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Sleep and sleepdisorders > Task 4 > Flashcards

Task 4 Flashcards

1
Q

Parasomnia

  • what is it
  • Manber
A
  • parasomnia is abnormal behavior or perception associated with CNS activation that occurs during sleep or transitions into or out of sleep
  • NREM parasomnia occur during partial arousal from SWS (N3)
  • REM parasomnia occur during second half of the night
  • NREM eyes are open and when awakened reorientation is difficult
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2
Q

Parasomnia

  • NREM sleep arousal disorder
  • Manber
A
  • NREM sleep arousal disorder is parasomnia from stage N3
  • Not fully awake (partial arousal)
  • amnesia for the episode is common
  • Sleep walking type
  • sleep terror type starts with scream, abruptly sit up in state of high arousal, no recall
  • more time in stage N3 avoid awakening
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3
Q

Parasomnia

  • Nightmare disorder
  • Manber
A
  • REM sleep disorder during second half of night
  • vivid, frightening and well-remembered dream from which a sleep wakes up and is oriented
  • loss of muscle tone
  • PSG reveals reduced efficiency and longer sleep latency and less SWS
  • nightmares occur repeatedl and high distress and impairment in functioning
  • difference with nocturnal panic is nightmare is not associated with dream content
  • difference sleep paralysis is nightmare is not aware of being fully awake when experiencing frightful imagery
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4
Q

Parasomnia

  • REM sleep behavior disorder
  • Manber
A
  • RSBD is characterized by dream enactment during sleep
  • loss of muscle atonia
  • individuals engage in complex behavioral consequences
  • if woken quickly oriented
  • latter half of the night
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5
Q

Somnambulism

  • what is it
  • Zadra
A
  • defined as a series of complex behaviors during arousals from SWS (N3) and culminate in walking around with an altered state of consciousness and impaired judgement
  • episoded last from few seconds to more than 30 min
  • more common in childhood
  • excessive daytime somnolance (sleepiness) characteristic somnambulism
  • 70% recalled short, unpleasant, dreamlike mentations associated with sleepwalking episodes
  • eyes usually open to navigate
  • first third of the night
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6
Q

Somnambulism

  • Diagnosis and clinical management
  • Zadra
A
  • nocturnal frontal lobe epilepsy and RSBD can be confused with somnambulism
  • nocturnal N2 sleep, cannot get out of bed
  • RSBD last half of night, REM sleep, awakened fully awake and functional, vivid dream recall
  • disorders that ease dissociation or induce confusional states can trigger somnambulism
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7
Q

Somnambulism

  • as a disorder of slow-wave sleep
  • Zadra
A
  • presence of intrinsic abnormalities in SWS and atypical response that sleepwalkers have to sleep deprivation
  • decrease in slow-wave activity
  • sleep deprivation results in more awakenings from SWS during recovery sleep
  • response to sleep deprivation are highly sensitive and specific
  • sleep deprivation increased activation of amygdala and decrease in connectivity with the PFC
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8
Q

Somnambulism

  • as a disorder of arousal
  • Zadra
A
  • delta activity recorder in half of all episoded during SWS –>sleepwalkers caught between NREM sleep and full EEG arousal and thus neither awake or asleep
  • arousal from SWS can induce sleepwalking episodes
  • sleepwalkers have abnormal arousal reactions
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9
Q

Homocidal somnambulism

  • case report
  • broughton
A
  • Kenneth Parks 23 difficult relationship (step)father
  • married and good relationship parents in law
  • bet at horseraces–> severe stress on mariage
  • problems getting asleep, completely sleepless nights and daytime headaches
  • gamblers anonymous telling grandmother and family
  • delay telling grandmother –>argument wife
  • no alcohol or drugs
  • did not recall seeing marks or blood on her face
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10
Q

Homocidal somnambulism

  • medical investigation of the patient
  • broughton
A
  • drug-related received no support
  • no suggestion of motivational or personal gain
  • severe bedwetter, deep sleeper, rare dream recall, chronic sleep talker and occasional sleepwalker
  • state instability, direcht SWS to wake arousals and high amount of SWS
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11
Q

Homocidal somnambulism

  • diagnosis and legal argument
  • broughton
A
  • absence of motive, affection, grief, lack of evidence during sleepwalking
  • somnambulism represents state of consciousness and sleep, along with organized behaviors
  • legal theory of continuing danger; condition with recurrent danger to public should be treated as insanity
  • legal theory of internal causes or disease of mind; sleepwalking is not a disease but a disorder of sleep
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12
Q

Parsomnias in childhood

  • What is parasomnia, wat provokes parasomnia
  • Kotagal
A
  • Parasomnias are consequence of dissociation between wakefulness, NREM or REM sleep
  • Down-regulation of descending GABAergic projections or diminished serotonergic inhibition may play a role in pathogenesis of sleep-wake transition parasomnias and arousal parasomnia
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13
Q

Parasomnias in childhood

  • Sleep-wake transition parasomnias
  • Kotagal
A
  • Hypnic starts
  • Benign neonatal sleep myclonus
  • isolated sleep paralysis (ISP)
  • rhythmic movement disorder
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14
Q

Parasomnias in childhood

  • Hypnic starts
  • Kotagal
A
  • isolated, quick jerks of the upper or lower extremities that occur at sleep onset
  • feeling of falling, dream-like feeling or flashing sensation
  • benign and occur in 70% of all ages
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15
Q

Parasomnias in childhood

  • benign neonatal sleep myclonus
  • Kotagal
A
  • symmetric or asymmetric, repetitive jerks of extremities during sleep in first month of life
  • benign and resolve spontaneously over weeks
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16
Q

