Sleep

Question 1

Define sleep

Answer 1

• A series of behavioral phases involving defined patterns of arousal & nervous system activity

Question 2

Describe the stages of sleep

Answer 2

• Slow wave stage 1: arousal relatively easy
• Slow wave stages 2-4: progressively deeper
• REM: sudden, asynchronous EEG patterns; loss of muscle tone, dreams

Question 3

Define circadian rhythms

Answer 3

• Distributed cellular & system functions that sync with environmental cues

Question 4

Define sleep-wake homeostasis

Answer 4

• A running sleep-wake balance that promotes sleep after long periods of wakefulness

Question 5

Possible purposes of or opportunistic processes associated with sleep

Answer 5

• Restoration
• Memory consolidation
• Clearing CNS free radicals
• Resetting saturated brain function

Question 6

What is included in proper sleep hygiene

Answer 6

• No caffeine (esp. <6hrs out from bedtime)
• Create consistent pre-bed relaxation patterns
• Don’t look at clock
• Avoid TV before bed
• Avoid internet before bed
• Avoid exercising too close to bedtime
• Wake up at a consistent time
• Don’t work in bed

Question 7

What suppresses melatonin

Answer 7

• Blue light

Question 8

How do anti-depressants affect sleep

Answer 8

• Decrease REM sleep
• Increase limb movement

Question 9

How do Benzos affect sleep

Answer 9

• Reduce sleep latency/WASO
• Increase arousal thresholds (can lead to greater O2 desaturation in apnea pts)

Question 10

How does alcohol affects sleep

Answer 10

• Early: decreases sleep latency and REM sleep; increases delta sleep
• After a few hours: increases arousal

Question 11

What behavioral domains does sleep deprivation affect

Answer 11

• Mood (irritability)
• Motor (balance, coordination)
• Cognitive (alertness, reaction time, cognition, memory)

Question 12

Sleep deprivation increases risk of

Answer 12

• DM
• Obesity
• CVD
• HTN
• Anxiety/Depression

Question 13

Common sleep disturbers

Answer 13

• Pregnancy
• Apnea
• Anything causing pain
• Narcolepsy

Question 14

What is the current reference standard for sleep testing

Answer 14

• Polysomnography

Question 15

Sleep scales and questionnaires

Answer 15

• Karolinska Sleep Questionnaire
• Pittsburgh Sleep Quality Questionnaire
• Basic Nordic Sleep Questionnaire
• Epworth Sleepiness Scale

Question 16

Patient reported outcome measures for sleep (PROMIS)

Answer 16

• Sleep Disturbance Bank
• Sleep Related Impairment Bank

Question 17

Define sleep paralysis

Answer 17

• Brief loss of muscle control just after falling asleep or waking up
• 75% of sleep paralysis episodes involve hallucinations

Question 18

Types of hallucinations that may occur during sleep paralysis

Answer 18

• Intruder hallucinations: involves the perception of a dangerous person or presence in the room
• Vestibular-Motor (V-M) hallucinations: includes feelings of movement or out of body sensations
• Chest pressure hallucinations: incites a feeling of suffocation

Question 19

Describe exploding head syndrome (EHS)

Answer 19

• Often described as hearing sounds like explosions, gunshots, thunder, and/or other load nosies
• The sound are not real or heard by anyone else