SLEEP Flashcards
The neural control of circadian rhythms is
thought to reside in the_________________more specifically; in the suprachiasmatic
nuclei
ventral-anterior region of the hypothalamus,
five stages of sleep, representative
of two alternating physiologic mechanisms, have been
defined. In each stage, the electrical activity of the brain
occurs in organized and recurring cycles, referred to as
the____________
architecture of sleep .
EEG Patterns of sleep
Stage 1:
Stage 2 sleep, 0.5- to 2-s bursts
of biparietal 12- to 14-Hz waves (sleep spindles) and
intermittent high-amplitude, central-parietal sharp
slow-wave complexes appear (vertex waves
slow, rolling eye movements and is called
The American Academy of Sleep Medicine (AASM) recommends
the following staging:
stage W (wakefulness), stage Nl (non-REM sleep, or NREM 1, formerly stage 1), stage N2 (NREM 2, formerly stage 2), stage N3 (\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, and stage R\_\_\_\_\_\_\_\_\_\_\_\_\_\_
NREM 3,combining former stages 3 and 4-or slow-wave sleep)
(rapid eye movement [REM] sleep).
EEG becomes desynchronized, i.e., it has a low-voltage,
high-frequency discharge pattern.
REM
This NREM-REM cycle is repeated at
about the same interval ____________during the night,
depending on the total duration of sleep
four to six times
In the latter portion of a night’s sleep,
the cycles consist essentially of two alternating stages: _____________
REM
sleep and stage N2 (spindle-K-complex) sleep.
Newborn full-term infants spend approximately
__________of their sleep in the REM stage
50 percent
The amount
of sleep in N3 decreases with age, and persons older than
70 years of age have virtually no_________
very deep slow-wave
sleep
Because the time spent in NREM is so much
greater than that in REM, approximately ____________of
dreaming occurs outside of REM periods but REM sleep
nonetheless maintains a special relationship to dreaming
20 percent
Gross body movements occur every 15 min or so in all stages of sleep
but are maximal in the_____________________, at which time the sleeping person changes
position, usually from side to side
transition between REM and
NREM sleep,
In the nonphasic periods of REM sleep, ____________ neurons are inhibited, the H responses
diminish and and the tendon and postural
and flexor reflexes diminish or are _______
alpha and gamma spinal
abolished
REM sleep has been found to have
_____ and ________ components
phasic and tonic components.
In addition to the rapid
eye movements, phasic phenomena include activation of
the ____________with attendant alternate
dilatation and constriction of the pupils and fluctuation
of the blood pressure, heart rate, and respiration
sympathetic nervous system
In the nonphasic periods of REM sleep,_____________are inhibited, the H responses
diminish
alpha
and gamma spinal neurons
During sleep, the decline in
temperature occurs mainly during the ___________,
and the same is true of the heartbeat and respiration,
both of which become slow and more regular in this
period.
NREM period
During the____________, there is a surge of growth hormone secretion,
mainly during slow-wave sleep.
first 2 h
of sleep
The secretion
of _________and particularly of _____________ peaks at the onset of sleep .
cortisol
thyroid-stimulating
hormone
Prolactin secretion increases during the night
in both men and women, the highest plasma concentrations being found __________
soon after the onset of sleep
___________ a
peptide that assumes great importance in the pathophysiology
of narcolepsy,
Hypocretin,
the ventrolateral preoptic nucleus of the hypothalamus
(VLPO) sends fibers to all the other major cell groups
of the hypothalamus and brainstem that are engaged
in _____________
arousal
a decrease in monoamines causes an increase in __________ and vice versa
REM activity
dopaminergic systems in the _________ areas elicit or modulate dreaming
basal forebrain
Most of the integrated rhythms
of sleep that are recorded at the surface of the brain,
including the background activity of slow-wave sleep
and the faster and more synchronized sleep spindles
and vertex waves, have their origins in the ______
thalamus.
In dreaming, activation of the _______and________, with attenuation of activity in the primary visual cortex and frontal association areas
extrastriate visual cortices
limbic- paralimbic regions
In sleep deprivation, The EEG shows a ______________and closing of the eyes no longer
generates___________
decrement of alpha waves,
alpha activity
When falling asleep after a long period of deprivation,
the subject rapidly enters __________ sleep, which
continues for several hours at the expense of N2 and
REM sleep.
