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Flashcards in PDF - Sleep Deck (28)
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1
Q

Progression into REM?

A

Progression “down” through stages 1, 2, 3, and 4 of NREM, then reverse “up” before first REM occurs

2
Q

What goes on in Stage 1?

A
  1. Drowsiness

2. Early EEG slowing

3
Q

What goes on in stage 2?

A
  1. Asleep but easily aroused

2. Unique sleep spindles on EEG

4
Q

What goes on in stages 3 and 4?

A
  1. Sleep deeps, hard to arouse

2. Slowest (delta wave) EEG activity

5
Q

Progression of REM sleep?

A
  • First REM period occurs 90 minutes after sleep begins
  • Reoccurs every 90 minutes thereafter
  • Lasts only a few minutes at first
  • Subsequently lengthens in duration to an hour
6
Q

When is limb hypotonia maximal?

A

REM sleep

7
Q

What is seem in REM?

A
  1. Limb hypotonia
  2. Subtle twitches of face and limbs
  3. irregular pulse and breathing
  4. Horizontal, rapid, conjugate eye movements
8
Q

EEG in REM?

A

Similar to wake state

9
Q

Recall in REM?

A
  • Recallable dreams occur in REM

- This stage is important for reinforcing memory traces

10
Q

What does lack of REM cause?

A
  1. Anxiety
  2. Hostility
  3. Hallucinations
  4. Amnesia
11
Q

Impact barbiturates on sleep?

A

Suppress REM

12
Q

Sleep changes with age?

A
  1. Newborns sleep 15 hours daily
    - Frequent yet shorter periods
  2. Elderly Sleep about 6 hours
    - More frequent drowsy periods
  3. Percentage of REM falls from 50% in infants to 20% in adults
  4. Slow wave sleep (stages 3 / 4) decreases with age
  5. Stage 1 and 2 sleep increases with age
13
Q

Function of ARAS?

A

Important in arousal and wakefullness

14
Q

What does lesion in ARAS cause?

A

Persistent somnolence or coma

15
Q

Function Pontine REM center?

A
  • Activates brain stem gaze centers responsible for rapid, conjugate eye movements during REM
  • Induces hypotonia and increased autonomic activity
16
Q

What controls REM and NREM sleep?

A
  • REM and NREM sleep are promoted by preoptic area of

ventrolateral hypothalamus

17
Q

What is hypothalamic suprachiasmatic nucleus?

A

“Biological clock”

  • Controls circadian sleep-wake cycle
  • Receives direct retinal input via optic chiasm, allowing environmental light stimuli to influence the “clock”
18
Q

Cardiopulmonary sequelae sleep apnea?

A
  • Frequent sleep apneas create nocturnal hypoxemia which in turn cause spulmonary hypertension or cardiac
    arrhythmias
19
Q

Pathology OSA?

A

Upper airway obstruction despite contraction of diaphragm and chest wall muscles

20
Q

Pathology Narcolepsy?

A
  • REM sleep occurring at inappropriate times

- Related to a deficiency of neurons in hypothalamus which release excitatory peptide hypocretin

21
Q

Features narcolepsy?

A
  1. Narcoleptic attacks
  2. Cataplexy
  3. Sleep paralysis
  4. Visual hallucinations when falling asleep or waking up.
22
Q

What is cataplexy?

A

Loss of muscle tone, for seconds - minutes in duration

  • Often provoked by emotional triggers, such as an angry outburst, laughing at a joke or being “surprised”
  • Slumps to ground because of REM hypotonia and may not speak well, yet breathes, stays awake, and recalls event
23
Q

What is sleep paralysis?

A

REM hypotonia transiently preventing getting out of bed on wakening

24
Q

Diagnosis narcolepsy?

A

Abnormally early onset REM as patient allowed to fall asleep several times (not in state of sleep deprivation)

25
Q

Utility modafinil?

A

Narcolepsy and somnolence from sleep apnea

26
Q

Rx cataplexy?

A

TCAs

27
Q

Definition insomnia?

A

Inadequate quantity and quality of sleep to maintain normal daytime behavior

28
Q

What is REM behavior disorder?

A
  • Abnormality of REM sleep, where typically older male patients lack normal hypotonia of REM
  • Appear to be “acting out” dreams to point of injuring themselves or their bed partner
  • Often precedes onset of Parkinson’s disease or Lewy body dementia