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Sleep medicine > Sleep Wake Mechanisms and Neurophysiology > Flashcards

Sleep Wake Mechanisms and Neurophysiology Flashcards

1
Q

Acetylcholine is produced from where?

A

Cholinergic neurons in the pedunculopontine tegmental and laterodorsal tegmental nuclei

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2
Q

2 neurotransmitters that are involved in sleep promotion

A

Gamma-aminobutyric acid (GABA) and galanin (GAL) from the VLPO

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3
Q

Pathways of the arousal system reach the cerebral cortex through what structures?

A

Thalamus, hypothalamus and basal forebrain

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4
Q

What class are both caffeine and theophylline and how do they work?

A

Xanthines

Adenosine receptor antagonists

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5
Q

What effect does an acute infection have on REM, N3 and NREM sleep?

A

Increased NREM

Increased N3

Decreased REM

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6
Q

What causes the inability to move in sleep paralysis?

A

Inhibition of motor neurons in the spine by glycinergic and GABAergic mechanisms from the sublateraldorsal nucleus (dorsal pons)

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7
Q

Where is NE produced?

A

Ventrolateral medulla and locus coeruleus (dorsal wall of the rostral pons in the lateral floor of the fourth ventricle)

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8
Q

Where is acetylcholine produced?

A

Pedunculopontine and laterodorsal tegmental nuclei (PPT/LDT)

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9
Q

Where is serotonin produced?

A

Dorsal raphe necleus (DR) located in the dorsal midbrain

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10
Q

Where is dopamine produced (when involved in wakefulness)?

A

Ventral periaqueductal gray matter (vPAG) located in the midbrain

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11
Q

Where is histamine produced?

A

Tuberomammillary nucleus (TMN)

(posterior hypothalamus)

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12
Q

Where is orexin (hypocretin) produced?

A

Lateral and posterior hypothalamus

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13
Q

Where is the VLPO located?

A

Anterior hypothalamus

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14
Q

What neurotransmitters do the VLPO cells produce?

A

Inhibitory GABA and GAL

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15
Q

How does the sleep switch work?

A

VLPO blocks input to the ARAS. The ARAS inhibits the VLPO

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16
Q

What are the 6 cytokines that promote sleep?

A
  • Interleukin 1ß
  • IL-6
  • TNF alpha
  • Nerve growth factor
  • BDNF
  • GHRF
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17
Q

How does GABA promote sleep?

A

It inhibits neurons containing:

  • NE
  • Histamine
  • Serotonin
  • Hypocretin
  • Glutamate
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18
Q

What are the effects of alcohol on sleep?

A
  • Disrupts sleep
  • Shortens LTSO
  • Decreases REM
  • Increases snoring and apnea
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19
Q

Antidepressants that increase REM sleep

A

Buproprion

Nefazodone

Trazodone

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20
Q

Antidepressants that don’t worsen RLS

A

Buprioprion

Trazodone

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21
Q

Most powerful REM suppressing antidepressant class

A

MAOIs (selegiline, tranylcylpromine)

22
Q

What antidepressant can increase eye movements in sleep?

A

Prozac (fluoxetine)

  • Increased eye movements in NREM
    • Can be slow rolling or REMs
    • “Prozac eyes”
    • Any SSRI can do this
    • Thought to be a mild form of serotonin syndrome
23
Q

What effect do most antidepressants have on REM sleep?

A

Decrease REM sleep

Prolong REM latency

24
Q

What are the general effects of antipsychotics on sleep?

A

Increased sedation

Improve sleep continuity

May slightly increase REM sleep

25
Q

Sleep effects of corticosteroids

A

Slight REM suppression

Can disrupt sleep and cause bizarre dreams

26
Q

Sleep effects of Mirtazepine

A

Increased sleep continuity and SWS

Can decrease OSA by improving upper airway tone but this is offset by weight gain

27
Q

Sleep effects of opiates

A

Sedation

Can disrupt sleep and reduce REM

Central apneas

28
Q

Sleep effects of benzodiazepines

A

Suppress N3 and REM

Increase N2 sleep and spindle density

non benzodiazepine receptor agonists (zolpidem) have little effect on sleep architecture (except at high doses)

29
Q

Sleep effect of amphetamines and cocaine

A

Suppress REM sleep

30
Q

Sleep effects of THC

A

Increases TST and N3

Mild suppression of REM

31
Q

What effect do SSRIs have on N3 sleep?

A

Either decrease or no effect on N3 sleep

32
Q

What effect do TCAs have on N3 sleep?

  • amitryptiline
  • nortriptyline
  • doxepin
A

They increase N3 sleep

33
Q

What effect does nefazodone have on N3 sleep?

A

It decreases N3 sleep

34
Q

What effect does lithium have on N3 sleep?

A

It increases N3 sleep

35
Q

What effect does carbamazepine have on N3 sleep?

A

It increases N3 sleep

36
Q

What effect do barbiturates have on REM and N3 sleep?

A

They decrease both

37
Q

What effects does lithium have on sleep?

A
  • Increased TST
  • Decreased N1
  • Increased N2 and N3
  • Increased REM latency
  • Inconsistent effect on REM
38
Q

What does nefazodone do to REM sleep?

A

It increases REM sleep

39
Q

What is the effect of estrogen on sleep?

A
  • Decreased sleep latency
  • Increased TST
  • Shortened REM latency
  • Increased REM sleep
40
Q

What are the effect of progesterone on sleep?

A
  • Increased REM latency
  • Decreased REM sleep
41
Q

What happens to acetylcholine, NE and serotonin during REM sleep?

A
  • Acetylcholine increases
  • NE and serotonin decrease
  • (opposite happens in NREM sleep)
42
Q

What effect does prostaglandin D2 have on sleep_

A

Strongly sleep promoting. An increase during sleep deprivation is necessary for NREM rebound

43
Q

Cholinergic activity is at its highest during what 2 states?

A

Wake and REM sleep

44
Q

Sodium oxybate acts on what receptor?

A

GABA-B

45
Q

Benzos, barbiturates, alcohol and non benzo-receptor agonists act on what receptor?

A

GABA A

46
Q

What are the medications (classes) that suppress REM sleep (7)?

A
  • TCAs (amitriptyline, etc)
    • One exception is trimipramine
  • MAOIs (phenelzine, selegiline)
  • Lithium
  • Scopalamine
  • Serotonergic drugs
  • Sympatholytic drugs (clonidine, phentolamine, beta blockers)
  • Stimulants like methylphenidate
47
Q

What effect does pregabalin have on SWS and REM sleep?

A

It increases SWS but decreases REM sleep

48
Q

What receptor does gabapentin and pregabalin bind to?

A

The alpha 2 delta subunit of the VGCC

49
Q

What SSRI can decrease both SWS and REM?

A

Fluoxetine

50
Q

RBD is how many times more likely to develop in patients taking antidepressants and patients with psychiatric disorders?

A
  • Anti-depressants = 5x more likely
  • psychiatric disorder = 10x more likely

Sleep medicine (21 decks)

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