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58 Cards in this Set
- Front
- Back
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Sleep and wake cycles that is 24-25 hours long is called the ____.
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Circadian Cycle
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REM and NonREM sleep make up the ____ cycle.
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Ultradian Cycle
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What type of sleep is this?
brain highly active body paralyzed fast respiration |
REM sleep
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What type of sleep is this?
brain not active high muscle tone slow respiration |
NON-REM sleep
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REM sleep cycle lasts about ___ min.
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90-100 min
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Stage III and IV of NON-REM sleep is also called ____.
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Slow-wave sleep / Delta sleep
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What is Delta sleep?
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Also known as slow-wave sleep: stage III and IV of NON-REM sleep.
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T/F: During healthy sleep, there is about 20% NON-REM and 80% REM sleep.
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False.
20% REM 80% NON-REM |
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How many cycles of REM and NON-REM are there is a night of healthy sleep?
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4-5 cycles
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T/F: REM sleep periods becomes longer and closer together as the night goes.
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T.
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Which muscles are still active during REM sleep?
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- occular muslces for eye movements
- diaphram |
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Describe the EEG of REM sleep:
- speed - amplitude - frequency |
fast
low amplitude mixed frequency |
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What type of sleep is this?
idling brain in a moveable body. |
NON-REM sleep
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Describe the levels of the following molecules during REM sleep.
- Ach - NE - Serotonine |
- Ach: high
- NE: low - Serotonine: low |
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Which neurotransmitter inhibits REM sleep?
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serotonine
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List some types of dyssomnias. (5)
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- primary insomnia
- primary hypersomnia - narcolepsy - breathing-related sleep disorder - circadian rhythm sleep disorder |
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List some types of parasomnias. (3)
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- nightmare disorder
- sleep terror disorder - sleepwalking disorder |
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What 2 types of sleep disorder are most commonly seen in primary care?
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- sleep apnea (breathing-related)
- periodic limb movements (nocturnal myclonus) |
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These people are at risk for which type of sleep disorder?
obeise hypertensive high palate, enlarged tonsils |
obstructive sleep apnea
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T/F: Males are more likely to have obstructive sleep apnea than women.
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True.
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Which ethnic group under age 25 is more likely to have obstructive sleep apnea?
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African American male
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What is the sequence of events that lead to obstructive sleep apnea?
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- low inspiratory pressure
- completely collapsed hypopharyngeal airway - hypoxemia - increased respiratory effort - more collapsed airway - pulmonary hypertension - right heart failure, systemic hypertension(stroke and CV disease) |
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People with obstructive sleep apnea are at risk for what diseases?
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pulmonary hypertention which leads to either right heart failure or systemic hypertension which will cause stroke and CV diseases.
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Why are people with obstructive apnea sleepy during daytime?
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People keeps waking up without knowing when effort to breath fails.
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What kinds of treatment are out there for people with obstructive sleep apnea?
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- nasal continuous positive airway pressure splints airway.
- surgery: limited use |
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What type of sleep disorder is this?
stereotypical leg twitches every 20-40s periods range from minutes to hours |
Nocturnal myoclonus / Periodic limb movement disorder
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Which muscle usually twiches in people with nocturnal myoclonus?
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anterior tibialis
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80% of people with restless leg syndrome will have this sleep disorder.
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nocturnal myoclonus
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What percentage of people with nocturnal myoclonus have restless leg syndrome?
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only 15%
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When does restless leg syndrome symptom occur?
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right before sleep
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How to treat nocturnal myoclonus?
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- Benzodiazapine: raises wakening threshold.
- Ropinorole (Requip): reduces twitches. |
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What is this sleep disorder?
- sleep attacks - cataplexy - sleep paralysis - hypnogogic or hypnopompic hallucinations These are the diagnostic tetrad for the disease. |
narcolepsy
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What is this called?
brief, almost imperceptible weakness of isolated muscle groups. This is a symptom of which disease? |
cataplexy, a symptom of narcolepsy.
