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Sleep Flashcards

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1
Q

how is sleep described in relation to consciousness

A
  1. easily reversible state of inactivity with a
  2. lack of interaction with the environment
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2
Q

what can unconsciousness be

A

coma (depressed state of neural activity)
sleep (VARIATION in neural activity)

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3
Q

what are the three states of consciousness

A
  1. wakefulness (alert, detect object and pays attention)
  2. core consciousness (wakefulness and emotional responses, simple memory)
  3. extended consciousness (all plus self awareness, autobiog memory, language and creativity)
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4
Q

what are some suggested functions of sleep

A

processing, storage of memories
recuperation of bodies immune system
conserve energy

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5
Q

does the sleeping brain consume oxygen

A

yes

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6
Q

what are the two main forms of externally discernable sleep

A

REM (rapid eye movement side to side)
non REM

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7
Q

how do you measure neuronal activity

A

EEG
electroencephalogram

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8
Q

how does the EEG work

A

post synaptic activity of SYNCHRONISED DENDRITIC ACTIVITY can be picked up
-individual neurons cannot

EEG electrode is connected to an amplifier EEG
read through layers to cells in cortex

only detect massive synchronised depolarisation- causes BIGGER DEFLECTION

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9
Q

how do you get synchronisation

A

either by neuronal interconnections or by pacemaker
the more neurons that are synchronised, the bigger the peaks on the EEG

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10
Q

are the neurons active during sleep

A

yes
sleeping brain consumes oxygen as much as wakeful brain

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11
Q

why do you get small and rapid depolarisations on EEG

A

brain working-not much synchronisation
lots of individual AP flying around
doing their own thing
lots of sparks
coincidence if depolarising at the same time
therefore small and rapid movements of trace

become synchronised during sleep
induced by pacemaker

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11
Q

why do you get small and rapid depolarisations on EEG

A

brain working-not much synchronisation
lots of individual AP flying around
doing their own thing
lots of sparks
coincidence if depolarising at the same time
therefore small and rapid movements of trace

become synchronised during sleep
induced by pacemaker

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12
Q

how is the EEG arranged
and how does it work

A

19 (+) pairs
at internationally agreed points on the surface of the head.

comparison between the pairs provides a coarse picture of the neuronal activity in various areas

separate different stages of sleep (REM and non REM) and further 4 stages

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13
Q

what are the EEG defined stages of sleep
and how many cycles in one sleep

A

AWAKE
STAGE 1
STAGE 2
STAGE 3
STAGE 4
REM

repeat around 5 REM sleeps per night
drowsy to deep sleep takes about 1 hour
minimum time between REM sleep about 30 mins

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14
Q

what are the EEG defined stages of sleep
and how many cycles in one sleep

A

AWAKE
STAGE 1
STAGE 2
STAGE 3
STAGE 4
REM

repeat around 5 REM sleeps per night
drowsy to deep sleep takes about 1 hour
minimum time between REM sleep about 30 mins

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15
Q

describe the awake stage

A

eyes closed ALPHA high frequency
eyes open BETA waves

high frequency and lower amplitude waves

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15
Q

describe the awake stage

A

eyes closed ALPHA high frequency
eyes open BETA waves

high frequency and lower amplitude waves

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16
Q

describe stage 1

A

THETA waves

easily roused
slow rolling eye movements

high amplitude
slower frequency

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17
Q

describe stage 2

A

Begin K complexes
fairly fast firing
high amplitude

some bursts of activity of synchronisation
no eye movement but body movements remain possible

SPINDLES- prelude to deep sleep
harder to rouse

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18
Q

describe stage 3

A

slower frequency DELTA waves

harder to rouse
few spindles
not regular
increased synchronisation

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19
Q

describe stage 4

A

biggest amplitude
biggest entrainment

deepest sleep and hardest to arouse
DELTA waves
lower heart rate and blood pressure
movement 15-30 min period

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20
Q

describe REM sleep

A

fast BETA waves and REM

easier to rouse than in stage 4
almost awake state
DREAMING-brain become very active
low muscle tone (very floppy- no movement)
if woke up from this you will remember dream you had

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21
Q

what controls the passage of stages

A

reticular formation (brainstem)
PINEAL GLAND— allows us to have a diurnal rhythm

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22
Q

describe the sequence of the thalamus on brain waves

Study These Flashcards
A

during day

reticular formation EXCITED
causes depolarisation
to thalamus (stays depolarised and active)
–non rhythmic output
INCREASED AROUSAL (alpha and beta waves)

sleep hygiene pattern kicks in/tired

reticular formation inhibited
hyperpolarise the thalamus
produce rhythmic output
slow EEG waves in cerebral cortex
–slow waves

