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Flashcards in Sleep & Sleep Disorders Deck (33)
1

Normal sleep 

What are the 2 sleep states?

What are the primary sleep neurotransmitters?

  • 2 sleep states
    • REM (rapid eye movement)
    • Non-REM sleep
  • Primary sleep NTs
    • REM: ACh
    • NREM: serotonin 

2

Fill in the blanks

 

3

Define:

  • Human Circadian Cycle
  • Awake EEG 
  • Sleep Latency 
  • Sleep Efficiency 

  • Human Circadian Cycle = 25 hrs
  • Awake EEG = beta & alpha waves
  • Sleep Latency = time it takes to fall asleep (<10 min)
  • Sleep Efficiency = time sleeping/time spent trying to sleep (100%)

4

Human Sleep Requirement 

  • Newborn 
  • Adolescent 
  • Adult 
  • Older adult  

  • Newborn = 16-18
  • Adolescent = 9-10
  • Adult = 8
  • Older adult = 7-8 

5

REM Sleep

  • What % of total sleep?
  • How long?
  • What happens physiologically?

  • 25% of all sleep
  • Every 90 min
  • Each REM episode = 10-40 min
  • Longer episodes – 2nd half of night
  • BP, pulse rate, respirations – increase
  • Penile & clitoral erection
  • Skeletal muscle paralysis
  • EEG – small, irregular brain waves
  • Dreaming occurs 

6

What % of Stages 1, 2, 3 & 4 are Non-REM sleep?

  • Stage 1 = 5% sleep
  • Stage 2 = 45% sleep
  • Stage 3 & 4 = 25% sleep
    • Most deep sleep (1st half of night) 

7

Stage 1 NREM

  • Length
  • Breathing 
  • HR 
  • BP 
  • Temperature 
  • Blood flow to brain 
  • EEG 
  • Ability to wake sleeper 

  • Lasts about 10 min
  • Breathing – slow & even
  • HR – regular
  • BP – decrease
  • Temperature – decrease
  • Blood flow to brain – decrease
  • EEG – brain waves smaller, slower, irregular
  • Sleeper easily awoken 

8

Stage 2 NREM

  • Length
  • Bodily functions 
  • EEG
  • Ability to wake sleeper 

  • Lasts about 20 min
  • Bodily functions continue to slow
  • Even if eyes are opened, sleep cannot see
  • EEG – larger brain waves, occasional quick bursts of activity
  • Sleeper can be awakened by sounds 

9

Stage 3 NREM

  • Length
  • EEG
  • Ability to wake sleeper

  • Begins about 30-45 min after sleep is initiated
  • EEG – brain waves are slow & large
    • Up to 5X as large as in Stage 2
  • Sleeper is much less easy awake, requiring loud noise or active attempts to wake 

10

Stage 4 NREM

  • Bodily functions
  • EEG
  • Ability to wake sleeper 

  • Bodily functions decline in the deepest state of rest
  • EEG – brain waves are large, slow & make a jagged pattern
  • Sleeper experiences oblivion – if awakened, very disoriented 

11

How does sleep change with aging

  • Decreased REM
  • Decreased Stage 3 & 4 sleep
  • Increased night-time awakenings – decreased sleep efficiency 

12

How does sleep change with depression?

  • Frequent awakenings – decreased sleep efficiency
  • Early morning awakening
  • Decreased REM latency – 1st REM within 45 min
  • Increased total REM
  • Decreased Stage 3 & 4 sleep 

13

Definitions

Dyssomnias

Parasomnias

  • Dyssomnias – abnormal timing, quality, & amt of sleep
  • Parasomnias – abnormal behaviors associated w/ sleep 

14

What are the different types if Dyssomnias?

  • Timing
    • Narcolepsy
    • Circadian rhythm sleep disorder
  • Quality
    • Restless legs
    • Sleep apnea
  • Amount
    • Insominia
    • Hypersomnia 

15

Key features of Narcolepsy 

  • Sleep attacks
  • Hypnogogic/hypnopompic hallucinations
  • Cataplexy
  • Sleep paralysis 

16

Narcolepsy abnormalities in sleep architecture

  • Decreased sleep latency
  • Decreased REM latency (<10 min)
  • Less REM overall 

17

Narcolepsy

Neurobiologic factors

Epidemiological factors 

  • Neurobiologic factors
    • Associated w/ hypocretin (orexin) deficiency
  • Epidemiologic factors
    • Usually diagnosed in adolescence
    • Significant genetic component 

18

How is narcolepsy treated?

