Neuroscience Week 7: Sleep Disorders Flashcards by Jay Sandoval

How is sleep regulated at a cellular level

There are sleep-promoting neurons and wake-promoting neurons that inhibit each other

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flip-flop switch circuit of sleep

There are sleep-promoting neurons and wake-promoting neurons that inhibit each other
notice which segments fire during wakefulness or sleep

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sleep pressure

builds throughout the day to make you want to sleep

need more stuff on this!!!

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physiological variables and circadian rhythyms

Core body temperature
Cortisol
Urine volume
thyroid stimulating hormone
Growth hormone
Prolactin
Parathyroid hormone
Motor activity

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Clock genes description and function

at least 10 of them

(e.g Bmal1, Clock, Per, Cry, etc.)

create circadian oscillations generated by negative feedback loops

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The main timekeeper of brain

Suprachiasmatic nucleus

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Suprachiasmatic nucleus location

above the optic chiasm

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Key Zeitgebers

4 listed

Light
Feeding schedules
Melatonin
Activity

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zeitgeber definition

time givers

time cues

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length of internal clock

24.2-24.9 hours

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Neurotransmitter systems active during sleep

Preoptic area (inhibits wakeful ness neurons

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SCN uses __________ to help synchronize or reset the clock daily

Zeitgebers

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Neurotransmitter systems that promote wakefulness and inhibit the sleep-promoting neuro systems

Basal Forebrain
Locus coeruleus
Tuberomammillary nucleus

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Lighten up to stay awake

sun comes into eyes
Retinohypothalamic tract
tells SCN that it is time to be active
NE to superior cervical ganglion to rest of body

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Melatonin is built up by

NE breakdown

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Melatonin release is inhibited by?

Light

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Process for sleep cycles

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What releases melatonin?

Pineal gland

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Homeostatic Sleep Drive AKA

Sleep pressure

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Sleep pressure _________ the longer we are awake

increases

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What comprises sleep pressure?

Adenosine rises as sleep debt builds up (a by-product of ATP)

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Adenosine rises as sleep debt builds up and causes

inhibits body processes of wakefulness
“Rinsed out” during sleep

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What reduces adenosine levels?

sleep

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How does coffee work?

caffeine antagonizes adenosine

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caffeine antagonizes

adenosine

Polysomnography

* awake eyes and dreaming eyes look very similar * chin tone: should be really skinny and relaxed ( if movement could be grinding teeth) * K complexes (stage 2 sleep) * Spindles (stage 2 sleep)

K complexes are present in this stage

stage 2 sleep

spindles come from this stage of sleep

Stage 2 sleep

Spindles function

thalamus telling brain to ignore sensory signals packets of info when consolidating memory

K complexes

from cortices telling theyre still busy

alpha is seen when

someone is about to go to sleep

Nasal line flat

no air coming in trying to breath but no air is coming in

Polysomnographic features of normal REM sleep 5 listed

* Rapid eye movements * Low chin tone * EEG dyssynchrony * Heart rate variability * Respiratory variability

Question 1

C. 70-120 minutes In a depressed person? - 30-70 minutes Treated for depression? - 120-180 minutes sleep deprived? - 15-30 minutes

Average time % spent in NREM1

Average time % spent in NREM2

45%

Average time % spent in NREM3

25%

Average time % spent in REM

25%

Hardest stages to wake up?

darker colors harder to wake up

stages most asleep?

darker colors

The most common sleep complaint

Insomnia

Types of insomnia 2 listed

* Chronic insomnia disorder * Short-term insomnia disorder

Insomnia description

complaint of sleep quantity or quality associated with problems falling asleep, staying asleep and or early morning awakenings

Insomnia criteria 3 listed

* causes distress/impairment * sleep problem occurs at least 3 nights/week * The sleep problem occurs despite adequate opportunity for sleep

Insomnia Non-pharmacological treatment

* CBT-I - Cognitive behavioral therapy (4-8 weeks) * Learn healthy sleep habits and develop new sleep behaviors to improve sleep quality and consolidation

Insomnia first-line treatment

CBT-I

Sleep hygiene 11 listed

FDA medications approved for insomnia

FDA medications approved for insomnia: Classes 5 listed

* Benzodiazepine receptor agonists * Non-Benzodiazepine receptor agonists * Selective melatonin receptor agonists * Antidepressant * Orexin receptor antagonist

Benzodiazepine receptor agonists for insomnia

* Triazolam * Temazepam * Estazolam * Quazepam * Florazepam

Non-Benzodiazepine receptor agonists for insomnia 3 listed

* Zaleplon * Zolpidem * Eszopiclone

Selective melatonin receptor agonist for insomnia

Ramelteon

antidepressant for insomnia

Doxepin

Orexin receptor antagonist for insomnia

Suvorexant

Suvorexant halflife

medium

Doxepin half-life

medium

Ramelteon half-life

short

Eszopiclone half-life

6 hr

zolpidem half-life

3 hr

Zaleplon half-life

1 hr

Florazepam half-life

longest

Quazepam half-life

Longer

Estazolam half-life

long

Temazepam half-life

short

Triazolam half-life

shortest

sleep-related breathing disorders 3 listed

* Obstructive apnea * Central apnea * Mixed apnea

We classify sleep apnea in a ______ based upon _________ effort during absent airflow