23
what is the broad definition of epilepsy
continuing tendency to have RECURRENT, UNPROVOKED SEIZURES rare risk of sudden death SUDEP
24
what are sleep spindles
characterisation on NREM found with k complexes in STAGE 2
24
what are sleep spindles
characterisation on NREM found with k complexes in STAGE 2
25
what may cause SUDEP
probs from electrical disruption in heart -AF - heart attack
26
how do you diagnose epilepsy
EEG- INTERICTAL period between seizures there are still characterisitcs of some types of epileipsy history taking important (including from observers)
27
what are some relevant features of epilepsy
PRE- aura/ warning/ fear/ deja vu abnormal movements (lip smacking, patting, stroking) POST- memory loss, confusion, headache wounds/ scares? from falls usually interictal exam is normal
28
what are the classification of epileptic seizures
FOCAL -focal aware -focal unaware can develop into-> GENERALISED -absence- typical/atypical -myoclonic -clonic -tonic -clonic-tonic -atonic UNCLASSIFIED
29
what are focal aware seizures
consciousness is preserved in positive or negative symptoms symptoms are related to AREA AFFECTED IN BRAIN person is aware
30
what can focal aware symptoms include
PRIMARY MOTOR CORTEX -simple clonic movements PREMOTOR AREAS -elaborate motor output VISUAL ASSOCIATION -faces or complex scenes OCCIPITAL LOBE -contralateral visual hallucinations AUDITORY CORTEX -roaring or underwater hearing ASSOCIATIVE AUDITORY CORTEX -music TEMPORAL -visceral discomfort, odour, anxiety, fear ALL OFTEN preceded by an AURA - can progress to generalised seizures
31
what is a focal unaware seizure
there can be impairment of consciousness - can't tell you about particular symptoms 1-2 mins start w aura unresponsiveness automatisms autonomic responses (tachy, pupil dilation) post ictal headache then confusion can evolve into generalised seizures auras then seen as prelude
32
what is the most common type of focal unaware seizure
TEMPORAL (40%) damage to hippocampus pyramidal cells (long processes- easy to damage) if small stroke/physical damage get scar tissue which acts a focus for origin of seizure
33
what are absent generalised seziures PETIT MAL
most typical: short period sudden abrupt cessation may be associated with mild clonic jerking of eyelids no recollection atypical: loss of posture autonomic phenomena automatisms characteristic 2.5-3.5 Hz spike and wave pattern DIFFERANCE FROM FOCAL UNAWARE-- second is LONGER
34
what are generalised seizures
both hemispheres affected manifestations of seizure are determined by cortical site at which seizure arises present in 40% of al epileptic syndromes ALWAYS alteration to consciousness
35
what are myoclonic seizures
myoclonic jerking -treated differently depending on type IF GENERALISED different medication for juveniles not focal leading to generalised
36
what are atonic seizures
sudden loss of postural tone most often in children- rare
37
what are tonic clonic seizures GRAND MAL
major convulsions with rigidity and jerking slows over 60-120 sec followed by stuporous state (post ictal depression)
38
what drug should you not give juveniles if they are having a myoclonic seizure (generalised)
CARBAMAZEPINE
39
what is status epilepticus
more than 30 mins of continuous seizure two or more sequential seizures spanning without recovery between seizures med emergency tonic-clonic cycle may also already have heart problems
40
are all seizures epilieptic
no can be caused by: withdrawal diabetic instability blow to head
41
what non-invasive tests can you use to support a diagnosis of a seizure
ECG - check for abnormal cardiac problems- SUDEP, arrhythmias, athersclerosis EEG- interictal EEG ---- INTERICTAL EPILEIPTFORM ACTIVITY CT- looking for brain shrinkage, brain not formed properly- focal areas where seizures may have started MRI- scarring, reduced perfusion (fmri), dysplasia, cortex damage RESOLUTION BETTER
42
What is interictal epileptiform activity
large electrophysiological events observed between seizures in patients with epilepsy. characteristic waves and spikes to predict type of epilepsy
43
what are attack triggers and pre-disposition of epilepsy
PRE-DISPOSITION -scar tissue -developmental issues -pyramidal cell damage -sub-optimal regulation of neuronal excitability DISEASE -tumours TRIGGERS -tired -alcohol -drugs (anti-depres) change of meds
44
what do anti- epileptic dugs (AED) do
decreases frequency/ severity of seizures in people with epilepsy treat SYMPTOMS, not cause GOAL-- max QofL by minimising seizures and adverse drug effects
45
what are the targets for AED
suppress excitatory NT- inhibit Na VOLTAGE DEPENDENT system/ Ca-- RAPID DEPOLARISATION IS SUPPRESSED enhance inhibitory NT system-GABA increase outward positive K many are PLEIOTROPIC
46
what does pleiotropic mean
they act via multiple mechanisms
47
what AEDs act primarily on Na channels
PHENYTOIN, CARBAMAZEPINE -block voltage dep sodium channels at high firing freq but reduce efficacy of contraceptive pill OXCARBAZEPINE -blocks volt depen NA at high freq -also effect K+ channels pleiotropic effect ZONISAMIDE -blocks volt-depen Na channels and T-type Ca channel LAMOTRIGINE -inhibit voltage sensitive Na channels -best starting drug
48
what drug do you only use for absence generalised seizures
ETHOSUXIMIDE
49
what is an issue with sodium valproate
can be teratogenic
50
what is an issue with carbamazepine
enzyme inducing effects- many interactions
51
what do both vigabatrin and tiagabine do
GABA enhancer
52
what can you use for focal onset and focal leading to generalised
carbamazepine lamotrigine oxcarbazepine sodium valproate levetiracetam
53
what should you use for generalised seizures
valproic avid lamotrigine topiramate
54
what treatment can you use for status epilepticus
diazepam, lorazapam intra veinous (fact acting) - GABA agonist then phenytoin, phenobarbital when there is contorl
55
what is satus epilepticus
more than 30 mins of continuous seizure activity two + sequential seizures spanning this period with no full recovery between med emergency

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