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68 Cards in this Set
- Front
- Back
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What is the definition of sleep?
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A reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment.
Physiologic - highly regulated |
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What is the definition of coma?
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A state in which the subjects lie with eyes closed and demonstrate no conscious responses to external stimuli, even after attempts to rouse them.
Pathologic. |
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What is the definition of consciousness?
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Awareness of self and the environment, with the ability to react to internal and external stimuli
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What are the two broad categories of types of sleep?
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REM sleep
Non-rem sleep |
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What are the characteristics of REM sleep?
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The body is active but the brain is paralyzed
-EMG suppression -EEG: irregular, like you're awake -Rapid eye movement |
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What are the characteristics of non-REM sleep?
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The brain is less active, but the body can move
EMG: normal EEG: synchronized, slow |
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What are the three stages of Non-REM sleep?
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N1 and N2: light sleep
N3: Deep sleep - delta waves |
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During sleep, what cycle do spend most of their time in?
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Stage 2
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How much time do you spend in REM as you age?
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In-utero: ALL THE TIME!
Progressively less as you age |
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What system in the brain is responsible for regulating sleep behavior?
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Ascending reticular activating system
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Where in the brain gives origin to the ARAS?
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Brainstem nuclei in the midbrain
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Where does input to the ARAS come from? Where does it send output?
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Input: cortex, thalmaus, sensory fibers; visceral and somatic systems
Output: thalamus, hypothalamus, basal forebrain, cortex |
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When ARAS is stimulated, what happens?
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You stimulate thalamocortical projections and are aroused
Basically, you're awake |
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What neurotransmitters are associated with ARAS activity?
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Monoamines (NE, 5-HT, Histamine)
Cholinergic (ACh) |
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What activity happens in the brain to cause the onset of sleep?
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GABA-ergic "hypnogenic neurons" fire
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Where are the GABA-ergic "hypnogenic neruons" located?
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Basla forebrain nuclei
Preoptic area of the hypothalamus |
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What changes happen in the ARAS nuclei when the hypogenic neurons fire?
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They have a burst of activity that inhibits the thalamo-cortical cells
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What happens to neurotransmitter levels during NREM sleep?
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Decrease in monoaminergic, cholinergic activity
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What is responsible for the onset of REM sleep during NREM sleep?
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REM-On neurons in the tementum of the pons become active
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What areas of the brain are stimulated with the induction of REM sleep?
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Thalamus
Basal forebrain |
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Where do the REM-On neurons project?
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Thalamus-->EEG desynchronization
Spinal interneurons-->inhibition of alpha motor neurons Reticular formation-->saccadic eye movmeents REM-off neurons of ARAS-->continued inhibition of these guys |
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How is REM sleep terminated?
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REM-off neurons become active and inhibit the REM-on neurons
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What are neurotransmitter levels during REM sleep?
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Decreased monoaminergic
Increased ACH |
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What hormone is responsible for sleep behavior?
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Hypocretin
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What is the activity of hypocretin?
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Stimlate REM-off cells-->inhibit REM sleep
They promote wakefulness, stimulate feeding, motor activity |
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Where is hypocretin produced in the brain?
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Hypothalamus
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Where do hypocretin cells project?
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All over the place, including the raphe nuclei
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What are the two processes involved in sleep?
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Process S: time since last asleep
Process C: circadian rhythms |
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What molecule is associated with process S?
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Adenosine
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What things regulate the circadian rhythm?
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Intrinsic clocks
External cues |
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What molecular mechanisms are responsible for the circadian rhythms?
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Patterns of gene expression
Proteins binding to their own promoters to have cyclic expression patterns (CLK, PER/TIM) |
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What nucleus in the brain controls the circadian rhythm?
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Suprachiasmatic nucleus
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What give input to the SCN?
Where does it send outputs? |
Inputs: the retina (specialized gangliion cells)
Outputs: Pineal gland-->melatonin secretion |
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What are the neurotransmitters associated with arousal?
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Monoamines: serotonin, norepinephrine, serotonin, dopamine, histamine
ACH Glutamate Hypocretin |
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What nuclei are the following neurotransmitters associated with:
Serotonin? NE? ACh? Dopamine? Glutamate? Histamine? Hypocretin? |
Serotonin: raphe nuclei
NE: Locus coeruleus ACh: basal forebrain Dopamine: ventral tegmentum Glutamate: thalamus Histamine: hypothalamus Hypocretin: hypothalamus |
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What are some NTs associated with sleep promotion?
