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Medicine > Sleep > Flashcards

Sleep Flashcards

1
Q

how is sleep described in relation to consciousness

A
  1. easily reversible state of inactivity with a
  2. lack of interaction with the environment
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2
Q

what can unconsciousness be

A

coma (depressed state of neural activity)
sleep (VARIATION in neural activity)

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3
Q

what are the three states of consciousness

A
  1. wakefulness (alert, detect object and pays attention)
  2. core consciousness (wakefulness and emotional responses, simple memory)
  3. extended consciousness (all plus self awareness, autobiog memory, language and creativity)
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4
Q

what are some suggested functions of sleep

A

processing, storage of memories
recuperation of bodies immune system
conserve energy

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5
Q

does the sleeping brain consume oxygen

A

yes

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6
Q

what are the two main forms of externally discernable sleep

A

REM (rapid eye movement side to side)
non REM

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7
Q

how do you measure neuronal activity

A

EEG
electroencephalogram

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8
Q

how does the EEG work

A

post synaptic activity of SYNCHRONISED DENDRITIC ACTIVITY can be picked up
-individual neurons cannot

EEG electrode is connected to an amplifier EEG
read through layers to cells in cortex

only detect massive synchronised depolarisation- causes BIGGER DEFLECTION

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9
Q

how do you get synchronisation

A

either by neuronal interconnections or by pacemaker
the more neurons that are synchronised, the bigger the peaks on the EEG

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10
Q

are the neurons active during sleep

A

yes
sleeping brain consumes oxygen as much as wakeful brain

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11
Q

why do you get small and rapid depolarisations on EEG

A

brain working-not much synchronisation
lots of individual AP flying around
doing their own thing
lots of sparks
coincidence if depolarising at the same time
therefore small and rapid movements of trace

become synchronised during sleep
induced by pacemaker

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11
Q

why do you get small and rapid depolarisations on EEG

A

brain working-not much synchronisation
lots of individual AP flying around
doing their own thing
lots of sparks
coincidence if depolarising at the same time
therefore small and rapid movements of trace

become synchronised during sleep
induced by pacemaker

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12
Q

how is the EEG arranged
and how does it work

A

19 (+) pairs
at internationally agreed points on the surface of the head.

comparison between the pairs provides a coarse picture of the neuronal activity in various areas

separate different stages of sleep (REM and non REM) and further 4 stages

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13
Q

what are the EEG defined stages of sleep
and how many cycles in one sleep

A

AWAKE
STAGE 1
STAGE 2
STAGE 3
STAGE 4
REM

repeat around 5 REM sleeps per night
drowsy to deep sleep takes about 1 hour
minimum time between REM sleep about 30 mins

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14
Q

what are the EEG defined stages of sleep
and how many cycles in one sleep

A

AWAKE
STAGE 1
STAGE 2
STAGE 3
STAGE 4
REM

repeat around 5 REM sleeps per night
drowsy to deep sleep takes about 1 hour
minimum time between REM sleep about 30 mins

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15
Q

describe the awake stage

A

eyes closed ALPHA high frequency
eyes open BETA waves

high frequency and lower amplitude waves

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15
Q

describe the awake stage

A

eyes closed ALPHA high frequency
eyes open BETA waves

high frequency and lower amplitude waves

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16
Q

describe stage 1

A

THETA waves

easily roused
slow rolling eye movements

high amplitude
slower frequency

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17
Q

describe stage 2

A

Begin K complexes
fairly fast firing
high amplitude

some bursts of activity of synchronisation
no eye movement but body movements remain possible

SPINDLES- prelude to deep sleep
harder to rouse

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18
Q

describe stage 3

A

slower frequency DELTA waves

harder to rouse
few spindles
not regular
increased synchronisation

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19
Q

describe stage 4

A

biggest amplitude
biggest entrainment

deepest sleep and hardest to arouse
DELTA waves
lower heart rate and blood pressure
movement 15-30 min period

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20
Q

describe REM sleep

A

fast BETA waves and REM

easier to rouse than in stage 4
almost awake state
DREAMING-brain become very active
low muscle tone (very floppy- no movement)
if woke up from this you will remember dream you had

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21
Q

what controls the passage of stages

A

reticular formation (brainstem)
PINEAL GLAND— allows us to have a diurnal rhythm

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22
Q

describe the sequence of the thalamus on brain waves

A

during day

reticular formation EXCITED
causes depolarisation
to thalamus (stays depolarised and active)
–non rhythmic output
INCREASED AROUSAL (alpha and beta waves)

sleep hygiene pattern kicks in/tired

reticular formation inhibited
hyperpolarise the thalamus
produce rhythmic output
slow EEG waves in cerebral cortex
–slow waves

23
Q

what is the broad definition of epilepsy

A

continuing tendency to have RECURRENT, UNPROVOKED SEIZURES

rare risk of sudden death SUDEP

24
Q

what are sleep spindles

A

characterisation on NREM
found with k complexes in STAGE 2

24
Q

what are sleep spindles

A

characterisation on NREM
found with k complexes in STAGE 2

25
Q

what may cause SUDEP

A

probs from electrical disruption in heart -AF - heart attack

26
Q

how do you diagnose epilepsy

A

EEG- INTERICTAL period between seizures there are still characterisitcs of some types of epileipsy
history taking important (including from observers)

27
Q

what are some relevant features of epilepsy

A

PRE- aura/ warning/ fear/ deja vu
abnormal movements (lip smacking, patting, stroking)
POST- memory loss, confusion, headache
wounds/ scares? from falls
usually interictal exam is normal

28
Q

what are the classification of epileptic seizures

A

FOCAL
-focal aware
-focal unaware

can develop into->

GENERALISED
-absence- typical/atypical
-myoclonic
-clonic
-tonic
-clonic-tonic
-atonic

