Sleep Flashcards
(114 cards)
1
Q
What is sleep?
A
Sleep is a natural state of bodily rest essential to human life. It is characterized by recumbency, closed eyes, decreased movement, and reduced responsiveness to external and internal stimuli, though some stimuli (e.g., one’s own name, loud noises, or the need to urinate) can still cause awakening. Sleep is now understood as a highly regulated neuroactivity associated with many important body functions.
2
Q
Is sleep a passive state?
A
No, sleep was once considered passive, but it is now known to be a highly regulated neuroactivity essential for various bodily functions.
3
Q
What are the two principal stages of sleep?
A
- Non-REM (NREM) Sleep – 75-80% of total sleep, occurs in stages of increasing depth, characterized by decreased body and eye movement, parasympathetic dominance, decreased body temperature, and reduced cerebral blood flow.
- REM (Rapid Eye Movement) Sleep – 20-25% of total sleep, occurs in cycles with NREM, includes sleep atonia (pseudo-paralysis), increased brain activity, increased blood flow, and bursts of rapid eye movements.
4
Q
How does the body function differently during NREM sleep?
A
• Body is in a strong parasympathetic state with slow, stable vital signs.
• Body temperature decreases.
• Cerebral blood flow decreases.
5
Q
How does the body function during REM sleep?
A
• Generalized muscle atonia (sleep atonia/pseudo-paralysis).
• Brain activity increases, with increased cerebral blood flow.
• Irregular patterns of blood pressure, heart rate, and respiration.
• Most REM occurs in the last third of an 8-hour sleep cycle.
• Possible explanation for why people with cardiovascular disease are more susceptible to heart attacks or other emergencies in the early morning.
6
Q
What is the typical sequence of a sleep cycle?
A
- Wakefulness (alpha waves)
- Stage 1 NREM (theta waves) – somnolence, drowsiness, shallow sleep
- Stage 2 NREM (theta waves) – light sleep
- Stages 3 → 4 → 3 NREM (delta waves) – deep sleep
- Stage 2 NREM
- REM Sleep (alpha waves)
- 1-2 minute wakefulness episodes
- Stage 1 NREM
- Repeat cycles
- Final REM Stage → Wake up
7
Q
How do people feel when awakened from NREM sleep?
A
People awakened from NREM sleep are usually foggy, confused, and irritable.
8
Q
What percentage of total sleep does each stage occupy?
A
• Stage 1 NREM: Up to 10%
• Stage 2 NREM: 40-50%
• Stage 3/4 NREM: 20%
• REM Sleep: 20-25%
9
Q
How long is each NREM-REM cycle?
A
Each cycle lasts 90-110 minutes.
10
Q
How do sleep stages change throughout the night?
A
• Stage 3/4 deep sleep is longer in the early night.
• REM sleep stages increase in duration later in the night.
• If someone gets less sleep than needed, REM sleep is most impaired.
11
Q
Why is it important to get a full night’s sleep?
A
Restorative sleep requires multiple complete sleep cycles, ensuring adequate deep sleep and REM sleep.
12
Q
How much sleep is needed at different ages?
A
• Newborns: Up to 18 hours
• 1-12 months: 14-18 hours
• 1-3 years: 12-15 hours
• 3-5 years: 11-13 hours
• 5-12 years: 9-11 hours
• Adolescents: 9-10 hours
• Adults (including elderly): 7-8+ hours
• Pregnant women: 8+ hours
13
Q
Is it true that seniors need less sleep?
A
No, this is a myth. Seniors tend to wake more frequently and have shorter, more disturbed deep sleep, so they must spend more total time in bed to get sufficient sleep.
14
Q
How does lack of sleep affect children and adolescents?
A
Sleep deprivation negatively affects physical and mental health, leading to decreased school performance and other issues.
15
Q
What are the key physiological functions of sleep?
A
- Regulation of glucose levels and glycogen replenishment.
- Restoration of white blood cell counts.
- Anabolic processes of metabolism, including:
• Tissue maintenance and restoration.
