8: Sleep Health Science and Interventions Flashcards
In order to readjust the circadian rhythm after traveling several time zones to the west, the process of entrainment is best accomplished by:
A) Sleeping an extra hour a day for the next few days.
B) Eating a large, carbohydrate-based meal immediately before the new ideal sleep time.
C) Exposing oneself to blue light prior to the new ideal sleep time.
D) Taking melatonin (1 mg sublingual) one hour before the new ideal sleep time.
E) Warming the air temperature prior to the new ideal sleep time.
D. Taking melatonin (1 mg sublingual) one hour before the new ideal sleep time.
Melatonin may help with entrainment. The other responses would all contribute to a delay of sleep onset at the new ideal time.
Unhealthy sleep is best characterized as:
A) A rise in melatonin during the first four hours of sleep.
B) A cortisol spike during the first four hours of sleep.
C) A drop in core body temperature during the first four hours of sleep.
D) Slow waves on the EEG during the first four hours of sleep
E) Decreased blood pressure during the first four hours of sleep.
B. A cortisol spike during the first four hours of sleep.
With healthy sleep, cortisol spikes upon awakening, not during the first four hours of sleep. The remaining answers characterize normal sleep during the initial hours of sleep.
A patient with a sleep disorder who snores loudly, is obese, has hypertension and is not responding well to first line medication most likely has a diagnosis of:
A) Behaviorally Induced Insufficient Sleep Syndrome (BIISS)
B) Chronic insomnia
C) Obstructive sleep apnea
D) Restless leg syndrome
E) Secondary insomnia
C. Obstructive sleep apnea.
The patient profile best fits obstructive sleep apnea
Which of the following actions would most likely contribute to a sleep disorder?
A) Drinking three cups of coffee every morning.
B) Taking a 30-minute nap after lunch each day.
C) Drinking a glass of red wine with dinner each evening.
D) Consuming a low carbohydrate dinner each evening.
E) Watching television in bed while falling asleep each night.
E. Watching television in bed while falling asleep each night.
Watching television exposes people to blue light, which contributes to a delay of the onset of sleep.
An overweight medical student presents with anxiety, depression and difficulty sleeping. He consumes caffeine and snacks to stay alert so that he can study late at night. He tries to catch up on sleep during the weekend. This patient most likely has a diagnosis of:
A) Behaviorally Induced Insufficient Sleep Syndrome (BIISS)
B) Chronic insomnia
C) Obstructive sleep apnea
D) Restless leg syndrome
E) Secondary insomnia
A. Behaviorally Induced Insufficient Sleep Syndrome (BIISS).
The patient profile best fits BIISS: A chronic, voluntary sleep restriction that commonly causes excessive daytime sleepiness and daytime fatigue.
A 50-year-old office worker comes to you complaining of fatigue. She has trouble getting up in the morning, so she drinks two cups of coffee to start her day. Then she has difficulty staying alert in the afternoon, so she has another cup of coffee. She gets home late, so she has a late dinner with a glass of wine to relax. She then has trouble getting to sleep, so she stays up watching TV and falls asleep in her chair. She comes to you for advice. You would be correct to recommend which of the following?
A) Eliminate daytime caffeine, and eliminate evening alcohol within two hours of bedtime.
B) Shift meals that have a higher concentration of carbohydrates to earlier in the day.
C) Eat higher sodium foods in the evening to help promote vasodilation.
D) Dim lights 15 minutes prior to bedtime to help promote relaxation.
E) All of the above.
B. Shift meals that have a higher concentration of carbohydrates to earlier in the day.
Eliminate daytime caffeine, but eliminate alcohol within three hours of bedtime. Avoid high sodium foods as they restrict vasodilation. Dim lights 30 to 60 minutes prior to bedtime.
A 60-year-old woman complains to you that she is waking up two hours early most days and can’t get back to sleep. She also feels tired later in the day. You suggest:
A) Shifting breakfast and any caffeine to 15 minutes after her ideal wakeup time.
B) Avoiding any bright lights until 15 minutes before her ideal wakeup time.
C) Going outside for a walk in the sunshine in the late afternoon.
D) Understanding that she is getting older, and this is a common problem with age.
E) All of the above.
