Vosko Sleep Flashcards
a number of common situations when sleep patterns change
During illness (“sick behavior”)
Affective changes (depression, stress, etc.)
Throughout the aging process
Seasonal changes (esp. during time changes)
Taking medication
Diet
Hormonally-induced changes
ie. aggressive treatment not always needed
Insomnia
initiation or maintaining?
Mech: psycho, neuro, genetic, pharm
How to dx? Polysom
Parasomnias
dissociated sleep states
mech: neuro, pharm, unknown
how to dx: Polysom
Hypersomnias
eg: narcolepsy
Mech: neuro (orexin)
how to dx: polysom
sleep-disordered breathing
eg: OSA, CSA, hypovent.
mech: structural, neuro, pharm
how to dx? polysom
circadian rhythm disorders
eg: jet lag, ASPS, DSPS
Mech: physio, pharm, genetics
how to dx: actigraphy
Neuro-degenerative disorders
e. g.: parkinson’s, ALS, Alzheimer’s
mech: neuro, pharm
How to dx: imaging, motor tests, cognitive tests, etc.
Determine if feeling tired (fatigue) is the same as feeling sleepy
Do I have a problem with sleep itself, or am I just feeling tired?
Range of “normal” (without chronic sleep disorder) totals: 0-10
What steps do I take next? Determine the nature: Insomnia Parasomnia Hypersomnia Sleep-disordered breathing Circadian rhythm disorder Neurodegenerative disorder
Micro-arousals:
Brief awakenings from sleep (usually < 15 seconds). Do not have conscious recollection.
Micro-sleeps:
Brief (seconds in duration) sleep episodes during wakefulness. May not have conscious recollection.
Perceived Insomnia:
Believing one has insomnia while showing the behavioral and polysomnographic characteristics of someone with normal sleep.
NREM (SWS)
Increased arousal thresholds Decreased thermoregulation *** Decreased postural muscle tone 4 stages Synchronous EEG 75% of Total Sleep Time Prominent in early phases of sleep
REM (Paradoxical Sleep)
Increased arousal thresholds Decreased thermoregulation Decreased postural muscle tone== most compromised Rapid Eye Movements Vivid recall of dreams Asynchronous EEG 25% of Total Sleep Time Prominent in later phases of sleep
Reflex circuits and muscle tone
Muscle tone is the resting level of tension in a muscle
Allows muscle to make an optimal response to voluntary or reflexive movement by keeping them in a state of readiness to resist stretch
During a night’s sleep, we cycle through NREM-REM in 90 minute cycles
Longer periods of REM in second half of night
- Deprivation of NREM sleep leads to “rebound” of NREM sleep
- Deprivation of REM sleep leads to a “rebound” of REM sleep
- SOREMPs (Sleep Onset REM Periods) are also indicative of other sleep disorders (eg. Narcolepsy)
