Sleep Flashcards

1
Q

What is consciousness?

A

A state of self-awareness, perception,

ability to respond to stimuli, ability to act with

judgement

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2
Q

What is ‘sleep’?

A

is a state of changed consciousness from which

a person can be aroused by stimulation, alternating in

a 24-hour cycle (circadian rhythm) with wakefulness

• Sleep is a physiological state

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3
Q

What is ‘coma’?

A

A state of profound unconsciousness

characterised by inability to sense and respond to

external stimuli and loss of sleep-wake-cycle

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4
Q

What assessment tool do we use to determine level of consciousness?

A

Glasgow Scale

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5
Q

What are the causes of coma? How long does it last?

A

Causes: Intoxication, acute neurologic injuries, metabolic

disorders, CNS infection, stroke, hypoxia

Duration: Generally few days to few weeks (2 - 5 weeks). Some

patients progress to a vegetative state or die.

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6
Q

What is a ‘persistant vegetative state’?

A

A state of unconsiousness in patients with severe brain injury.

Frequently observed in patients in whom coma has progressed to a

certain state of wakefulness (e.g. sleep-wake cycles, open eyes)

without detectable awareness (unresponsive to external stimuli

except possibly pain)

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7
Q

What is ‘brain death ‘?

A

Irreversible coma, characterised by lack of brain activity. Loss of

pain responses and cranial nerve reflexes (pupillary response

(fixed pupils), corneal reflex), loss of spontaneous respiration.

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8
Q

what are four types of biologcial rhythms?

A

•Circannual rhythm

Infradian rhtyhms

Menstrual cycle

•Circadian rhythms

Sleep/wakefulness cycles

Hormone secretion (e.g. cortisol)

Body temperature

  • Circannual rhythm
  • Infradian rhtyhms

Menstrual cycle

•Circadian rhythms

Sleep/wakefulness cycles

Hormone secretion (e.g. cortisol)

Body temperature

•Ultradian rhythmys

REM/NREM cycles

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9
Q

where is Melatonin produced?

A

in the Pineal Gland in the brain - helps to induce sleep - higher production in winter when nights are longer, brain uses the duration of melatonin secretion to adjust to seasonal variations/travel

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10
Q

what are the stages of sleep?

A

Slow Wave Sleep (NREM) = stages 1,2,3,4 - autonomic stability HR BP and temperature fall

Rapid Eey movement (REM)= autonomic instability HR, BP and Temp vary- recall dreaming

90 min. cycles - repeated 5-6 times per night

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11
Q

What does an EEG record?

A

Changes in frequency

  • Changes in amplitude
  • Changes in synchronisation
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12
Q

What tool measures eye movements?

A

Eye movements

  • Electroculograph (EOG)
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13
Q

what is the difference in EEG reading between awake with eyes open and awake with eyes closed?

A
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14
Q

Describe the first stage of sleep

A

Light sleep, lasts for a few minutes

  • Easily awakened
  • Slow eye movements (rolling)
  • Muscle activity slows down
  • EEG: Theta waves (high amplitude, low frequency)

Occasional a waves

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15
Q

Describe the second stage of sleep

A
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16
Q

Describe the 3rd and 4th sleep stages

A
17
Q

What would you see on EEG, EMG and EOG during REM sleep?

A

•EEG: fast, small amplitude like wakefulness

but behaviourally asleep, difficult to

arouse, associated with dreaming

  • EMG: hypotonicity or flaccidity
  • EOG: rapid eye movements
18
Q

what are the benefits of sleep?

A

Improves cognitive ability

• Solidifies memory (in particular SWS: ‘declarative

memory’- ‘What we know’)

  • Processes and repackages newly learned lessons
  • Increases decision-making skills
  • “Eraser” theory- get rid of the things you don’t need and retain what you do need
19
Q

what are the benefits of sleep on the periphery?

A

Sleep deprivation is lethal in animal models

• Sleep loss increases blood pressure, increases heart rate,

disrupts glucose metabolism, and increases obesity

• During NREM/slow wave sleep, growth hormone is secreted,

in particular in the “healing and repair” period between 10pm

and 2am

  • Sleep improves infections, cytokines can induce sleep
  • (Only 10 % - 20 % energy saving)
20
Q

REM sleep is particularly important for what aspect of consciousness?

A

REM appears to play a major role in benefits of sleep

with respect to learning, organising information, and

decision making (‘procedural memory’ – ‘How’)

Reduction in REM occurs during shortened sleep

periods

•Reduction in REM occurs when consuming alcohol or

nicotine or in response to certain medications (antidepressants,

anxiolytics)

21
Q

The REM/NREM cycle is controlled by what?

A

reticular formation

22
Q

What controls the sleep/wake cycle?

A

The suprachiasmatic nucleus

23
Q

describe the neuronal pathways in wakefulness (arousal_

A

Wakefulness with activation of cerebral cortex is maintained

by activity in two ascending systems of reticular formation /

brainstem neurones contributing to the reticular activating

system (RAS)

  • neurones which synthesise acetylcholine
  • neurones which synthesise monoamines

(noradrenaline, serotonin, histamine

24
Q

describe what happens during NREM slow wave sleep to the neuronal activity?

A

neuronal activity in both cholinergic and

monoaminergic pathways slows down

• Excitatory glutamatergic neurons that

inhibit REM sleep and promote NREM

sleep.

25
Q

describe the neuronal changes during REM sleep

A

cholinergic neurones fire rapidly

• monoaminergic neurones stop firing

26
Q

What is the job of the suprachiasmatic nucleus in the hypothalamus?

A

input signals from retina

links to light/night/day cycle

• ablation of SCN eliminates

sleep/wake cycle

• SCN signals to pineal gland

that produces melatonin, as

well as other brain structures

27
Q

What is EDS?

A

EDS is defined as a difficulty maintaining wakefulness

and an increased likelihood of falling asleep in

unsuitable situation

•EDS can be a symptom of a medical condition

including sleep disorders and fatigue

28
Q

What is Sleep Apnea?

A

Disorder of interrupted breathing during sleep

• Causes: Brain signal interruption (central, rare) or windpipe

collapse during inhalation (obstructive, common)

  • Airflow is blocked for up to 1 minute
  • Hypoxic CNS initiates breathing
  • Symptoms and consequences: Snoring, EDS, high blood

pressure

• Frequently associated with obesity

29
Q

What is Narcolepsy

A

Excessive daytime sleepiness (EDS)

• Cataplexy (abrupt loss of muscle tone without loss of

awareness)

  • Sleep paralysis (muscle paralysis of sleep)
  • Hypnagogic hallucination
  • High levels of REM