UNCLASSIFIED

29
Q

what are focal aware seizures

A

consciousness is preserved in positive or negative symptoms
symptoms are related to AREA AFFECTED IN BRAIN
person is aware

30
Q

what can focal aware symptoms include

A

PRIMARY MOTOR CORTEX
-simple clonic movements

PREMOTOR AREAS
-elaborate motor output

VISUAL ASSOCIATION
-faces or complex scenes

OCCIPITAL LOBE
-contralateral visual hallucinations

AUDITORY CORTEX
-roaring or underwater hearing

ASSOCIATIVE AUDITORY CORTEX
-music

TEMPORAL
-visceral discomfort, odour, anxiety, fear

ALL OFTEN preceded by an AURA
- can progress to generalised seizures

31
Q

what is a focal unaware seizure

A

there can be impairment of consciousness - can’t tell you about particular symptoms

1-2 mins
start w aura
unresponsiveness
automatisms
autonomic responses (tachy, pupil dilation)
post ictal headache then confusion

can evolve into generalised seizures
auras then seen as prelude

32
Q

what is the most common type of focal unaware seizure

A

TEMPORAL (40%)
damage to hippocampus pyramidal cells (long processes- easy to damage)
if small stroke/physical damage
get scar tissue which acts a focus for origin of seizure

33
Q

what are absent generalised seziures
PETIT MAL

A

most typical:
short period
sudden
abrupt cessation
may be associated with mild clonic jerking of eyelids
no recollection

atypical:
loss of posture
autonomic phenomena
automatisms
characteristic 2.5-3.5 Hz spike and wave pattern

DIFFERANCE FROM FOCAL UNAWARE– second is LONGER

34
Q

what are generalised seizures

A

both hemispheres affected
manifestations of seizure are determined by cortical site at which seizure arises

present in 40% of al epileptic syndromes

ALWAYS alteration to consciousness

35
Q

what are myoclonic seizures

A

myoclonic jerking
-treated differently depending on type

IF GENERALISED different medication for juveniles
not focal leading to generalised

36
Q

what are atonic seizures

A

sudden loss of postural tone
most often in children- rare

37
Q

what are tonic clonic seizures
GRAND MAL

A

major convulsions with rigidity and jerking
slows over 60-120 sec followed by stuporous state (post ictal depression)

38
Q

what drug should you not give juveniles if they are having a myoclonic seizure (generalised)

A

CARBAMAZEPINE

39
Q

what is status epilepticus

A

more than 30 mins of continuous seizure
two or more sequential seizures spanning without recovery between seizures
med emergency

tonic-clonic cycle
may also already have heart problems

40
Q

are all seizures epilieptic

A

no
can be caused by:
withdrawal
diabetic instability
blow to head

41
Q

what non-invasive tests can you use to support a diagnosis of a seizure

A

ECG - check for abnormal cardiac problems- SUDEP, arrhythmias, athersclerosis

EEG- interictal EEG
—- INTERICTAL EPILEIPTFORM ACTIVITY

CT- looking for brain shrinkage, brain not formed properly- focal areas where seizures may have started

MRI- scarring, reduced perfusion (fmri), dysplasia, cortex damage
RESOLUTION BETTER

42
Q

What is interictal epileptiform activity

A

large electrophysiological events observed between seizures in patients with epilepsy.
characteristic waves and spikes to predict type of epilepsy

43
Q

what are attack triggers and pre-disposition of epilepsy

A

PRE-DISPOSITION
-scar tissue
-developmental issues
-pyramidal cell damage
-sub-optimal regulation of neuronal excitability

DISEASE
-tumours

TRIGGERS
-tired
-alcohol
-drugs (anti-depres)
change of meds

44
Q

what do anti- epileptic dugs (AED) do

A

decreases frequency/ severity of seizures in people with epilepsy

treat SYMPTOMS, not cause

GOAL– max QofL by minimising seizures and adverse drug effects

45
Q

what are the targets for AED

A

suppress excitatory NT- inhibit Na VOLTAGE DEPENDENT system/ Ca– RAPID DEPOLARISATION IS SUPPRESSED

enhance inhibitory NT system-GABA

increase outward positive K

many are PLEIOTROPIC

46
Q

what does pleiotropic mean

A

they act via multiple mechanisms

47
Q

what AEDs act primarily on Na channels

A

PHENYTOIN, CARBAMAZEPINE
-block voltage dep sodium channels at high firing freq
but reduce efficacy of contraceptive pill

OXCARBAZEPINE
-blocks volt depen NA at high freq
-also effect K+ channels
pleiotropic effect

ZONISAMIDE
-blocks volt-depen Na channels and T-type Ca channel

LAMOTRIGINE
-inhibit voltage sensitive Na channels
-best starting drug

48
Q

what drug do you only use for absence generalised seizures

A

ETHOSUXIMIDE

49
Q

what is an issue with sodium valproate

A

can be teratogenic

50
Q

what is an issue with carbamazepine

A

enzyme inducing effects- many interactions

51
Q

what do both vigabatrin and tiagabine do

A

GABA enhancer

52
Q

what can you use for focal onset and focal leading to generalised

A

carbamazepine
lamotrigine
oxcarbazepine
sodium valproate
levetiracetam

53
Q

what should you use for generalised seizures

A

valproic avid
lamotrigine
topiramate

54
Q

what treatment can you use for status epilepticus

A

diazepam, lorazapam intra veinous (fact acting)
- GABA agonist

then
phenytoin, phenobarbital when there is contorl

55
Q

what is satus epilepticus

A

more than 30 mins of continuous seizure activity
two + sequential seizures spanning this period with no full recovery between
med emergency

Medicine (54 decks)

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