neurons and Neurotransmitters of Arousal

A

Histamine (HA), Serotonin (5-HT), Noradrenalin (NA), Dopamine (DA),
Acetylcholine (ACH), Glutamate (GLU), Hypocretin/orexin (HCT)

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4
Q

Regulatory Neurons and Hormones of Sleep

A

○ Ventrolateral preoptic nucleus (VLPO)/Median preoptic nucleus (MnPO)
○ Melatonin
○ Adenosine (AD)

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5
Q

Ventrolateral preoptic nucleus (VLPO)/Median preoptic nucleus (MnPO)

A

Promotes sleep through monosynaptic GABAergic
inhibition of monoamine neurons

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6
Q

Suprachiasmatic Nucleus (SCN) is part of the_____

A

anterior hypothalamus and is
the “master clock” of the body

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7
Q

“master clock” of the body.

A

Suprachiasmatic Nucleus

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8
Q

Melatonin

A

: Helps regulate circadian rhythm
○ Produced in the pineal gland and controlled by light input as processed
by the SCN

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9
Q

Sleeps effects on the CNS

A

○ Assists with brain plasticity, neural maturation, memory consolidation,
and learning. This leads to improved cognition.
○ There is evidence that clearance of neurotoxic waste in the CNS occurs

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10
Q

Sleeps effect on General Restoration, Rejuvenation, and Energy conservation

A

○ Mitigates adverse consequences of stress
○ Physical growth, including muscle growth
○ Assists the immune system functions
○ Tissue repair
○ Protein and Hormone synthesis

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11
Q

Adults 18 to 60 years should sleep
_____ hours a night on a regular basis

A

seven or more

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12
Q

Prolonged Sleep Deprivation (ie, little or
no sleep):

A

● Decreased cognition and memory
● Abnormal moods and decreased
inhibition
● Potential psychosis

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13
Q

Microsleeps

A

Short episodes of uncontrollable sleep
lasting between a fraction of a second to 30 seconds. There is complete lapse of consciousness and no ability to respond to stimuli.

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14
Q

Fatal Familial Insomnia (FFI)

A
  • Progressive genetically linked insomnia with loss of the normal
    circadian sleep-activity pattern
  • FFI is a rapidly fatal disease with a mean duration of 13 months. There
    is no specific treatment for FFI. Management is generally supportive
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15
Q

Electroencephalogram (EEG)

A

● Electrical activity is recorded from standardized placement sites on the scalp (usually 10 to 20)
● The electrical activity is described in terms of amplitude and frequency

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16
Q

Beta Waves Patterns

A

High frequency & low amplitude &
more desynchronous than other waves

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17
Q

Alpha wave EEG Patterns

A

Brain waves become slower (low
frequency), increase in amplitude
(high amplitude) & become more
synchronous

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18
Q

What waves are typical when you are awake?

A

Beta or alpha (calm wakefulness)

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19
Q

Stage 1 sleep EEG findings

A

Theta waves (lower frequency)
and greater amplitude

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20
Q

Stage 2 EEG findings

A

● EEG Findings: Theta waves continue,
interspersed with 2 phenomenon:
○ Sleep spindles: short bursts of ↑ wave
frequency
○ K-complexes: sudden ↑ wave amplitude

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21
Q

Sudden twitches or hypnic jerks are
common happen in this stage

A

Stage 1

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22
Q

Stage 3 (Slow Wave Sleep) EEG findings

A

Delta waves (slowest & highest
amplitude)

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23
Q

Rapid Eye Movement (REM) sleep (Stage R) EEG findings

A

Low voltage, mixed EEG pattern and “Sawtooth” waves.
○ These are similar to wakeful EEG findings

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24
Q

Atonia

A

inactivity of all voluntary muscles (except extraocular muscles,
diaphragm). Result of inhibition of alpha motor neurons.
Happens in REM sleep

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25
Q

T/F Brain is activity is high in Rem Sleep

A

T

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26
Q

Stage 1 is not repeated, but is replaced by ____

A

REM

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27
Q

Rapid onset to REM, occurring quickly after sleep begins, suggests
_____

A

narcolepsy or a circadian rhythm disorder

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28
Q

Sleep deprivation may increase ____

A

stage N3 and REM sleep

29
Q

In Lab Polysomnography (PSG) indications

A

obstructive sleep apnea (OSA), central apnea, periodic limb movements,
parasomnias, narcolepsy, and excessive daytime sleepiness

