Sleep Flashcards
(98 cards)
1
Q
What percentage of people work night shifts?
A
20%
2
Q
60 million have trouble sleeping but only 10% seek help. What indirect costs does this cause?
A
Presenteeism - at work, no productive
increase risk of long term disability
mistakes/accidents
3
Q
There has been an increase in short sleep since the 1970s. What percentages haves <6 and <7 hours?
A
<6 - 20&
<7 - 37%
4
Q
How much sleep does the average American get?
A
6 hr 57 mins
5
Q
What are the endogenous oscillators?
A
Peripheral and central
6
Q
What is the central oscillator? Where is it? What does it do? How?
A
SCN, in hypothalamus, regulates melatonin secretion, entrainment of circadian rhythm by connecting to other tissues/organs
7
Q
Where are the periperal oscillators? What do they do?
A
in organs, synch to the central clock - SCN
8
Q
What are the RGCs? What do they do? What do they contain?
A
non-visual light sensitive neurones
send spectra and wavelength of light to SCN to alter melatonin secretion
also AWAKENS CORTISOL SPIKE
contains melanopsin which is most sensitive to short wavelengths (blue - 480nm)
9
Q
The peripheral and central oscillators are stimulated by what 5 things?
A
- light INTENSITY
- Light WAVELENGTH
- ambient temperature
- Food - CARBS
- FLUID - blood osmolality
10
Q
What is entrainment?
A
Synchronisation of oscillators based on external inputs
11
Q
Sleep propensity?
A
ability to GET TO SLEEP and STAY ASLEEP
12
Q
Cricadian rhythms?
A
body clock
regulated of oscillatorys
brought into rhythm to align physiology and behaviours with solar cycle
13
Q
Modifiers x 3?
A
- Pupillary reflex - limits light getting to RGC
- Sunglasses/back lights
- SNPs - Single Nucleotide Polymorphisms
- Cutaneous fat stores - affects core/peripheral temps
- Vascular tone - affects temps/fluid volume
14
Q
Two factors affecting vascular tone:
A
Na - vasconstriction - increases BP
NO/oestrogen - increases vasodilaton - decreases BP
15
Q
What are SNPs?
A
Single Nucleotide Polyomorphisms
genetic variations
If SNPs are found in in gene-coding portions can lead to non-functioning/enhanced/abnormal proteins
16
Q
If SNPs form in x 2 what can cause circadian rhythm to be impaired?
A
CRY
PER proteins
controls circadian rhythms in the peripheral oscaillators
they work by inhibiting function of other proteins until they degrade over 24 hours
17
Q
What are the operators?
A
body’s reactions to the modifiers (pupillary reflec, sunglasses, backlights, SNPs)
- core body temp changes
- melatonin suppression/secretion
- cortisol secretion and timing of spike
- increase/decrease of blood flow
18
Q
Outputs?
A
Sleep/function - e.g strength, stamina, food-seeking behaviour, alert, motor skills, precision, quantity and quality
19
Q
Inputs?
A
Light Cards Exercise Fluid status Ambient temp
20
Q
What effects does low daytime light exposure have?
A
decreased mood
decreased daytime alertness and activity
DECREASED CORE BODY TEMP
INCREASED MELATONIN SUPRESSION AT NIGHT
e.g daytime 10K lux for 6 hours can’t suppress night melatonin from 90 lux
21
Q
If low light exposure 2-3 days ago, causes?
A
more sensitive to light at night
22
Q
Blue night exposure at night causes?
A
increased cortisol/BP/HR
alertness
increased body temp
decreased melatonin
23
Q
Blue light?
A
420-480nm
greatest melatonin suppression at lower intensities and shorter duration
24
Q
What is the kelvin of a colour?
A
dominant colour at a certain temp
lower - warm colours = red, orange
higher - cooler - blue, violent
25
Kelvin of blue light?
