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Flashcards in 20 Sleep respiration Deck (23):
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Sleep waveforms

Stage 1- relatively disordered- some theta waves (2-8%)
Stage 2- sleep spindles(quick oscillation) and K complexes (large waves) (45-55%)
Stage 3,4- Synchronus wave pattern (13-23%)
REM- Disorganized with areas of saw tooth waves (20-25%)

1

Sleep architecture

Usually 2 cycles to stage 4, then 1 to stage 3, then a few stage 2

2

Sleep control

Process H/S- buildup of need for sleep
Process C- Alertness signaling that increases until sleep (circadian)

3

Circadian clock

Located in SCN
Reset with photoperiod

4

Sleep promoting factors

Cytokines (flu)
Prostaglandin D2
Adenosine
Serotonin
ACH

5

Wake promoting factors

Epi
NE
Histamine
Serotonin

6

NREM vs. REM sleep CNS activation and blood flow

NREM
-Low discharge rate
-Glucose utilization decreased

Rem
- Increase in mean discharge of neurons
-Glucose utilization increased- resembles waking
-cerebral blood flow increased

7

REM vs. NREM somatic activity

NREM-
- repositioning and light motor events

REM
-Paralysis (postsynaptic inhibition through hyperpolarization)
-Phasic eye movements and muscle twitches

8

Brreathing in sleep

*Periodic breathing in stages 1 and 2
* Regular breathing stage 3-4
*REM Irregular breathing - paradoxical

9

Additional sleep tidbits

GH increases 90 inutes after sleep onset- slp. deprav. dec. GH
Parathyroid increased during sleep
ACTH deccreases n sleep onset (dec cortisol) increases before wakening.
BODY TEMP- set point lower with NREM, and unregulated in REM

10

Sleep diaries

Make a patient do one of these before bringing them into the lab

Record sleep times
naps
waking
work
etc.

11

Actinography

Movement sensor (though not reliable in insomnia as patients tend to lie very quietly

12

Multiple sleep latency test

*20 minute opportunities to nap every two hours (5 sessions)
*measure time from lights out to sleep
*Pathological sleep is less than 8 min (normal >10)
* More than one REM is abnormal

13

Obstructive sleep apnea affect on heart and BP

* Obstruction causes negative intrathoracic pressure- overfill RV, underfill LV (CO can drop by as much as 25%)

*Decreased CO increases sympathetic tone, and spikes BP after opening of airways

14

Cheyne Stokes respiration

Apnea followed by crescendo-decrescendo effort and breathing
*blunted pCO2 response secondary to low perfusion
*increased response of lung receptors causes overshoot and hypercapnea

Treat heart failure regamin and then CPAP- CPAP decreases lung overshoot and helps remiss the cheyne stokes

15

Sleep latency

10-12 Normal
Below 8 - resident or Sleep apnea
below 6- idiopathic hypersomnia
below 4- narcolepsy

16

Narcolepsy

Environmental and Genetic
Maybe trauma, antigen binding, sleep depravation
*Hypocretin cell loss
Basically screws up hypothalamic sleep control ( cant stay away or stay asleep)
*REM intrusion into wakefulness- paralysis/cataplexy and dreaming while awake

17

Periodic movement disorder

Withdraw reflex overactive- hyperactive limb movements causing sleep disturbances.
*RLS
*Neuropathy
*Medications/ withdrawl

18

Non 24 hour sleep disorder

*Retnally blind at risk
*treat with melatonin

19

REM behavior disorder

No paralysis in REM sleep

20

Night terror

Abnormal arousal from slow wave sleep- related to sleep walking
*Only partially awake
*little or no dream recall
*frequently goes back to sleep
*racing heart, thrashing, screaming.

21

NREM parasomnias

Sleep walking
Sleep talking
Sleep eating
Confusional arousal
Night terrors

22

REM

Nightmares
Sleep paralyss
REM behavior disorder