30
Q

In Lab Polysomnography (PSG) procedure

A
  • Patients are connected to a variety of monitoring devices during a PSG,
    including an EEG. Then they sleep while being observed.
  • Information is collected on the patient’s sleep stages, EKG findings, respiratory
    effort/airflow, oxygen saturation, snoring, body position, and limb movements.
  • Additional conclusions can be made about Sleep efficiency, Sleep latency,
    Apneas/Hypopneas, Cheyne-Stokes breathing, and EEG abnormalities
31
Q

Central disorders of hypersomnolence

A

Narcolepsy and Idiopathic hypersomnia

32
Q

Circadian rhythm sleep-wake disorders

A

Sleep-wake phase disorders, Non-24-hour sleep-wake rhythm disorder, and Shift work/jet lag disorders

33
Q

Sleep-related movement disorders

A

Restless legs syndrome, Periodic limb movement disorder, Bruxism

34
Q

Insomnia

A

Difficulty initiating sleep, maintaining sleep, or both, despite adequate
sleep opportunity, with associated daytime impairment

35
Q

Acute vs Chronic insomnia

A
  • Acute: Can be a symptom of adjustment
  • Usually lasts a few days or weeks (Less than 3 months)
  • Chronic: Occur at least 3 times a week and persist for at least 3 months
36
Q

Insomnia

A
  • Increasing age
  • Separated or divorced
  • Low socioeconomic status
  • Associated with medical & psychiatric disorders
  • Use of alcohol, drugs, and certain medications
37
Q

Ideal room temperature for sleeping

A
  • Cool (60-68 degrees!)
38
Q

Progressive Relaxation Therapy

A
  • Tensing & relaxing muscles systematically from head to toe
  • Guided imagery & meditation
  • May combine with bio-feedback to give patients immediate input as to their
    stress levels & its response to therapy
39
Q

Recommended Initial Treatment for Insomnia (after lifestyle changes)

A

Sleep Restriction Therapy/ CBT-I

40
Q
  • Sleep restriction therapy initially limits the _____
A

total time allowed in bed, including naps
and other sleep periods outside of bed
* ↑ the drive to sleep
* Leads to sleep consolidation & improved sleep efficiency (Percentage of time in bed spent sleeping)

41
Q

Pharmacotherapy for insomnia

A
  • Nonbenzodiazepine BZRAs
  • Melatonin agonists
  • Hypnotic Benzodiazepines
  • Anxiolytic benzodiazepines
  • Orexin Receptor Antagonists:
  • Antidepressants
  • Antipsychotics
  • OTCs
42
Q

Narcolepsy

A

A neurologic disorder that affects control of sleep & wakefulness.
- Characterized by chronic daytime sleepiness, cataplexy, hypnagogic
hallucinations, and sleep paralysis (most patients won’t have all of them)

43
Q

Epidemiology of narcolepsy

A
  • Typically begins in the teens and early
    twenties
  • Some genetic risk
  • 40 - 70 cases per 100,000
44
Q

Pathogenesis of narcolepsy

A
  • Defective REM sleep regulation**
  • Loss of orexin (hypocretin) neuropeptides, made in the lateral hypothalamus.
  • Orexin neurons are most active during
    waking and almost stop firing during slow
    wave and REM sleep.
  • Possible autoimmune etiology
  • Rarely due to damage to the hypothalamus.
45
Q

Clinical Presentation: 4 Cardinal Symptoms of Narcolepsy

A
  • Daytime sleepiness: Moderate to severe daytime sleepiness
  • Cataplexy: Emotionally-triggered transient muscle weakness. Often partial,
    can cause transient facial weakness or falls
  • Hypnagogic Hallucinations: Hallucinations when falling asleep or awakening
  • Sleep paralysis: Inability to move for one or two minutes immediately after
    awakening or when falling asleep.
46
Q