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GABA
Melatonin (released by the pineal gland to regulate cycle C) Adeonsine (involved in process S) |
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What are some of the different kinds of sleep disorders?
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Insomnias
Sleep-related breathing disorders Hypoersomnias not due to breathing problems Circadian rhythm sleep disorders Parasomnias Sleep-related movement disorders Other |
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What is the cause of obstructive sleep apnea?
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Anatomically, the airway is blocked during sleep
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What is the pattern of activity during sleep apnea?
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Occlusion-->ventilation stops-->Oxygen saturation falls-->awake briefly-->activate pharyngeal muscles-->sleep
As a result, you don't sleep well at all. |
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What other health issues is obstructive sleep apnea associated with?
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CV disease
Stroke Sleepiness |
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What type of people are particularly vulnerable to sleep apnea?
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Obese people
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What is the treatment for obstructive sleep apnea?
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Continuous positive airway pressure
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What are the four cardinal features of narcolepsy?
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Excessive daytime smnolence
Cataplexy: sudden loss of postural tone Sleep paralysis: atonia at sleep onset/immediately upon wakening Hypnagogic hallucinations (vivid dream-like experiences at sleep onset/on awakening) |
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What test can you do to test for narcolepsy?
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Multiple sleep latency test: see how long it takes someone to fall asleep over 5 nap periods
In narcoleptics, it's always less than 5 minutes. |
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What are some different things that can provoke cataplexy?
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Emotion, especially laughter
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What muscles are effected by cataplexy?
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All striated muscles
Not eye movements, respiration |
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What hormone is deficient in human narcolepsy?
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Hypocretin
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What brain centers have hypocretin?
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Lateral hypothalamus
In narcolepsy, this palce doesn't have any hypocretin |
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What are some drugs that you can give to manage narcolepsy's daytime somnolence?
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Modafinil, armodafinil
Dextroamphetamine Methylphenidate Gamma-hydroxybutyrate (date rate drug) |
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What are the drugs that you can give to manage cataplexy?
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Tricyclic antidepresants
Gamma hydroxybutyrate |
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What are some disorders that cause sleep onset delay?
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Psychophsyiologic insomnia
Delayed sleep phase syndrome |
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Why is psychophysiologic insomnia so terrible?
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It's a cycle, right.
You have a trigger (stress, etc.) that causes you to be unable to get to sleep. You can't fall asleep and you're laying in your bed, and eventually associate your bedroom with being unable to sleep. |
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What are some of the circadian rhythm disorders?
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Delayed sleep phase shyndrome: falling asleep at 4 (can't fall asleep earlier)
Advanced sleep phase syndrome: falling asleep at 5 Jet lag Shift work |
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What protein is mutated in circadian rhythm disorders?
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Per2: a casein-kinase binding doman
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What are the common causes of problems with early morning arousal?
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Depression
Psychophysiologic (like psychophsiologic sleep onset delay) Advanced sleep phase syndrome |
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What are some of the treatments for insomnia?
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CBT
Benzodiazepines, non-BZD receptor agonists Melatonin agonists |
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What are some examples of parasomnias?
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REM:
-REM sleep behavior disorders -Nightmares Non-REM: Night terrors Confusional arousals Sleep walking/talking Periodic limb movements Misc. |
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What kinds of people are at risk for REM sleep behavior disorder?
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Males
Old People with synucleopathies (Parkinson's, MSA, DLB) |
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What is the treatment for REM sleep behavior disorder?
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1. Clonazepam
2. Melatonin, donepezil, dopamine agonist |
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What are the characteristics of sleep terrors?
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Non-rem
Intense autonomic arousal In kids, no psychological reason. In adults, yes More common in males than in females |
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When does sleepwalking/talking occur?
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First third of the night, Non-REM sleep
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Who sleepwalks?
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Children 4-6
People with a family history |
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What's the medical management of sleepwalking/talking?
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BZDs
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What is restless leg syndrome?
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Creeping, crawling sensation on the feet that's associated with a desire to move the legs
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Who gets restless leg syndrome?
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People with anemia, renal failure
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When does restless leg syndrome occur?
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When lying/sitting
It gets worse at night |
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What's the relationship between periodic limb movement and restless legs syndrome?
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80-90% of people with restless leg syndrome have periodic limb movements of sleep
Very few people with periodic limb movements have restless legs syndrome |
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What's the treatment for restless legs syndrome and periodic limb movemnets?
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Levodopa
Dopamine agonists Clonazepam Gabapentin |