* PSG * INSPIRATORY

Obstructive sleep apnea and symptoms 9 listed

Obstructive sleep apnea risk factors 6 listed

* male sex * older age (40-70) * Postmenopausal status * BMI \>35 * Hypertension * Large neck circumference

Obstructive sleep apnea consequences 9 listed

* stroke * heart failure * atrial fibrillation * heart attack * insulin resistance * obesity * sudden death * mood problems * memory problems

Treatment for Obstructive sleep apnea 5 listed

Obstructive sleep apnea CPAP

continuous positive air pressure therapy

Obstructive sleep apnea psychiatric

behavioral therapies are often helpful in desensitizing treatment options improving overall sleep hygiene and alleviating underlying causes of anxiety and depression

Obstructive sleep apnea dental devices

small and easy to wear dental devices are an excellent treatment for mild to moderate sleep apnea

Obstructive sleep apnea weight loss

a loss of 10% body weight may be an effective treatment for some sleep apnea cases

Obstructive sleep apnea surgical

New treatments require less recovery time, and some can be performed in an outpatient setting

Before and after PAP

Narcolepsy description

an irresistible need to sleep due to loss of orexin neurons

Narcolepsy symptoms

5 listed

Narcolepsy sleep attacks

irresistible need to sleep

Narcolepsy sleep paralysis

REM atonia when going to sleep or waking

Narcolepsy Hypnagogic hallucinations

dream intrusion into wake

Narcolepsy poor sleep at night

* due to sleep fragmentation * poor sleep/wake stability

Narcolepsy Cataplexy (Type I)

* sudden loss of voluntary muscle tone * Reflexes are absent * in response to strong emotional stimuli

Narcolepsy Treatment

Narcolepsy Treatment: Hypersomnolence 3 listed

* timed SHORT naps during the day * Stimulant medications (methylphenidate and amphetamines) * Wakeful promoting agents (Modafinil and Armodafinil)

Narcolepsy Treatment: Cataplexy

* Antidepressants * decrease REM intrusion * Sodium Oxybate (only FDA approved RX)

Only approved Rx for Narcolepsy Cataplexy

Sodium Oxybate

Narcolepsy Treatment: Poor sleep at night 2 listed

* Sodium Oxybate * Timing of naps and stimulant use

Circadian Rhythm Disorders 6 listed

* Delayed sleep-wake phase disorder * Advanced sleep-wake phase disorder * Irregular sleep-wake rhythm * Non-24-hour sleep-wake rhythm disorder * Shift work disorder * Jet lag disorder

Delayed Sleep phase syndrome may look like?

Sleep onset insomnia

Delayed Sleep phase syndrome symptoms 4 listed

* Inability to arise in the morning * normal sleep if initiated at a delayed bedtime * Bedtime & wake times are later on vacations (4 a.m. - 12p.m.) * Peak onset at adolescence

Delayed Sleep phase syndrome prevalence

peak onset in adolescence

Delayed Sleep phase syndrome differentials

* sleep-onset insomnia * bipolar disorder * inadequate sleep hygeine

NREM Parasomnias description

unwanted nocturnal behaviors

NREM Parasomnias pathogenesis

heritable

NREM Parasomnias occurs when and what sleep stage

* often in the first 3rd of the night * NREM 3 stage

NREM Parasomnias prevalence

most common in children

NREM Parasomnias increased with? 4 listed

* Sleep deprivation * sickness * stress * side effects to medications

NREM Parasomnias examples 4 listed

* Night terrors * Confusional arousals * sleepwalking * sleep-related eating disorders

Night Terrors characteristics 7 listed

Episodes of abrupt terror intense fear autonomic arousal inconsolable eyes open brief to 30+ minutes not easily remembered in the AM

Confusional arousals characteristics 3 listed

* Mental confusion or confused behavior * absence of terror or ambulation * not easily remembered in the AM

Sleepwaking AKA

Somnambulism

Sleep talking AKA

Somniloquy

Bedwetting AKA

Enuresis

Teeth grinding AKA

Bruxism

Sleep-related eating disorders characteristics

eating while asleep

REM Parasomnias examples 3 listed

* REM sleep behavior disorder * Recurrent isolated sleep paralysis * Nightmare disorder

Nightmares memory and time of occurence

recall intact upon awakening second half of the night

Sleep paralysis definition

awake but unable to move

Sleep-related hallucinations subtypes 2 listed

* Hypnogogic (when falling asleep) * Hypnopompic (when waking up)

REM Behavioral Disorder memory

recall intact upon awakening

REM Behavioral Disorder characteristics

dream enactment (themes of being pursued or fear)

REM Behavioral Disorder associated with?

Neurodegenerative diseases

Predates onset of Alpha-synucleinopathies: REM Behavioral Disorder 3 listed

* Parkinson's disease * Multiple system atrophy * Dementia with Lewy bodies

REM Behavioral Disorder: Lesions affecting the brainstem 3 listed

* Multiple Sclerosis * Narcolepsy * Stroke

REM Behavioral Disorder: Medications

Antidepressants

Normal Neurophysiology of REM Sleep

REM sleep without Atonia

ACh from the superior pons starts dreaming but the glycine is not activated to inhibit the anterior spinal horn cells and REM behavioral disorder is caused

Acting out dreams

RBD Treatment REM Behavioral Disorder

* Ensure safe environment * Melatonin * Clonazepam * Antidepressant change * Other medications: Selegeline, Donepzil , Barbiturate withdrawal, bisoprolol