SM_87b: Circadian Rhythms and Sleep

Question 1

Relaxed wakefulness has ___

Answer 1

Relaxed wakefulness has alpha waves

Question 2

Stage N1 of sleep has ____

Answer 2

Stage N1 of sleep has theta waves

Question 3

Stage N2 of sleep has ____ and ____

Answer 3

Stage N2 of sleep has sleep spindles and K complexes

Question 4

Stage N3 of sleep has ____

Answer 4

Stage N3 of sleep has delta waves

Question 5

____, ____, and ____ are active neurotransmitters during wakefulness

Answer 5

ACh, monoamines (DA, NE, serotoni), and orexin/hypocretin are active neurotransmitters during wakefulness

Question 6

___ has higher firing rate and ___ has slower firing rate during NREM sleep

Answer 6

VLPO/MNPO has higher firing rate and monoamines (DA, NE, serotonin) has slower firing rate during NREM sleep

Question 7

____, ____, and ____ have increased firing rate during REM

Answer 7

ACh, MCH, and VLPO/MNPO have increased firing rate during REM

Question 8

Flip-flop switch involves activation of ____ for wakefulness and ____ for sleep

Answer 8

Flip-flop switch involves activation of locus coeruleus / tuberomamillary nucleus / raphe for wakefulness and venterolateral preoptic nucleus (VLPO)/eVLPO for sleep

Question 9

Two process model of sleep regulation posits that the interaction of ____ and ____ generate timing of sleep / waking

Answer 9

Two process model of sleep regulation posits that the interaction of sleep/wake dependent homeostatic Process S and circadian Process C generate timing of sleep / waking

Question 10

____ regulates circadian rhythms

Answer 10

Suprachiasmatic nucleus regulates circadian rhythms

Question 11

Rate-limiting step in molecular clock is ____

Answer 11

Rate-limiting step in molecular clock is phosphorylation of PER/CRY by CK1ε/δ

Question 12

Describe the molecular clock

Answer 12

Molecular clock

1. CLOCK and BMAL1 are transcribed and exit the nucleus.
2. They dimerize, then re-enter the nucleus to upregulate PER and CRY.
3. PER and CRY exit the nucleus and dimerize
4. PER and CRY are phosphorylated by CK1ε/δ (this is the rate limiting step)
5. PER and CRY re-enter the nucleus to inhibit their own transcription.

This whole process takes ~24 hours

Question 13

Melatonin levels are highest at ____

Answer 13

Melatonin levels are highest at night

Question 14

Melatonin is measured in the ____, ____, and ____

Answer 14

Melatonin is measured in the urine, saliva, and plasma

Question 15

Advanced sleep wake disorder involves ____ and ____

Answer 15

Advanced sleep wake disorder involves advance in phase of major sleep period in relation to desired sleep / wake time and normal sleep quality and duration

Question 16

____ is the broken step in most patients with advanced sleep wake phase disorder

Answer 16

Phosphorylation of PER and CRY is the broken step in most patients with advanced sleep wake phase disorder

Question 17

Advanced sleep wake phase disorder is treated with ____, ____, and ____

Answer 17

Advanced sleep wake phase disorder is treated with planned sleep schedules, timed evening light exposure, and timed morning melatonin administration

Question 18

Irregular sleep wake disorder is a chronic complaint of ____, ____, or both but total sleep time per 24 period is essential normal

Answer 18

Irregular sleep wake disorder is a chronic complaint of insomnia, excessive sleepiness, or both but total sleep time per 24 period is essential normal

Question 19

Irregular sleep wake disorder is usually seen in ____ and ____

Answer 19

Irregular sleep wake disorder is usually seen in developmentally delayed children and adults with dementia

(due to poor sleep hygeine or neurological impairment)

Question 20

Irregular sleep wake disorder is treated with ____, ____, and ____

Answer 20

Irregular sleep wake disorder is treated with mixed modality therapy, timed light exposure, and timed melatonin administration

Question 21

Delayed sleep wake phase disorder involves ____ and ____

Answer 21

Delayed sleep wake phase disorder involves delay in the phase of major sleep period in relation to the desired sleep / wake time and normal sleep quality / duration

Question 22

Delayed sleep wake phase disorder is treated with ____, ____, and ____, but NOT ____

Answer 22

Delayed sleep wake phase disorder is treated with planned sleep schedules, timed light exposure, and timed melatonin administration but NOT hypnotics

Question 23

Non-24 hour sleep wake disorder involves ____

Answer 23

Non-24 hour sleep wake disorder involves complaint of insomnia / excessive sleepiness related to abnormal synchronization between 24 hour light-dark cycle and endogenous circadian rhythm

Question 24

Non-24 hour sleep wake disorder results in the blind due to ____

Answer 24

Non-24 hour sleep wake disorder results in the blind due to loss of photic input to the SCN through the retino-hypothalamic tract

Question 25

Non-24 hour sleep wake disorder results in the sighted due to ____

Answer 25

Non-24 hour sleep wake disorder results in the sighted due to multiple factors, including a combination of minimal social cues and a prolonged intrinsic circadian period

Question 26

Non-24 hour sleep wake phase disorder is treated in the blind via ____

Answer 26

Non-24 hour sleep wake phase disorder is treated in the blind via timed melatonin administration

Question 27

Non-24 hour sleep wake disorder is treated in the sighted via ____, ____, and ____

Answer 27

Non-24 hour sleep wake disorder is treated in the sighted via timed melatonin administration, strict sleep schedules, and timed light exposure

Question 28

____ is approved medication for treatment of non-24 hour sleep wake disorder

Answer 28

Tasimelteon is approved medication for treatment of non-24 hour sleep wake disorder

Question 29

Shift work sleep disorder is ____

Answer 29

Shift work sleep disorder is complaint of insomnia / excessive sleepiness that is temporally associated with a recurring work schedule that overlaps the usual time for sleep

Question 30

Shift work sleep disorder is treated with ____, ____, and ____

Answer 30

Shift work sleep disorder is treated with light pulses, light exposure on awakening, and specific sleeping times

Question 31

Jet lag sleep disorder is ____

Answer 31

Jet lag sleep disorder is complaint of insomnia / excessive daytime sleepiness associated with jet travel across at least two time zones

• Associated impairment of daytime function, general malaise, or somatic symptoms such as GI disturbance within 1-2 days after travel

Question 32

Jet lag sleep disorder is treated with ____ and ____

Answer 32

Jet lag sleep disorder is treated with light exposure and melatonin administration

Question 33

Light in the biological morning (after core body temperature is minimum) and melatonin at night _____ the circadian clock

Answer 33

Light in the biological morning (after core body temperature is minimum) and melatonin at night advance the circadian clock

Question 34

Light at night and melatonin in the morning ____ the circadian clock

Answer 34

Light at night and melatonin in the morning delay the circadian clock