Body Mass Index, Sleep Patterns, And Sleep Disorders

Front 1

Body-mass index (BMI)

Back 1

BMI is a measure of weight adjusted for height.

BMI = (weight in kg)/(height in meters)^2

Front 2

BMI by the numbers

Back 2

-BMI under 18.5 is underweight

18.5 to 24.9 is normal weight

25.0 to 29.9 is overweight

Over 30 = obesity

Over 35 = severe obesity

Over 40 = morbid obesity

Over 45 = super obesity!

Front 3

Sleep stages – acronym for EEG waveforms

Back 3

"At night, BATS Drink Blood"

Beta – highest, frequency, lowest amplitude
Alpha
Theta
Sleep spindles and K complexes

Delta – lowest frequency, highest amplitude
Beta

Front 4

Awake (eyes open)

Back 4

-Alert, active mental concentration.
-Beta waves

Front 5

Awake (eyes closed)

Back 5

-Alpha waves

Front 6

Stage N1

Back 6

5% of total sleep time in young adults.

-Light sleep

-Theta waves

Front 7

Stage N2

Back 7

45% of total sleep time in young adults

-Deeper sleep, bruxism

--Bruxism is the excessive grinding of the teeth and/or excessive clenching of the jaw.

-Sleep spindles and K complexes

Front 8

Stage N3

Back 8

25% of total sleep time in young adults.

-Deepest non-REM sleep (slow-wave sleep)

-Sleep-walking, night terrors, bedwetting

-Delta waves (lowest frequency, highest amplitude).

Front 9

REM sleep

Back 9

25% of total sleep time in young adults

-Dreaming, loss of motor tone, erections, increased brain O2 use

-REM sleep may have a memory processing function

Front 10

Sleep facts

Back 10

-Serotonergic predominance of rap he nucleus is key to initiating sleep.

-Sleep enuresis (bedwetting) is treated with oral desmopressin acetate (DDAVP), which mimics vasopressing (ADH).
--DDAVP is preferred over imipramine because of the latter's adverse effects.

-Alcohol, benzodiazepines, and barbiturates are associated with *reduced* REM and delta sleep.

-Benzodiazepines are useful for night terrors and sleep walking

Front 11

REM sleep

Back 11

"REM sleep is like sex: increased pulse, penile/clitoral tumescence (swelling), decreased frequency with age."

-Because REM sleep has the same EEG patterns as wakefulness, it has been termed "paradoxical sleep" and "desynchronized sleep."

-REM sleep occurs every 90 minutes, with duration increasing through the night.

-ACh is the principal neurotransmitter in REM sleep, while NE reduces REM sleep.

Findings:
-Increased and variable pulse and blood pressure.
-Extraocular movements during REM sleep due to activity of PPRF (paramedic pontine reticular formation, i.e., conjugate gaze center).
-Penile/clitoral tumescence.

Front 12

Sleep patterns of depressed patients

Back 12

Patients with depression typically have the following changes in their sleep stages:

-Decreased slow-wave sleep (Stage N3)

-Decreased REM latency

-Increased REM early in sleep cycle

-Increased total REM sleep

-Repeated nighttime awakenings

-Early-morning awakening (important screening question)

Front 13

Narcolepsy

Back 13

Narcolepsy:

-Disordered regulation of sleep-wake cycles; primary characteristic is excessive daytime sleepiness.

-May include hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations.

-Patient's nocturnal and narcoleptic sleep episodes start off with REM sleep.

-Cataplexy (loss of all muscle tone following a strong emotional stimulus) is seen in some patients.

-Strong genetic component.

-Treated with daytime stimulants (e.g., amphetamines, modafinil), and nighttime sodium oxybate (GHB).

Front 14

Circadian rhythm

Back 14

Drive by suprachiasmatic nucleus (SCN) of hypothalamus.

Circadian rhythm controls ACTH, prolactin, melatonin, nocturnal NE release.

SCN --> NE release --> pineal gland --> melatonin.

SCN is regulated by environment, i.e., light.

Front 15

Sleep terror disorder

Back 15

Sleep terror disorder is characterized by periods of terror with screaming in the middle of the night.

-Most common in children

-Occurs during non-REM sleep (no memory of arousal), as opposed to nightmares that occur during REM sleep (with subsequent memory of scary dream).

-Cause unknown, but triggers may include emotional stress during the previous day, fever, or lack of sleep.

-Usually self-limited