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The sleep attacks in people with narcolepsy are composed of what type of sleep? (hint: REM or NON-REM)
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REM mostly
*may progress to full REM sleep |
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What is this called?
inability to move during sleep onset or wakening.The person is wake, but cannot move. This is a symptom of what disease? |
Sleep paralysis: a symptom of narcolepsy.
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In normal people, REM normally occurs within ___ minutes after falling asleep.
What about in narcoleptic people? |
60-90min for normal people
<10 min for narcoleptic people (decreased REM latency) |
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In normal people, REM normally occurs within ___ minutes after falling asleep.
What about in narcoleptic people? |
60-90min for normal people
<10 min for narcoleptic people (decreased REM latency) |
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What drugs treat narcolepsy?
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agents that stimulate NE which suppresses REM:
- methylphenidate - amphetamine - pemoline * modafinil: reduce GABA release, alter DA transporter. |
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What is the underlying cause of narcolepsy?
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Lack of normal REM inhibition: alpha-adrenergic and serotonin inhibition on pontine reticular activating system.
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What physical conditions will cause insomnia? (4)
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- pain
- CV disorders: CHF, chronic obstructive pulmonary disease - GI disorders: reflux esophagitis - genitourinary: nocturia, UTI, prostatic hypertrophy |
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Why do people with CHF more likely to have insomnia?
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CHF -> pulmonary edema (worsened when lying down)
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Sleep onset insomnia is characteristic of what syndrome?
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anxiety: sleep architecture is preserved.
also seen in depression. |
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What does this person has?
sleep onset insomnia early AM wakening midnight wakening |
major depression
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For people under major depression, what is their sleep architecture?
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shortened REM latency
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Shortened REM latency is seen is which 2 conditions?
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- narcolepsy
- major depression (still longer than narcolepsy) |
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What is the mainstay treatment this?
self-contained depression reactive to stress sleep pattern resemble anxiety |
psychotherapy
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What is the mainstay treatment for major depression?
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antidepressants
no need for hypnotic adjunctive |
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What is the effect of alcohol on sleep?
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- reduce sleep latency
- supresses REM - interferes with slow-wave sleep |
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Which substance cause the following?
- reduce sleep latency - supresses REM - interferes with slow-wave sleep |
alcohol
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Which has more effect on REM and slow-wave sleep?
alcohol vs its metabolite (acetaldehyde) |
metabolite acetaldehyde
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Compare the sleep architecture between alcohol intake and withdrawal.
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alcohol:
- reduced REM - reduced NON-REM alcohol withdrawal: - increased REM - decreased NON-REM |
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Some considerations when doing a sleep history.
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- interview bed partner as well: movement, snoring
- ask about other physical conditions (eg CV, GI, GU) - ask about sleep habits, exercise, alcohol. - ROS to rule out psychiatric disorders |
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What should you do if still unsure about a sleep disorder diagnosis after careful history, physical exam, and labs?
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order polysomnography.
(need to confirm the condition before starting treatments) |
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What should you tell patients when you can't find a specific etiology for insomnia?
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- behavioral interventions: sleep habits, diet, caffeine, alcohol, exercise.
- relaxation techniques |
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What is the effect of classic benzodiazepine on sleep?
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supresses REM
- induce sleep: BZ1 - relieve anxiety: BZ2 - muscle relaxant: BZ3 can induce delirium and dependence |
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Name 3 drugs that are specific for BZ1 receptors.
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- zaleplon (sonata)
- zolpidem (ambien) - eszopiclone (lunesta) |
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Is melatonin useful for treating insomnia?
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depends (variable content and purity)
-improves sleep onset, duration and quality. - keep sleep architecture intact |
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Which drug binds to MT1 and MT2 melatonine receptors in the suprachiasmatic nucleus of the hypothalamus?
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Ramelteon (Rozerem): too new to evaluate vs melantonin,
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