Orexin neurons are most active during
____ and almost stop firing during ____

A

waking; slow wave and REM sleep

47
Q

Evaluation Almost always performed before diagnosing narcolepsy

A

Multiple sleep latency test (MSLT): Measures a person’s tendency to sleep during the day

48
Q

Narcolepsy subtypes

A

Type 1: With Cataplexy
Type 2: Without Cataplexy

49
Q

Polysomnogram (PSG) findings for narcolepsy

A

Looking for fragmented sleep stages and rapid onset REM

50
Q

Management of narcolepsy

A
  • Napping and Sleep Hygiene
  • Psychosocial Support
  • Medications
51
Q

Idiopathic Hypersomnia

A

Chronic excessive daytime sleepiness (daily periods of irrepressible
need to sleep or daytime lapses into sleep) and often difficulty waking
up from nocturnal sleep or daytime naps

52
Q

Must exclude narcolepsy and apnea before making this diagnosis

A

Idiopathic Hypersomnia

53
Q

Alterations of the circadian system

A
  • Delayed sleep-wake phase disorder
  • Advanced Sleep-wake phase disorder
  • Non-24-hour sleep–wake phase disorder (lack light/dark cycle input)
  • Shift work Disorder
54
Q

Lack light/dark cycle input

A

Non-24-hour sleep–wake phase disorder

55
Q

Circadian Rhythm Disorder treatments

A
  • Sleep hygiene, synchronize sleep & wakefulness
  • Appropriate time cues (timed exposure to bright lights)
  • Blackout curtains
  • Melatonin is effective in jet lag & shift work
56
Q

Bright Light Therapy

A
  • Exposure to bright light can be used to treat
    circadian rhythm sleep disorder
  • The goal is to combine a healthy sleep pattern with
    an appropriately timed circadian rhythm
  • Light therapy can help “set” the internal clock
57
Q

Hypnic Jerks

A

Brief jerk of a part or all of the body as a person falls asleep. A
common example is the feeling of falling accompanied by jerking up in bed.

58
Q

Bruxism

A

Teeth clenching and grinding. Occur during micro-arousals from sleep
accompanied by an activation of the autonomic nervous system. Can lead to sleep disruption, tooth wear, jaw soreness, and headaches. Oral devices can help

59
Q

Nocturnal Leg Cramps

A

These are painful muscle contractions that often last for
over a minute. Occur anytime during the night

60
Q

Parasomnias

A

Complex Movements/Behaviors during sleep

61
Q

Disorders of arousal

A

A mixture or combination of NREM and wakefulness.
Characterized by minimal cognitive functioning, amnesia of the events, and behaviors that make the person appear awake.
– Confusional arousals
– Sleepwalking
– Night or Sleep terrors
– Sleep-related eating disorder (SRED)

62
Q

Somnambulism

A

Sleepwalking

63
Q

Sleep Terror Disorder

A

Incomplete arousal from NREM stage 3 & 4 (usually first 1/3 of the night)
* Appears to abruptly awaken from sleep with panicky scream, tachycardia,
rapid breathing, sweating.
* Unresponsiveness to others, amnesia of the episode (nightmares are remembered)

64
Q

Restless Leg Syndrome (RLS)

A

● Results in an urge to move the legs, usually associated with
unpleasant sensations. The urge to move the legs is worse at
rest and at night and is relieved by movement.
● Commonly associated with sleep disturbance
● Periodic limb movement disorder (PLMD)

65
Q

Sleep Apnea

A

Defined as abnormal ventilation during sleep, manifested by apnea and/or hypopnea
* Apnea - Breathing cessation for ≤10 seconds or
* Hypopnea - Still breathing but there is partial airway obstruction

66
Q

Central Apnea:

A

No ventilatory effort during an apneic episode

67
Q

Obstructive Apnea:

A

Ventilatory effort continues during an episode but no
airflow occurs.
* Usually due to transient obstruction of the upper airway

68
Q

Sleep Apnea screening : STOP-Bang

A

● Snoring loudly (or been told they snore)
● Tired during the day
● Observed choking/gasping or not breathing
● Pressure (Hypertension)
● BMI greater than 35
● Age older than 50
● Neck Size greater than 16 inches
● Gender (Male

Behavioral Dynamics Exam 3 (5 decks)

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