• Wound healing.
• Hormone production (growth hormone, prolactin, testosterone, thyroid-stimulating hormone).
16
Q
How does metabolic rate affect sleep duration?
A
• Animals with high metabolic rates (e.g., rats) sleep longer (14+ hours).
• Animals with low metabolic rates (e.g., elephants) sleep very little (3-4 hours).
17
Q
How does sleep affect the musculoskeletal system?
A
Sleep allows for general rest and rejuvenation of musculoskeletal structures.
18
Q
What brain maintenance processes occur during sleep?
A
• Increased protein synthesis in the CNS.
• Clean-up of redundant or excess synapses.
• Organization and updating of working memory (decision-making, reasoning, ongoing thought processing).
• Declarative memory (fact storage) is consolidated in deep sleep.
• Procedural memory (skills/processes) is consolidated in REM sleep.
• Emotional restoration and processing.
19
Q
How does REM sleep relate to learning and brain development?
A
• REM sleep increases when new skills are learned during the day.
• Newborns go directly into REM and spend 50% of sleep in REM.
• Premature babies experience the most REM.
• By age 3, REM sleep stabilizes at 20-25%.
• REM is essential for skills memory and the creation of synaptic pathways.
• Proper childhood sleep is critical for stabilizing lifetime sleep patterns and limbic system development.
20
Q
What is sleep?
A
Sleep is a natural state of bodily rest essential to human life. It is characterized by:
• Recumbency, closed eyes, decreased movement
• Reduced responsiveness to internal and external stimuli
• Filtering and indifference to stimuli, though not complete non-responsiveness
• Some stimuli (e.g., name being called, loud noise, baby crying, physical cues) can still wake a person
• Once considered a passive state, sleep is now understood as a highly regulated neuroactivity associated with essential body functions
21
Q
A
22
Q
What are the two principal stages of sleep?
A
- Non-REM (NREM) Sleep (75-80% of total sleep)
• Occurs in stages of increasing depth
• Eye and body movements diminish as sleep deepens
• Body is in a strong parasympathetic state with slow, stable vital signs
• ↓ body temperature
• ↓ cerebral blood flow - REM (Rapid Eye Movement) Sleep (20-25% of total sleep)
• Cycles with NREM throughout the night
• REM cycle lengths increase over an 8-hour sleep, with most occurring in the last third
• Includes sleep atonia (generalized muscle atonia, aka pseudo-paralysis)
• Brain activity and blood flow increase
• Bursts of rapid eye movement, irregular blood pressure, heart rate, and respiration
• Possible link to higher risk of heart attacks in early morning hours
23
Q
What are the stages in a normal sleep cycle?
A
- Wakefulness (alpha waves)
- Stage 1 NREM (moving to theta waves) → Somnolence, drowsiness, shallow sleep
- Stage 2 NREM (theta waves) → Light sleep
- Stages 3 → 4 → 3 NREM (delta waves) → Deep sleep
- Stage 2 NREM
- REM Sleep (alpha waves)
- 1-2 minute wakefulness episodes
- Stage 1 NREM → Cycle repeats
- Final REM Stage
- Person Wakes Up
🔹 People awakened from NREM are often foggy, confused, and irritable.
24
Q
What are the normal sleep ratios for different sleep stages?
A
• Stage 1 NREM: up to 10%
• Stage 2 NREM: 40-50%
• Stage 3/4 NREM: 20%
• REM Sleep: 20-25%
NREM-REM Cycle rotates every 90-110 minutes.
• Deep sleep is longer in the earlier part of the night
• First REM is ~10 minutes; REM stages lengthen as the night progresses
• Missing even 1-2 hours of sleep mainly affects REM sleep
25
How much sleep is required for different age groups?
• Newborns: up to 18 hours
• 1-12 months: 14-18 hours
• 1-3 years: 12-15 hours
• 3-5 years: 11-13 hours
• 5-12 years: 9-11 hours
• Adolescents: 9-10 hours
• Adults (including elderly): 7-8+ hours
• Pregnant women: 8+ hours
26
Is it true that seniors need less sleep?
