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psycopathology > Sleep-wake Disorders > Flashcards

Sleep-wake Disorders Flashcards

1
Q

What is the purpose of sleep?

A

No definitive answer, but evidence indicates it is critical for ongoing physiological function

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2
Q

What is the physiological definition of sleep?

A

Physiological: Characterized by reversible unconsciousness, specific brainwave patterns, sporadic eye movement, and a loss of muscle tone

The physiological definition applies well to birds and mammals, but in other less complex animals, the behavioral definition is more often used

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3
Q

What is the Behavioral definition of sleep?

A

Characterized by minimal movement, non responsiveness to external stimuli (i.e. increased sensory threshold), adoption of a typical posture, and the occupation of a sheltered site, all of which is usually repeated on a 24-hour basis

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4
Q

What is the importance of sleep(in general)?

A

-Observed in all mammals, birds, reptiles, amphibians and some fish and in some form, in insects and simpler animals such as nematodes

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5
Q

What would we expect to find if sleep were not essential?

A
  • Animals that do not sleep at all
  • Animals that do not need recovery sleep after staying awake longer than usual
  • Animals that suffer no serious consequences from a lack of sleep
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6
Q

What happens when rats don’t sleep?

A
  • Weight loss
  • Reduced body temperature
  • Skin lesions
  • Hyperphagia
  • Loss of body mass
  • Hypothermia
  • Eventually, fatal sepsis
  • Hindered burn healing
  • 20% decrease in white blood cell count
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7
Q

What happens when humans don’t sleep?

A
  • Slower brain waves in frontal cortex
  • Shortened attention span
  • Higher anxiety
  • Impaired memory
  • Negative mood
  • Decreased temperature
  • Increased appetite
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8
Q

How do dreams occur?

A

Random firing of neurons in the cerebral cortex during the REM period. Left hemisphere interpreter creates a story to reconcile nonsensical sensory information, hence the odd nature of many dreams

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9
Q

What are the 4 physiological purposes of sleep?

A
  • Restoration
  • Memory consolidation
  • Tissue repair
  • Dreams
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10
Q

How does sleep provide restoration?

A

Reduced metabolism, removal of metabolic waste products, immune system function

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11
Q

How does sleep provide memory consolidation?

A

Declarative memory( N-REM early sleep), procedural memory (REM late sleep)

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12
Q

How does sleep provide tissue repair?

A

Cell repair, wound healing

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13
Q

What causes dreams to occur?

A

Random firing of neurons in the cerebral cortex during the REM period. Left hemisphere interpreter creates a story to reconcile nonsensical sensory information, hence the odd nature of many dreams

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14
Q

How many stages of non-REM sleeps are there?

A

3 stages

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15
Q

Describe stage 1 Non-REM sleep

A

Stage 1- occurs mostly in the beginning of sleep, with slow eye movement: relaxed wakefulness. Alpha waves disappear and theta waves appear. People aroused from this stage often believe that they have been fully awake.

Hypnic jerks are common

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16
Q

Describe stage 2 Non-REM Sleep

A

No eye movement and dreaming is very rare. Sleeper is easily awakened.

Sleep spindles : short bursts of high frequency brain activity

K-complexes: Large spikes in brain activity

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17
Q

Describe stage 3 Non-REM sleep

A

Slow wave

Onset of delta waves, associated with deep sleep

Dreaming can happen in this stage

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18
Q

What is REM Sleep?

A
  • Random/rapid movement of eyes
  • low muscle tone throughout the body
  • Vivid dreams
  • Physiologically similar to waking states: low-voltage desynchronized brain waves
  • Suspension of central homeostasis: large fluctuations in respiration, thermoregulation and circulation
  • Perservation of certain types of memories: procedural, spatial and emotional
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19
Q

List the sleep disorders

A
  • Insomnia disorder
  • Hypersomnolence disorder
  • Breathing-Related sleep disorders
    - Obstructive sleep apnea
    - Central sleep apnea
  • Narcolepsy
  • Circadian Rhythm Sleep-wake disorder
  • Parasomnias
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20
Q

Give the epidemiology of sleep-wake disorders

A

-Currently affects 50-70 million U.S. adults

  • Insomnia the most common
  • Carryover effects:

Drowsy driving causes up to 1550 deaths and 40,000 injuries on America’s roads

-Accidents increases significantly following “spring head” in time and decrease significantly following “fall back” time

21
Q

Give the sleep-wake etiology

A
  • Varies depending on the specific disorder
  • Commonly a problem with transition between phases of sleep
  • Developmental phase of life(I.e. sleep problems in childhood and late adulthood
  • Behavioral factors:
    • Drug and alcohol use
    • Shift work patterns
    • travel
    • Stress and anxiety
22
Q

How are Sleep-wake disorders assessed/differentiated?