Parasomnias in childhood

  • isolated sleep paralysis ISP
  • Kotagal
A
  • isolated or recurrent episodes of transient inability to move the body as falling asleep or upon wakening
  • consciousness and hallucinations
17
Q

Parasomnias in childhood

  • rhythmic movement disorder
  • Kotagal
A
  • rhythmic movements in infants and toddlers at time of drifting off from wakefulness to sleep
  • occur at transition from wakefulness to N1 sleep, during NREM and in REM sleep
  • disorder when it leads to consequences
18
Q

Parasomnias in childhood

  • Arousal parasomnias (NREM parasomnias)
  • Kotagal
A
  • occur at transition from SWS (N3) into lighter stages of sleep
  • first third of night sleep
  • confusion arousals
  • sleep terrors
  • sleep walking
19
Q

Parasomnias in childhood

  • confusion arousals
  • Kotagal
A
  • common in infants and toddlers
  • onset of symptoms within 2-3 hours at time of SWS (N3) to lighter stage
  • typically sit up in bed, no sweating, flushing of face or stereotypic motor behavior
  • no recollection of event
20
Q

Parasomnias in childhood

  • sleep terrors
  • Kotagal
A

-awakenes abdruptly from sleep with a scream, appears agitated, flushed over the face, sweating and tachycardia

21
Q

Parasomnias in childhood

  • sleep walking
  • Kotagal
A

-Sits up and crawls around the crib, or a child walking quietly in sleep

22
Q

Parasomnias in childhood

  • REM sleep parasomnias
  • Kotagal
A
  • nightmares
  • REM sleep behavior disorder
  • catathrenia
23
Q

Parasomnias in childhood

  • nightmares
  • Kotagal
A
  • recurrent episodes of awakening from sleep with recall of intensely disturbing dream mentation involving fear, anxiety and anger
  • full awareness upon awakening
  • early hours of the morning
  • treatment; avoiding television, rescripting techniques, desensitization techniques
24
Q

Parasomnias in childhood

  • REM sleep behavior disorder (RBD)
  • Kotagal
A
  • aggressive motor behavior during dream eneactment in adults
  • predictive of degenerative neurological disorders
25
Q

Parasomnias in childhood

  • catathrenia
  • Kotagal
A
  • nocturnal groaning or catathrenia
  • unaware of expiratory groaning sound
  • second half of the night
26
Q

Parasomnias in childhood

  • Miscellaneous parasomnias
  • Kotagal
A
  • sleep related ensuresis
  • bruxism
  • status dissociatus
27
Q

Parasomnias in childhood

  • sleep related enuresis
  • Kotagal
A
  • recurrent bedwetting
  • primary enuresis; child has not had dry period of 6 months
  • secondary enuresis; period of 6 months dry
28
Q

Parasomnias in childhood

  • bruxism
  • Kotagal
A

-involuntary, non-functional and forceful clenching, grinding or rubbing of teeth

29
Q

Parasomnias in childhood

  • status dissociatus
  • Kotagal
A

structural brainstem lesions associated with sleep talking, vigorous movements accompanied by vivid dreams, enuresis and daytime sleepiness

30
Q

Breakdown rem sleep in RBD

  • what is RBD
  • Peever
A
  • parasomnia characterized by elaborate and often violent motor behaviors during REM sleep can result in injury
  • more than 80% develop neurodegenerative disease
  • link between dream content and motor behavior in RBD
  • excessive tonic of phasic chin EMG activity or excessive limb EMG twitching during REM required for RBD diagnosis
31
Q

Breakdown rem sleep in RBD

  • idiopathic and secondary RBD
  • Peever
A
  • iRBD when none of the conditions listed for secondary RBD or other conditions that mimic nocturnal manifestation of RBD is present
  • secondary RBD when there is an associated condition that likely contributes to its etiology
32
Q

breakdown rem sleep in RBD

  • treatment
  • Peever
A
  • dopaminergic agents (pramipexole) results are mixed

- melatonin partially restores REM sleep atonia but negligible effects on phasic motor activity

33
Q

breakdown rem sleep in RBD

  • mechanisms of REM sleep atonia
  • Peever
A
  • GABA- and glycine- mediated inhibition of motoneurons underlies REM sleep atonia
  • loss of this inhibitory mechanism is a candidate in RBD pathogenesis
34
Q

breakdown rem sleep in RBD

  • REM sleep circuitry
  • Peever
A
  • subcouruleus nucleus and subdorsolateral tegmental nucleus (SLD) cells are REM-on –> induce REM atonia by recruiting inhibitory circuits
  • REM-on glutamate SLD cells excite GABA- and glycine containing neurons in the gigantocellular reticular nucleus (GiV) –> which trigger atonia by directly inhibiting skeletal motoneurons
  • healty REM sleep; the SLD-GiV inhibits motoneurons which prevents pyramidal neurons in motor cortex from producing movement
  • SLD neurons generate REM sleep atonia but do not induce phasic motor events of REM sleep
35
Q

breakdown rem sleep in RBD

  • models of RBD
  • Peever
A
  • pathologies affecting the brainstem circuits that control REM sleep
  • lesions of dopamine system
  • dysfunction of normal inhibitory neurotransmission
36
Q

breakdown of rem sleep in RBD

  • disease mechanisms in RBD
  • Peever
A
  • brainstem lesions can trigger RBD
  • loss of subcoeruleus neurons
  • changes in normal cholinergic system activity
  • pathological changes in basal ganglia anatomy
37
Q

SPECT during sleepwalking

-Bassetti

A
  • decreased cerebral blood flow in frontoparietal cortices during sleepwalking
  • sleepwalking is a dissociated state consisting of motor arousal and persisting mind sleep
  • increase blood flow in anterior cerebellum and posterior cingulate cortex

Sleep and sleepdisorders (6 decks)

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