650
26
```
Light intensity:
moonless night
moon
bright industrial light
overcast
street light
cloud day
nursing home
bright sunlight at noon
office/kitchen
households
```
```
moonless night 0.001-0.0001
moon 1 lux
bright industrial light 1-5 lux
overcast 2-10 lux
street light 20 lux
cloudy day 25 lux
nursing home 50
bright sunlight at noon 100k
office/kitchen 200-500
households - 50-200
```
27
What is the process of sleep onset?
darkness>pineal gland secretes melatonin> cutaneous vasodilation> warmer extremities> cools core body temp> sleep initiaion
28
Sleep onset to mid sleep process?
melatonin continues to rise> peripheral skin temp increases>continued core cooling> NADIR
restorative process - decreases BP and symp tone
29
What is NADIR?
LOW POINT core temp - reached 2-3 hours before waking
30
Throughout sleep?
```
leptin/ghrelin secretion
gradual increase in cortisol
FA metabolism
insulin regulation
ATP synthesis
emotional regulation
memory encoding/consolidatio
DNA remodelling/repair
Increase in GH
increased peptide synthesis
```
31
Late sleep?
mid sleep>waking
decrease in melatonin> decrease in peripheral temp> increase in core body temp
increase in BP/symp tone/baroreceptor sensitivity as body prepares to wake
32
Longer REM sleep?
fear estingushing/limb system functioning
33
Awakening?
cortisol spike (24 hr peak)
34
SCN clock length most people have and ideal?
ideal - 24 hr
| most - 24.2
35
What is a delayed phase shift?
SCN longer than 24 hrs
| e.g. 1-3 hrs of evening light - delays melatonin secretion - delays sleep
36
What direction of travel causes a delayed phase shift to the SCN clock?
Eastward travel
| can also occur with home lighting
37
Why are nightowls nightowls?
Mor suscepible to evening light so melatonin supressed
38
Advanced phase shift?
SCN clock is shorter than 24 hours
39
When does an advanced phase shift occur?
with light exposure early in the day
40
What happens to morning people?
more susceptible to desynchronisation due to morning light - so shifts them to early morning waking
41
If someone has a shorter cycle (<24 hrs due to being an early bird and therefore more sensitive to dysregulation) what do they need to do?
advancement of 10 minutes
42
If someone has a longer SCN clock (>24 hrs) and are therefore night owls, what should they do?
backwards by 20 minutes
43
If someone is falling asleep too late, what can alter food wise?
eat dinner earlier, eat less carbs at dinner, avoid after dinner snacks
eat high carb breakfast soon after waking
44
If someone falls asleep too early, what food changes can they make?
eat later carb breakfast
45
If you have a late breakfas or skip breakfast?
diminished cortisol awakening
breaskfast early - shifts ealier wake up time
46
Healthy sleep causes an increase in leptin - what does that do?
decreases food seeking behaviour
healthy sleep also decreases cortisol/glucose and improves insulin sensitivity
47
Impaired sleep and short duration cases?
```
increased NIGHT CORTISOL AND GLUCOSE
decreased insulin sensitivity
DECREASED DAY LEPTIN - INCREASES CARB INTAKE
DECREASED TESTOSTERONE
DECREASED GH
INncreased CHO
endoethelial dysfunction
increased AGE deposition in vascular system
```
riased BMI, obesity, met dynrome, T2DM, CVD risk, mortality
48
Is someone is phased advanced they?
wake early
49
what exercise pattern is best for phase advancing?
morning and afternoon
50
if you want to phase delay - exercise?
evening exercise
51
WHat happens to core body temp in the afternoon?
opposite to night - core body temp increases and peripheral temp will decrease so HR and cardiac output decreases
52
late afternoon blood osmolality?
increases> core body temp increases to peak
(if fluid volume is decreased, less cutaneous blood flow at night, so increase cardiac activation/symp tone - shunts blood to core)
53
What 3 conditions are more sensitivty to melatonin suppression?