A
  • To differentiate the sleep-wake disorders, an interview is conducted and often followed by a “sleep study” (polysomnography [PSG])
  • PSG measures various physiological parameters, (e.g. brain waves, muscle contractions, oxygen levels) to assist in diagnosis
23
Q

What is insomnia?

A

Difficulty initiating or maintaining sleep for 3+ months

24
Q

Explain the etiology of insomnia

A

Classical conditioning- bed is associated with wakefulness(due to poor sleep habits, known as “poor sleep hygiene”)

Before conditioning
UCS= poor sleep hygiene —> UCR= wakefulness Neutral=bed

During conditioning= Neutral(bed) paired with UCS(poor sleep hygiene)

After conditioning

CS=bed—> CR= wakefulness

25
Q

How can insomnia be treated using behavioral strategies?

A
  1. Behaviorial -stimulus control(bed=cue for sleep)
    - use bed only as a place to sleep
    - Lie down bolt when tired
    - if not asleep in 10 min, depart bed and only return when tired
  2. Behavioral-general strategies
    - consistency in bedtime/awakening
    - no naps(unless taken consistently)
    - no caffeine past noon
    - exercise(2+ hours before bedtime)
    - Avoid noise and excessive naps
26
Q

How can insomnia be treated Pharmologically?

A
  • sedatives (benzodiazepines such as Valium) are effective to induce sleep and increase duration
  • Only recommended for short term use (2-4 weeks) due to side effects (e.g. tolerance, withdrawal, disruptive effects on sleep effects on sleep quality-they decrease slow wave sleep)
  • Non-benzodiazepines (e.g. zolpidem [ambien]) have Fewer side effects
27
Q

Describe hypersomnolence disorder

A

-excessive sleepiness despite sufficient sleep(7+ hours) for 3+ months

Etiology: non-specific (unidentified brain causes)

Treatment: stimulants (modafinil[Provigil]) to keep the person awake

28
Q

What is narcolepsy?

A

-recurrent irresistible sleep occurring within the same day, several times per week, for 3+ months

And one of the following:
-Cataplexy(sudden, brief loss of voluntary muscle tone that is typically precipitated by emotion)

  • Considered an abundant manifestation of REM sleep
  • Other REM-related behaviors may manifest but are NOT diagnostic criteria (e.g., sleep paralysis, hallucinations during the transition of sleep/wake)
29
Q

What may cause narcolepsy?

A
  • Hypocretin (orexin) deficiency from autoimmune response that disregulates sleep
  • Neurotransmitter secreted by the hypothalamus
  • Characteristic PSG abnormalities that may indicate other potential sleep pathologies such as obstructive sleep apnea; reduced sleep latency onset REM
30
Q

How can narcolepsy be treated?

A

Pharmological: Often a 2-pronged treatment approach:

  1. Stimulants (e.g., modafinil[Provigil]) to treat someone
  2. Antidepressants to treat cataplexy
31
Q

What causes Obstructive sleep apnea hyponea (OSAH)?

A
  • multiple episodes of cessation of breathing per night caused by upper airway obstruction
  • Obstruction usually occurs when soft tissue in the back of the throat collapses during sleep
  • rise in CO2 during apnea’s causes temporary arousal (usually not awakenings from sleep
32
Q

What are the symptoms of Obstructive sleep apnea Hyponea(OSAH)?

A
  • person moves from a deep to light sleep stage
  • May have slept an adequate length of time but still feels unrefreshed
  • Profile: middle aged, overweight male who snores loudly and intermittently
33
Q

How can Ostructive sleep apnea Hyponea (OSAH) be treated?