  • Scheduled daytime naps
  • Psychostimulants
    • Methylphenidate (Ritalin)
    • Modafinil (Provigil) 

19

What are the features of circadian rhythm sleep disorder?

  • Inability to sleep at appropriate or desired times
  • 2 types: delayed & advanced
  • Causes: intrinsic & extrinsic (shift work, jet lag)

20

How is circadian rhythm sleep disorder treated?

  • Delayed sleep phase
    • Melatonin 5-10 mg/hr before bedtime
    • Light at desired waking time
  • Advanced sleep phase
    • Light in the evening
  • Shift work
    • Modafinil 100-200 mg or caffeine for alertness
    • Melatonin or other hypnotic at bedtime 

21

What are the features of restless legs?

  • Uncomfortable sensation in legs
  • Repetitive limb jerking
  • Frequent night-time awakenings 

22

Restless Legs

Epidemiology

Treatment

  • Epidemiology
    • Older adults
  • Treatment
    • Anti-Parkinsonian agents
    • Levodopa
    • Carbidopa/levodopa (Sinemet)
    • Ropinirole (Requip) 

23

What are the features of sleep apnea?

  • Cessation of breathing
  • CO2 increases
  • Frequent awakenings
  • Increased rate of sudden death 

24

Sleep apnea

Associated features

Laboratory 

  • Associated features include:
    • Snoring (if obstructive variant)
    • Daytime sleepiness
    • Morning headache
  • Laboratory: respiratory acidosis 

25

What are the two types of sleep apnea?

  • Central Sleep Apnea
    • Decreased respiratory effort
  • Obstructive Sleep Apnea
    • Normal respiratory effort
    • Airway obstruction 

26

Sleep apnea

Epidemiology

Treatment

  • Epidemiology
    • Central Sleep Apnea (older adults)
    • Obstructive Sleep Apnea
      • Middle-aged adults
      • Men >>> Women
      • Associated w/ obesity
  • Treatment
    • Weight loss (if obesity present)
    • Continuous positive airway pressure (CPAP)
    • Medroxyprogesterone acetate
    • Uvulopalatoplasty/Tracheostomy 

27

What are the features of insomnia?

  • Difficulty falling asleep or staying asleep
  • 3X/wk or more
  • Duration at least 1 mo
  • Daytime sleepiness 

28

Insomnia

Epidemiology

Treatment 

  • Epidemiology
    • At least 30% of population
    • Associated w/ cognitive impairment & accidents
  • Treatment
    • Avoid caffeine, especially in evenings
    • AM exercise
    • Develop sleep routine
    • Relaxation techniques
    • Hypnotic medication
      • May, however, decrease REM & delta sleep 

29

What are the different types of Parasomnias?

  • Bruxism (tooth grinding)
  • Night terror
  • Sleep walking
  • REM sleep behavior disorder

30

Bruxism

Features

Stage of Sleep

Treatment 

  • Features
    • Tooth-grinding
    • Tooth damage & jaw pain
  • Occurs during Stage 2 sleep
  • Treatment: dental appliance worn at night 

31

Night terror

Features

Stage of Sleep

Population 

  • Features
    • Repetitive experiences of fright
    • Not easily awakened
    • No memory upon awakening
  • Occurs in Stage 3 & 4 sleep
  • Usually occurs in children 

32

Sleep walking

Features

Stage of Sleep

Treatment 

  • Features
    • Repetitive walking
    • Can be injured
    • Eyes open
    • No memory upon wakening
  • Occurs in Stage 3 & 4 sleep (usually 1st half of night)
  • Usually occurs in children
  • Treatment
    • Manipulate environment (safety) 

33

REM sleep behavior disorder 

Features

Stage of Sleep

Treatment

  • Features
    • Motor activity while dreaming
    • Eyes closed
    • Awakens fully alert & able to recount their dream
  • Occurs in REM (usually 2nd half of night)
  • Associated w/ Parkinson disease & Lewy Body Dementia
  • Treatment
    • Environmental manipulation: safety
    • Melatonin or low-dose benzodiazepines