No, it's a myth. Seniors:
• Wake up more frequently
• Have shorter/more disturbed deep sleep
• Need more time in bed to achieve sufficient sleep
27
How does sleep affect children/teens?
Children and teens are increasingly sleep-deprived, which affects physical/mental health and school performance.
28
What are the known purposes of sleep?
• Glucose regulation, glycogen replenishment
• White blood cell restoration
Tissue maintenance, wound healing
• Hormone production (growth hormone, prolactin, testosterone, thyroid-stimulating hormone)
• CNS maintenance (protein synthesis, synaptic cleanup, working memory organization)
• Memory consolidation
- Deep sleep → Declarative memory (facts)
- REM sleep → Procedural memory (skills, processes)
• Emotional processing and brain development
- REM increases after learning new skills
- Newborns spend 50% of sleep in REM, which supports synaptic and cortical development
29
What is the purpose of dreaming?
• Dreaming involves perception of sensory images in sleep
• Freudian theories (dreams = frustrated desires) are discredited
• Dreams are essential for memory processing and consolidation
• NREM dreams: rational, linear, little/no recall
• REM dreams: vivid, complex, bizarre, good recall
30
What are the three key sleep controls?
1. Homeostatic Regulation → Sleep drive builds up based on time awake and physical/emotional factors
2. Circadian Rhythm → Modulated by hypothalamus and entrains to light/dark cycles
3. Ultradian Rhythm → Regulates sleep stages within a sleep cycle
31
What is the role of the hypothalamus in sleep?
• Key sleep/wake regulator
• Ensures rapid transitions between states (in-between states are dangerous)
• Anterior hypothalamus = sleep-inducing region
• Posterior hypothalamus = wakefulness-promoting region
• Modulates circadian rhythm, autonomic functions
32
What is a chronotype?
A person’s natural tendency to be a morning or night person, linked to body temperature peaks.
33
What chemicals regulate sleep?
• Adenosine → Accumulates with wakefulness, inhibits arousal (caffeine blocks adenosine receptors)
• Melatonin → Maximal secretion at night, promotes sleep
• Acetylcholine → Activates REM sleep, also involved in wakefulness
• GABA → Inhibitory, promotes sleep onset and stage shifts
• Hypocretins (Orexins) → Promote wakefulness and override sleep urge
• Serotonin, Norepinephrine, Histamine → Promote wakefulness (antihistamines induce sleep)
34
What is sleep debt?
• Not getting enough sleep creates homeostatic sleep pressure
• Humans cannot stay awake voluntarily beyond 2-3 days
• Sleep must occur at the right circadian time to be effective
35
What are the signs and symptoms of sleep deprivation?
• Daytime sleepiness, irritability, hyperactivity
• Muscle stiffness, trembling, clumsiness
• Blurred vision, poor color perception, hallucinations
• Increased/decreased appetite, nausea
• Low body temperature, dizziness, fainting
• Memory lapses, impaired focus, poor judgment
• Slurred speech, delirium, ADHD-like symptoms
🔹 50% of North Americans are underslept
🔹 Sleep deprivation = Similar to alcohol impairment
36
37
What is dreaming?
Dreaming involves the perception of sensory images during sleep, typically in a sequenced manner, making the dreamer feel like they are part of an action or story.
38
What did Freudian theories suggest about dreams, and are they still supported?
Freudian theories suggested that dreams reflect sublimated frustrated urges and desires, but these theories have largely been discredited.
39
What is the current belief about the purpose of dreaming?
Dreaming is believed to be essential for memory processing and the consolidation of experience and learning during sleep.
40
How do dreams differ between NREM and REM sleep?
• NREM dreams: Rational, linear, straightforward, with little or no memory of them.
• REM dreams: Vivid, complex, emotionally layered, often non-linear, fanciful, irrational, or bizarre. The dreamer generally accepts these elements within the dream, and recall is good.
41
What is required for sleep to be restorative?