SAD
Bipolar
Major depressive disorder
54
What factors affect light in elderly?
cataract/corneal opacity limits light retinal exposure
naturally lower production of melatonin with age
e. g 45 yr old has 50% retinal luminance than 10 year old
e. r 65 year old, has 50% lower compared to 45year old
55
What is BIISS?
Behaviourally induced Insufficient sleep syndrome
voluntary sleep restriction - sleep longer on weekends
inadequate sleep for function
7-20% on pop
30-39 yrs
Alcohol abuse, working >40 hr weeks, stress, depression
56
Chronic Insomnia?
most common
3/week for 3 months
diff initiating and or maintaining sleep despite adequate opportunity
fatigue, impaired concentration, decrease motivation, mood, work/driving errors, headaches, GI, persisting worries about sleep
57
How much of OSA is undiagnosed?
Assoc?
Scale?
80%
OW/Obese/HTN/mrt syndrome/ AF
Apnoea hypopnoea Index - 5-15 mild, 15-30 mod, 30 severe
58
Restless leg syndrome?
```
5-15% US pop
sens/motor
uncomfortable sensation at REST
LEGS
can be pain/paresthesia
worse - EVENINGS
Jerky movements of limbs whilst awake
GENETIC/ACQUIRED
PHASE DELAY OF SLEEP
High or low iron - no correlation with levels
MG
VIT D
```
59
Short sleep misperception?
less sleep then realised
60
secondary insomnia?
meds/vascular dysfunction/ peripheral hypoperfusion/visual impairment/renin-angiotension dysfunction
61
Periodic Limb Movement?
```
patient unware
movement 30 sec intervals during sleep
no abn sensations
>50 years ++
assoc with restless leg syndrome
may complain of restless sleep/waking in night/increase daytime sleepiness
```
62
What is the deepest stage of sleep?
Non-REM sleep, stage 3 - slow-wave
healthy sleep will have high proportion
increases learning/memory/fast cognitive processing/ fear extinguishing
63
Impaired sleep causes decreased?
BDNF - misinterpretation of social cues, decrease alertness/cog processing/diminished fear extinguishment (amygdala unable to get rid of fearful events), impaired learning
64
CV changes with good duration and quality of sleep?
decreased symp tone
increase high periperhal perfusion and core body temp decrease
INCREASE CV STAMINA AND CV RECOVERY TIME
65
Impaired sleep - CV effects?
increase symp tome, endoethelial injury, increase Cho, HTN esp at night, decreased peripheral perfusion
NO REDUCTION IN BP IN EARLY HOURS
increased risk of MI/CVD DEATH/VASOSPASTIC DISORDERS
66
Poor sleep is associated with which cancers?
BEPCA
```
breast
endometrial
prostate
colorectal
AML
```
67
Cancer and poor sleep risk factors?
poor sleep - increases cancer stimulating cytokines - IL10
aberrant DNA methylation
Healthy sleep helps - DNA repair/histone remodelling, apoptosis and anti-cancer cytokines - IL1, IL2, TNFalpha
68
Short sleep deprivation:
pms
| PTSD and traumatic brain injury worse if poor sleep before or after
69
Lifestyle changes for better sleep?
```
naps <30 mins
Bed - S&S only
regular sleep/wake times
natural cooling throughout night
peripheral warming- hot de caff drinks/socks/heat pads/bath and showers
hide alarm clocks/light
```
70
How to improve with respect to light?
increase daytime light exposure outdoors
| decrease light at night - turn off lights/dim lights 1 hr before bed especially blue light
71
What spectrum of light to use at night?
2500k colour warm
72
Diet changes for better sleep?
```
limit day caffeine/no night caffeine
no ALCOHOL 3 HOURS BEFORE BED
NO AFTER DINNER SNACKS
ADEQUATE DAYTIME FLUID (esp late afternoon)
avoid Na esp at dinner
optimise weight
```
73
PA to improve sleep?
increase morning or late afternoon PA
| AT LEAST ONE HOUR A DAY
74
Stress for better sleep?
settle down 1 hr before bed - music 60 bpm/editation
windown routine
stop stimulating things 90 mins before bed
MBSR/CBT
75
Intensive treatments for chronic insomnia?