C. Going outside for a walk in the sunshine in the late afternoon.
Shift breakfast and any caffeine until 45 minutes after her ideal wakeup time. Avoid any bright lights until her ideal wakeup time. Light in the late afternoon increases melatonin production and will help her sleep cycle.
D is true, but patient may be able to change her lifestyle to help improve her sleep.
A 30-year-old male comes in complaining of decreased concentration at work and wonders if a stimulant would help. He stays up late or gets up early to get work done and gets about six hours of sleep during the week. On the weekend he gets 10 hours of sleep to try and catch up. He doesn’t feel rested during the week or on the weekend. You advise him that his sleep patterns may be more the issue. “Red flags” on the Mini Sleep Assessment you take include:
A) Getting less than seven hours of sleep at a time.
B) One or more hours sleep duration differentiation between the weekday and weekend.
C) Irregular sleep timing.
D) He does not feel he has time for sleep.
E) All of the above.
E. All are correct.
A Mini Sleep Assessment includes asking about typical weekday hours of sleep, typical weekend hours of sleep and perceived sleep quality. In addition to the above, other “red flags” include poor sleep quality despite seven or more hours in bed and getting more than nine hours of sleep.
Describe the correct circadian physiology during the sleep cycle:
A) The steps of sleep initiation include: 1) darkness triggering the pineal gland to secrete melatonin, 2) cutaneous vasodilation 3) extremity warming and 4) cooling of core body temperature.
B) With a continued rise in melatonin, there is a decrease in peripheral skin temperature and continued cooling of core body temperature. The nadir of core body temperature occurs about four hours after sleep onset.
C) Between mid-sleep and awakening, melatonin starts to decrease as does peripheral skin temperature. This is followed by increased core body temperature.
D) A and C
D. A and C
Melatonin and peripheral skin temperature are directly related. B is incorrect because as melatonin increases, so does the peripheral skin temperature.
Which is a correct statement about blue light spectra:
A) Melatonin suppression is less with higher light intensities and increased duration of light exposure
B) Decreases nighttime heart rate, blood pressure and core body temperature.
C) Increases sleepiness.
D) Leads to delayed phase sleep similar to westward travel.
D. Leads to delayed phase sleep similar to westward travel.
Blue light creates greater melatonin suppression at higher intensities and higher durations. It increases nighttime heart rate, blood pressure and core body temperature. Blue light decreases sleepiness. It also leads to delayed phase sleep that is similar to westward travel (e.g., it postpones sleep onset by making the body think it’s earlier than it is).
All of the following statements about sleep duration and quality are true except:
A) Healthy sleep duration and quality are associated with a higher proportion of slow wave sleep and REM sleep.
B) Healthy sleep leads to enhanced learning and memory.
C) Impaired sleep quality leads to increased fear extinguishing and preserved memory of fearful events.
D) PTSD is worse if a person is sleep deprived for the two weeks prior to the event.
C.
Impaired sleep quality leads to decreased fear extinguishing and preserved memory of fearful events.
What is the effect of sleep deprivation/reduced short-wave sleep on:
A. beta cell function
B. cortisol
C. ghrelin
D. leptin
A. impaired
B. increased (lack of production inhibition)
C. increased
D. decreased
List 9 negative metabolic/hormonal effects of sleep disruption
- Cortisol increased
- Insulin sensitivity decreased
- glucose elevated
- leptin decreased
- testosterone decreased
- growth hormones decreased
- AGE deposition increased
- dyslipidemia
- endothelial dysfunction
Describe the following for ghrelin:
A. where produced
B. impact on appetite
C. timing of impact
A. stomach
B. tells brain we are hungry (it “ghrrrrgles”)
C. short-term weight hormone
What 5 cancers are associated with sleep disruption/short sleep?
BEP-CA:
breast
endometrial
prostate
colorectal
AML
Light triggers how long and direction of shift at each point?
A. Noon - no effect
B. Just after 6pm, 30 minute delay (fall asleep later)
C. Around 8-9pm, 60 minute delay
D. Around 3am, 60 min advance - will wake up too early!
E. On awakening (end of night), advances the clock 30 minutes, but is normal and necessary (because the natural clock lasts 24.1-24.4 hours!)