Sleep is restorative if a person gets enough sleep to feel replenished and is not sleepy the following day.
42
When is restorative sleep especially necessary?
It is more necessary after sleep loss, during illness, injury recovery, stress, and engagement in new learning experiences.
43
What are the three major factors that control sleep?
1. Homeostatic Regulation – The body’s sleep drive based on the time elapsed since the last sleep and other physical/emotional factors.
2. Circadian Rhythm – The intrinsic sleep-wake cycle modulated by the hypothalamus and influenced by environmental cues, especially light/dark.
3. Ultradian Rhythm – Regulation of sleep stages, integrating homeostatic and circadian processes.
44
What is the key brain area involved in sleep/wake regulation?
The hypothalamus.
45
What are the functions of the anterior and posterior hypothalamus in sleep?
• Anterior hypothalamus: Contains the sleep-inducing region.
• Posterior hypothalamus: Contains the wakefulness-promoting region.
46
How does the hypothalamus harmonize sleep/wake cycles with autonomic functions?
• Regulates body temperature (higher when awake, lower during sleep).
• Modulates sympathetic vs. parasympathetic dominance (sleep is parasympathetic predominant).
47
What is a person’s chronotype?
A person’s natural preference for being a “morning person” or “night person,” influenced by biological differences such as body temperature peaks.
48
What are the key chemicals, neurotransmitters, and hormones involved in sleep-wake regulation?
• Adenosine: Accumulates in the brain as a result of neuron metabolism, inhibiting arousal-promoting neurons (caffeine blocks adenosine receptors).
• Melatonin: Secreted by the pineal gland at night; promotes sleep and resets the circadian clock when taken at dawn or dusk.
• Acetylcholine: Excitatory; responsible for REM activation and plays a role in awakening.
• GABA: Inhibitory; promotes sleep onset and stage shifts in the ultradian cycle.
• Hypocretins (Orexins): Neuropeptides promoting wakefulness; override the sleep urge.
• Serotonin, Norepinephrine, Histamine: Wakefulness-promoters, inhibited by GABA.
* Note: Antihistamines promote sleep, while antidepressants (SSRIs, SNRIs, MAOIs, tricyclics) suppress REM sleep.
49
What is sleep debt?
The result of not getting enough sleep, leading to a homeostatically induced sleep pressure that intensifies over time.
50
Can humans voluntarily stay awake indefinitely?
No, adult humans cannot voluntarily stay awake for more than 2–3 days due to the absolute drive for sleep.
51
What factors determine whether a sleep episode is adequate?
Sleep must occur at the right circadian time—maximum melatonin concentration and minimum body temperature must both occur after the midpoint of sleep but before waking.
52
What are the effects of small amounts of sleep debt?
Altered physical and cognitive functions similar to mild alcohol intoxication, often unrecognized by the individual.
53
What is accumulated sleep debt called?
Sleep deprivation.
54
What percentage of the North American adult population is estimated to be underslept?
50%, with increasing concerns for children and teenagers.
55
What are some key physical, cognitive, and emotional symptoms of sleep deprivation?
• Physical: Daytime sleepiness, muscle stiffness, blurred vision, nausea, dizziness, headaches, increased BP, impaired immunity.
• Cognitive: Memory lapses, slowed reaction time, impaired judgment, poor impulse control.
• Emotional: Irritability, anxiety, depression, emotional detachment, hyperactivity (temper tantrums in children).
• Other: Reduced libido, inefficient communication, increased accident risk.
56
Are naps recommended for sleep deprivation?
No, sleep experts do not recommend naps as a remedy for sleep deprivation.
57
When can naps be beneficial?
For stress relief, illness, post-surgical recovery, and as personal breaks when overloaded.
58
Why don’t naps fully compensate for lost nighttime sleep?
They do not follow the proper ultradian rhythm, skipping deep sleep and the final long REM segment.
59
How can regular napping interfere with sleep?
It prevents proper brain re-training, making it harder to establish healthy nighttime sleep habits.
