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56 Cards in this Set

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Non-REM?
slow of EEG pattern
a lot of Muscle Tone
No eye movement
What is non-REM?
brain is inactive
body is active
Non-REM STages? 1,2,3,4
6-8 hours sleeping
What wave in EEG and distribution % stage 1?
Tetha Waves

alpha disappears, 5%
Steage 2?
k complexes/sleep spindles
45%
What is the longest stage we sleep in?
Stage 2
When does delta waves happen?
Stage 3 and stage 4
What % of sleep is spent in stage 3?
12%
WHat % of sleep is spent in stage 4?
13%
What is REM?
aroused EEG pattern

Penile Erections

Saccadic Eye Movements (dreaming)

Generalized Muscular ATONY (except middle-ear and eye muscles)
How long do we stay in REM?
25%
What is the slowest waves in sleep?
Delta

Ala-Deltas go real slow
Anothe name for Stage 3,4 sleep?
Delta Sleep

Slow wave sleep

Deepest Stage

Hardest to arouse

Dissapear in the elderly
What is the easiest to wake up?
REM
What two stages do we wake up?
REM
or Stage 2
If you remember your dream what did you wake up in?
REM Stage
What is characteristic of REM throught the night?
the REM stages are longer as the night progresses

gets longer 1st REM 15-20
Last REM 30-40 minutes
Where do you find more rem?
2nd half of the night
What is REM Latency?
From the moment you fall asleep to the 1st REM period

average 90 minutes
What are two things that affect REM latency?
Depression
(shortens 60 min.)

Narcolepsy (start REM after 10 min.)
What is sleep latency?
moment you go to bed to the moment you fall asleep

about 10-15 min.
People with insomnia what happens to sleep latency?
Sleep Latency increases
(longer)
If you are very tired what happens to sleep latency?
shortens

immediately fall asleep
Total sleep time changes w/ age?
baby sleeps 14-16 hours of sleep
Adolescents sleeps 8-10 hours

Elderly 4-5 hours/day

Total sleep time decreases with age
What happens to REM in age?
REM decrease with age

Everything decreases with age
What are the neurotransmitters of sleep?
SAND Mr. Sandman bring us our sleep

Serotonin increase (Initiates Sleep)
Acetylcholine increase (Dreaming REM)
Norepinephrine increases (REM)
Dopamine increase (arousal wakefulness
What Neurotransmitter causes induction of sleep?
Serotonin increase
What neurotransmitter causes REM dreaming?
Acetylcholine and Norepinephrine increase
What neurotransmitter wakes us up/arouses the person from sleep?
Dopamine increase
What is precursor of serotonin?
Tryptophan

(turkey sandwich and milk)

induces sleep
What does bromocriptine in sleep?
Dopamine agonist

sleeping less
it arouses you
wake up sooner
What does Haloperidol do to sleep?
Dopa antagonist

decreases DOPA
causes sleep
What do benzodiazepines do in sleep? What stage do they block?
blocks stage 4

increase sleep latency

can't give benzos more than 2 weeks
What does alcohol intoxication do to sleep?
supresses REM

sleep deprived
What happens w/ barbiturate intoxication and sleep?
supresses REM
When you are in withdrawal for barbiturate/alcohol?
REM Rebound

dream more
What happens w/ major depression and REM?
1st rem starts sooner at 60 min.
also longer 1st REM

suppresion of DELTA
no 3,4 stages

early morning awakening
What is narcolepsy?
Patient that falls asleep suddenly

licence suspended

falls asleep when talking to friends
When question says he feels refreshed when awakening?
clue for narcolepsy
Narcolepsy has 4 things associated with it?
1) sleep attack
2) cataplexy (pathognomonic)
3) hallucinations
hypogogic and hypnopompic
4)Sleep Paralysis (cant' move)

G gogic going to sleep
P waking uPPP!
What is cataplexy?
sudden loss of muscle tone

vs. syncope (no loss of consciousness)
Theory behind cataplexy?
enter REM

falls to ground

What triggers it
1) loud noise
2) stress
What is the tx of narcolepsy?
1)Amphetamine
Psycho-stimulants

2) TCAs
REM suppressants

3) Gets forced naps during day
How do you repressed cataplexy in narcolepsy?
TCAs

tricyclics
What are the three clues to sleep apnea?
overweight

pat. snores

feels tired all day

Wife complains about too mnay
What is Sleep Apnea defined as?
Sensation of breathing for more than 10 seconds

pathologic >5 episodes an hour
>30 episodes during the night

usually more than 300 episodes
What is apnea associated with?
depression
mood changes
daytime sleepiness

wife complains of restlessness
pat. complains of dry mouth, dry throat in the morning
headaches in morning, hypoxemia, Pulm. hypertension
What are the 3 types of sleep apnea?
1) Obstructive
2) Central
3) Mixed
What is the MC sleep apnea?
Obstructive
What is central sleep apnea?
muscle atonia in oropharynx: nasal, tongue, or tonsil obstruction
What is central sleep apnea involved in?
Lack of respiratory effort
Tx of sleep apnea?
sleep w/ a mask
O2
PEEP

surgical correction
Pat. 70yo man trouble sleeping? 7p.m. wake up at 3:00a.m.
Tell patient to go to bed later

not insomnia
What is the MC prescription of the elderly?
Benzodiazepines

don't give, makes them more confused
What triggers insomnia?
anxiety
depression
nervousness
What is stimulus control?
You only use the bed for sleeping