N3 (NREM)
__________seems to be the most important sleep stage in restoring the altered functions that result from prolonged sleep deprivation.
N3
The term _________ signifies a chronic inability t o sleep
despite adequate opportunity to do so; it is used popularly to indicate any impairment in the duration, depth, or restorative properties of sleep
insomnia
This term i s reserved for the condition in which nocturnal
sleep is disturbed for prolonged periods and none of the
symptoms of anxiety, depression, pain, or other psychiatric
or medical diseases can be invoked to explain the
sleep disturbance
Primary insomnia
main conditions causing secondary insomnia
pain in the joints or in the spine, abdominal
discomfort from peptic ulcer and carcinoma, pulmonary
and cardiovascular insufficiency, and the nocturia
engendered by prostatism.
___________ is otherwise called asthenia crurum paresthetica and also, anxietas tibiarum
RLS
Sx of RLS
.
unpleasant
aching and drawing sensations in the calves and thighs,
often associated with creeping or crawling feelings; other
descriptions have included “worms,” “internal itch,”
and “coldness,” and the legs may feel tired, heavy, and
weak.
The symptoms are provoked by rest, and rapidly,
but temporarily, relieved by moving the legs
Etiology of RLS
1.
2.
3.
- Idiopathic
- IDA
- Low Feritin
In RLS, _____________worsens restless legs syndrome, and there is a tendency for it to be worse in warm weather.
Fatigue
Like the restless legs syndrome, it may
result in sleep deprivation and daytime somnolence or,
more often, in disturbance of a bed partner. diagnosis depends on finding
them during polysomnographic recordings, whereas
restless leg syndrome is identified on clinical grounds
periodic leg movements
of sleep.
Associated conditions with Periodic leg movements of sleep
it also occurs independently with narcolepsy,
sleep apnea, following the use of tricyclic and serotonin
reuptake inhibiting antidepressants, L-dopa, and
withdrawal from anticonvulsants and sedative-hypnotic
drugs.
Initial Tx for RLS
Effects of these drugs;________
As a first choice, many practitioners favor treatment
with dopamine agonists such as prarnipexole (0.25
to 0.75 mg) or ropinirole (0.5 to 1 .5 mg), either one taken
1.5 to 2 h before bedtime. Long acting rotigotine may also be used
enhancement of the restless leg syndrome
Chronic and even short-term use of alcohol, barbiturates,
and certain nonbarbiturate sedative-hypnotic
drugs markedly reduces _____ as well as stages
________
REM sleep
3 and 4 of NREM sleep (N3
“Rebound insomnia,” a worsening of sleep compared
with pretreatment levels, has also been reported upon
discontinuation of short-half-life benzodiazepine hypnotics,
notably _______
triazolam
In the tx of insomnia, In the past, benzodiazepines were popular but these have been replaced by newer nonbenzodiazepine receptor
agonists with shorter half-lives and fewer side effects
such as ______.
Patients who
do not respond to these medications may be given an
intermediate-duration benzodiazepine such as _______
(e.g., zolpidem, zaleplon, and eszopiclone).
temazepam.
In the tx of insomnia, __________is inadvisable during pregnancy and
should be used cautiously in patients with alcoholism
or advanced renal, hepatic, or pulmonary disease, and should be avoided in patients with ______
Hypnotic use
sleep apnea syndrome.
________ has reportedly been as effective
as the sedative-hypnotics and may cause fewer shortterm
side effects, but both of these statements are difficult
to confirm.
Melatonin (3 to 12 mg)
_______appears to be
a sleep-enhancing drug even in those who are not anxious
or depressed.
Amitriptyline (25 to 50 mg at bedtime)
Nonprescription
drugs containing diphenhydramine (Benadryl), valerian,
or doxylamine, which are minimally or not at all effective
in inducing sleep, may impair________ and lead
to drowsiness the following morning.
the quality of sleep
Many neurologic conditions seriously derange the total
amount and patterns of sleep (see Culebras). Lesions in
the upper pons, _________, are particularly
prone to do so.
near the locus ceruleus
Lesser degrees of tegmental damage-as
might occur with Chiari malformations, unilateral medullary
infarction, syringobulbia, or poliomyelitis-may
cause _____ and __________
sleep apnea,
daytime drowsiness