60
What is microsleep?
Brief episodes where theta or delta waves break through wakefulness, causing a few seconds of sleep.
61
Why is microsleep dangerous?
It can cause accidents and cognitive problems, and people are generally unaware they are experiencing it.
62
What major disasters were linked to sleep deprivation?
The Exxon Valdez oil spill, NASA Challenger explosion, and Chernobyl nuclear plant accident.
63
What are some major health risks associated with sleep deprivation?
• Increased risk of obesity, Type 2 diabetes, heart disease, hypertension.
• Impaired immunity, tissue repair, thermoregulation, digestive function.
• Mood disorders, intensified pain, learning/memory issues.
• Increased risk of accidents (e.g., 100,000 sleep-related traffic accidents in the US per year).
• Impaired fetal development and promotion of sleep disorders.
64
What are common causes of sleep loss?
• Psychological: Stress, anxiety, overwork, life imbalance, clock watching.
• Environmental: Light, noise, uncomfortable bed, partner’s sleep issues.
• Health-related: Pain, illness, injury, hormonal fluctuations, obesity, apnea, frequent urination.
• Lifestyle: Erratic schedule, shift work, evening exercise, travel.
• Substance use: Caffeine, stimulants, alcohol, marijuana, various medications (e.g., antidepressants, beta-blockers, cold medicines with pseudoephedrine).
• Rebound effects: Sleeping pill withdrawal can cause sleep disturbances.
65
What conditions are primarily associated with hyposomnia?
• Fibromyalgia
• Chronic fatigue syndrome
• Parkinson’s Disease
• Cardiac disease, hypertension
• Hyperthyroid conditions
• Dyspneic disorders (e.g., cystic fibrosis, emphysema/COPD)
• ADHD
• Digestive disorders, heartburn
• Arthritis and other painful joint conditions
• Headaches (especially cluster types)
• Anxiety disorders
• Most sleeping disorders
• Pregnancy and menopause
66
What conditions are primarily associated with hypersomnia?
• Anemia
• Hypothyroidism
• Some PTSD cases
• Some sleeping disorders (e.g., narcolepsy)
67
What conditions are associated with both hyposomnia and hypersomnia?
• Cancer and cancer treatments (30-50% incidence of sleep dysfunction)
• Alzheimer’s Disease, dementia
• Multiple sclerosis
• Alcohol and drug abuse, withdrawal
• Depressive disorders (90% incidence of sleep dysfunction)
• Bipolar disorder and various psychiatric disorders
• Terminal illness
• Chronic stress
68
What are the five major categories of sleep disorders?
• Insomnia
• Sleep Apnea
• Circadian Rhythm Sleep Disorders
• Narcolepsy
• Parasomnias
69
What is insomnia?
The most common sleep complaint, usually in the form of hyposomnia, where sleep is absent or inadequate despite the opportunity for sufficient rest.
70
What are the different types of insomnia?
1. Transient Insomnia – lasts up to a week, often called adjustment sleep disorder.
2. Short-Term Insomnia – lasts up to 6 months, usually due to longer stressful situations (e.g., spousal death).
3. Chronic Insomnia – lasts more than 6 months, associated with a variety of conditions.
71
How is Primary Insomnia diagnosed?
When there is no identifiable cause for the sleep disturbance; it is not well understood.
72
What are common causes and symptoms of insomnia?
• Causes: See "Causes of Sleep Loss / Hyposomnia".
• Symptoms: See "S/S and Effects of Sleep Deprivation".
73
How does gender and age affect insomnia?
Insomnia complaints are more common in women (60/40%) and increase with age.
74
What is sleep apnea?
A sleep disorder where breathing pauses during sleep, causing oxygen desaturation and frequent awakenings.
75
How is sleep apnea usually diagnosed?
• By a sleeping partner (noticing snoring that stops during apneic episodes, gasping, etc.).
• Presence of co-factors such as hypertension, obesity, heart disease, stroke, or premature birth.
76
What are the three types of sleep apnea?