A
  • Continuous Positive Airway Pressure( CPAP): A device that maintains an open airway by delivering compressed air via mask
  • Additional approaches include weight loss, avoiding back sleeping, orthodontic devices, and surgery
34
Q

What is central sleep apnea?

A

-2+ episodes of breathing cessation per night caused by CNS Dysregulation of breathing

Etiology: idiopathic(unknown)
Treatment: respiratory stimulants

35
Q

How can OSAH be distinguished from central sleep apnea (CSA) ?

A

Look at thoracic effort during PSG at the start of apneic episode:

  • OSAH (Thoracic effort occurs)
  • CSA( no thoracic effort occurs)
36
Q

What is CIrcadian Rhythm Sleep-wake disorder?

A
  • Excessive sleepiness or insomnia resulting from a mismatch between a person’s circadian sleep-wake pattern and the sleep-wake schedule required by the environment.
    • delayed sleep phase type: delayed sleep onset and awakening times, with the inability to fall asleep and awaken at @ desired earlier time
37
Q

How can circadian rhythm sleep-wake be treated?

A
  • Phototherapy at strategic times during the day to adjust the timing of the sleep-week cycle
  • Setting of the circadian clock (governed by the suprachiasmatic nucleus [SCN] of the hypothalamus)
38
Q

What is the science behind treatment of circadian sleep-wake treatments?

A

Light —> SCN—> inhibits pineal gland —> decreases melatonin—> alert

No light —> SCN—> activates pineal gland —> increases melatonin —> drowsy

39
Q

What are parasomnias?

A

Disorders characterized by abnormal behaviors associated with sleep

  1. Non-REM sleep arousal disorder
  2. Nightmare disorder
  3. REM sleep behavior disorder
  4. Restless legs syndrome
  5. Periodic limb movements
40
Q

What is Non-REM sleep arousal disorder?

A

Repeated episodes of incomplete awakening from sleep with either of the following:

Sleep walking: rising from bed, walking about with a blank and staring face, unresponsive, and difficult to wake

Sleep terrors: Abrupt terror arousals (usually with panicky scream), intense fear and autonomic arousal, and unresponsive to comfort

41
Q

How is NON-REM sleep arousal disorder characterized?

A

Characterization:

  • Episodes occur in first 1/3 of sleep(slow wave sleep [ SWS])
  • No (or little) dream imagery
  • Amnesia for the episodes
42
Q

Describe treatment for NON-REM sleep arousal disorder

A

Benzodiazepines to reduce SWS. If sleep walking, then consider environmental protection

43
Q

What is nightmare disorder?

A

Extremely Dysphoric dreams typically involving threats to survival, security or physical integrity

Characterization:
-Awakening in the 2nd half of sleep period during REM sleep)

  • Rapid alertness upon awakening
  • Dream content is well remembered
  • good recall of the awakening the next morning
44
Q

How is nightmare disorder treated?

A

If needed, antidepressants to reduce REM sleep

45
Q

What is REM sleep disorder?

A
  • Vocalizations and/or complex motif movements occur during REM sleep
  • REM sleep without atonia is confirmed by PSG
  • not induced by a substance
  • Typically action-filled, violent dreams
  • Immediately awake, oriented and alert with detailed dream recall
  • loss of motor inhibition during REM is associated with neurodegeberative disease (e.g., Parkinson’s disease, levy body dementia)
46
Q

How is REM sleep behavior disorder treated?

A
  • Clonazepam (a benzodiazepines) -therapeutic mechanism of action is unclear
  • Modification of sleep environment for safety
47
Q

What is restless leg syndrome?

A

Urge to move legs in response to uncomfortable sensations with all the following:

  • Occurs/worsens during inactivity
  • Nocturnal worsening of symptoms
  • Temporary relief from discomfort by moving

Patient is aware of symptoms and complains of insomnia

48
Q

What is treatment for restless leg syndrome?

A

Parkinson’s drugs to increase dopamine(also, benzodiazepines, anticonvulsants)

49
Q

What are periodic limb movements?

A

Repetitive muscle contractions during sleep, usually of the lower limb:

  • Associated with multiple sleep state arousals
  • Patient complains of daytime sleepiness but is unaware of movements
  • Electromyogram during PSG confirms diagnosis
  • Treat using similar drugs as for restless leg syndrome

psycopathology (23 decks)

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