1st line - chronic insomnia - more likely sustained benefit
behavioural/stimulus control/rlaxation therapy/sleep hygiene
good for >60 yrs
76
Significant differences in endogenous?
melatonin between individuals
77
Supplemental melatonin:
best bioavailability?
sustained preps best for?
no adverse effects at dose?
sublingual
westward jet lag - but may cause morning jet lag
1-6mg - but may interaction with some cytochrome P-450 drugs
78
Hypnotic meds risks?
death - esp 18-55years
| increased all cause mortality in all age groups - OD, car accidents, falls, deperssion, cancer, suicide
79
Difficulty maintaining sleep - tx?
```
dark room, cool glass of water near bed, cooling room
increase morning and mid afternoon light
avoid turning lights on if wakes
increase later afternoon hydration
avoid evening soda/alc/caff
exercise without creating pain
stress mx
```
80
Sleep deficiency from early waking - tx?
warm bedcovers
avoid light until wake up time
increase PA
increase late afternoon sunlight to stimulate melatonin
81
Jet leg travelling east?
hearty breakfast within 30-45 mins of new wake up time
GET LIGHT ESP OUTDOORS CLOSE TO NEW WAKE UP TIME
DIM LIGHT 1 HOUR PRIOR TO NEW SLEEP TIME
melatonin 1mg SL 1 hour before new bedtime
82
Jet lag travelling west?
GET LATE AFTERNOON AND EVENING LIGHT
AVOI DIM LIGHT UNTIL 1 HOUR BEFORE NEW BEDTIME
BREAKFAST 30-45 MINS AFTER WAKE UP TIME
COMPLEX CARBS 2-3 HRS BEFORE NEW SLEEP TIME
1 MG SL melatonin
83
Does P.I ncrease of decrease tiredness?
2-4 times more likely to be tired
84
restless legs more common in?
DM
85
Dyssommnia? Parasomnia?
sleep disordes that negatively impact quantity and quality of sleep
unusual physical events before sleep/during sleep/arousal e.g. abn movements/sleep terrors
86
>8.5hrs assoc with?
obesity
87
Sustained release melatonin
best for westward travel but morn drowsiness
88
how long should sleep diaries be?
one week (for first visit)
89
STOP is an assessment tool for?
OSA
```
snore loudly?
tired?
observed you stop breathing?
pressure? BP
Bmi>35, large nexk 40cm, M
```
>2 increased risk
90
sleep cycle?
1. theta - very light - hallucinations
2. light/transitional - theta + K-complex
3. deep sleep - theta and delta
4. deep - only delta
5. REM - dream sleep
91
coffee blocks?
adenosine R
92
red light
2500k
93
short term sleep deprivation can increase?
BP
94
cortisol increases?
morning, up by 50% in 20-30 mins from waking
95
sleep depreivation ghrelin and leptin
ghrelin - increases appetite and obesity
| leptop decreases appetite
96
irregular sleep affect on leptin
decreases appetite
97
```
Sleep for:
newborns 0-3m
infants - 4-11months
toddler 1-2 years
pre-school 3-5yrs
school age 6-13 yrs
teens 14-17 yrs
younger adult - 18-25yrs
adults 26-64yrs
older adult >65
```
```
newborns 0-3m - 14-17 hrs
infants - 4-11months - 12-15 hrs
toddler 1-2 years - 11-14 hrs
pre-school 3-5yrs 10-13 hrs
school age 6-13 yrs 9-11 hrs
teens 14-17 yrs 8-10 hrs
younger adult - 18-25yrs 7-9 hrs
adults 26-64yrs 7-9 hrs
older adult >65 7-8 hrs
```
98
REM sleep at different ages?
50% in REM sleep
25% 10 yrs old
15% over 50 yrs