1. Obstructive Sleep Apnea (OSA) – due to muscle relaxation in the throat causing airway obstruction.
• More common in obesity, hypertension, and Type 2 diabetes.
• Symptoms: Morning headaches, depression, weight gain.
2. Central Sleep Apnea (CSA) – caused by brain dysfunction in the respiratory center.
• Leads to cycles of apnea and compensatory hyperpnea.
• Can cause sudden death over time.
3. Mixed/Complex Sleep Apnea – a combination of OSA and CSA.
77
What are common treatments for Obstructive Sleep Apnea (OSA)?
• CPAP device (Continuous Positive Airway Pressure).
• Dental appliances or corrective surgery.
• Weight loss and management of correlated conditions.
• Didgeridoo training (strengthens airway muscles).
78
How is Central Sleep Apnea (CSA) treated?
• NIPPY device (Non-Invasive Positive Pressure Ventilation).
• Medication (e.g., Acetazolamide lowers blood pH to encourage breathing).
• Cardiac function support.
• Side-lying sleep position may reduce severity.
79
What percentage of insomnia complaints are due to circadian rhythm disorders?
7-10%.
80
What can cause Circadian Rhythm Sleep Disorders?
• Time changes (e.g., travel, shift work).
• Living in extreme light/dark regions.
• College student/party schedules.
• Hypothalamic lesions/abnormalities.
81
What are the three types of Circadian Rhythm Sleep Disorders?
1. Delayed Sleep-Phase Syndrome (DSPS) – inability to fall asleep and wake at normal times (most common).
2. Advanced Sleep-Phase Syndrome (ASPS) – very early sleep and wake cycle (6-9 PM, 3-5 AM); seen in seniors and depression.
3. Irregular Sleep-Wake Cycles – disrupted ultradian/circadian cycles, often in Alzheimer’s Disease or brain damage.
82
How are Circadian Rhythm Sleep Disorders treated?
• Light therapy
• Melatonin or melatonin agonists
• Sleeping medications
• Good sleep hygiene (avoiding naps, addressing co-conditions, etc.)
83
What are the main characteristics of narcolepsy?
• Excessive daytime sleepiness and sudden sleep attacks.
• Sleep paralysis (inability to move while falling asleep/waking).
• Hypnagogic (falling asleep) & hypnopompic (waking) hallucinations.
• Vivid dreaming during short naps.
• Cataplexy (loss of muscle control) in 70% of cases, triggered by emotional changes.
84
What is the genetic component of narcolepsy?
• Autosomal recessive inheritance.
• 1-2% incidence in first-degree relatives.
• 1 in 3 incidence in identical twins.
• Highest in Japan (1:500); North America (1:1000).
85
What are parasomnias?
Undesirable motor or verbal behaviors that occur during sleep.
86
Name some common parasomnias.
• Confusional Arousal – disorientation and automatic behaviors during sleep.
• Sleep Terrors – screaming, fear, and aggression in Stage 3/4 NREM.
• Sleepwalking (Somnambulism) – movement during Stage 3/4 NREM.
• Sleep Bruxism – jaw clenching/teeth grinding.
• Sleep Talking (Somniloquy) – occurs in Stage 1/2 NREM.
• REM Sleep Behavior Disorder – acting out dreams (often seen in Parkinson’s, dementia).
• Restless Legs Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD) – limb movements disrupting sleep.
• Sudden Infant Death Syndrome (SIDS) – unexplained cessation of breathing/heart function.
87
When did research on sleep begin, and how much is understood about it?
Research on sleep began in the 1920s/1930s. There is still much that is not fully understood about sleep and sleep disorders.
88
What is sleep medicine, and how recent is it as a specialty?
Sleep medicine is a relatively recent specialty focused on diagnosing and treating sleep disorders.
89
What is polysomnography, and what does it measure?
Polysomnography is the recording of multiple electrophysiological signals during sleep, including:
• EEG (brain activity)
• EMG (muscle movements)
• Actigraphy (small device worn on wrist)
• EOG (eye movements)
90
What other diagnostic equipment is used in sleep medicine?
Equipment to monitor:
• Nose/mouth airflow
• Respiratory muscle stress
• Oxygen saturation
• Heart rate
91
What are some non-equipment-based diagnostic tools in sleep medicine?
• Sleep logs
• Detailed sleep histories
• Sleep labs for direct observation
• Response to light therapy
• Response to melatonin for resetting sleep patterns
92
Why is current sleep pharmacology not ideal?
It can suppress wakefulness but does not create naturally staged sleep, meaning important physiological functions are missed.
93
What is the general recommendation for sleeping pills?
They are only recommended for short-term use, and non-pharmaceutical methods are preferred.
94
Are sleeping pills safe during pregnancy?
Many are not safe during pregnancy.
95
What are sedative-hypnotics, and what are some examples?
These are newer drugs with rapid action and little morning residual sedation. They tend to be GABAergic. Examples include:
• Zaleplon (Sonata)
• Zolpidem (Ambien)
• Eszopiclone (Lunesta)
96
What are benzodiazepine hypnotics, and how do they compare to barbiturates?
Benzodiazepine hypnotics largely replaced barbiturates due to better safety. They are GABAergic but can cause morning sedation and rebound effects. Examples include:
• Triazolam (Halcion)
• Estazolam (ProSom)
• Flurazepam (Dalmane)
• Temazepam (Restoril)
97
What are some antidepressants used for sleep disturbances?
1. Trazodone (Desyrel) – Short onset, consolidates sleep, helps with depression-sleep maintenance insomnia.
2. Amitriptyline (Elavil) – Tricyclic antidepressant with sedative properties.
3. Mirtazapine (Remeron) – Newer antidepressant superior to SSRIs for depression with severe insomnia and anxiety.
98
What are melatonin agonists, and what is an example?
They promote melatonin release to strengthen the sleep-wake cycle. Example:
• Ramelteon (Rozerem) – Good for sleep onset difficulties.
99
What are dopamine agonists, and when are they used?
They are used for movement disorders that impair sleep, such as Parkinson’s, MS, Restless Legs Syndrome (RLS), and Periodic Limb Movement Disorder (PLMD). Example:
• Ropinirole Hydrochloride (Requip)
100
What are CNS stimulants used for in sleep medicine?
They are used for narcolepsy. Examples include:
• Methylphenidate (Ritalin)
• Amphetamines
101
What are some natural supplements used for sleep disturbances?
• Melatonin (may react negatively with medications)
• Valerian
• L-Tryptophan (found in milk, turkey)
• St. John’s Wort
102
What are some herbal teas that can help with sleep?
Non-caffeinated herbal teas such as:
• Chamomile
• Jasmine
• Sage
• Peppermint
103
What supplement can be taken before bed to aid sleep?
Calcium supplements
104
What are some behavioral and alternative methods for improving sleep?
• Biofeedback
• Meditation/Guided imagery
• Relaxation techniques (e.g., soothing bath)
• Behavioral therapy
• Acupuncture
• Regular moderate exercise (not in the evening)
• Eye masks
• Soothing music
• Massage therapy
105
What childhood comfort items can aid sleep?
Teddy bears, blankies, etc.
106
Why is it important to address underlying conditions in sleep disturbances?
Poor sleep is often secondary to anxiety, stress, pain, or physical symptoms. Addressing the primary issue may improve sleep.
107
What are some environmental factors that can improve sleep hygiene?
1. Room should be free of distractions (no pets, no TV).
2. Comfortable sleeping temperature and noise level.
3. White noise machine may help reduce external noise.
4. Soft mattress for body support.
108
Why is having a consistent bedtime and wake-up time important?
It ensures the minimum sleep needed for proper function.
109
What is the recommended "wind-down time" before bed?
60-90 minutes before bedtime to relax and disconnect from the day’s events.
110
What should be avoided before bed?
• Stimulating TV shows and news
• Books that are difficult to put down
• Caffeine, nicotine, and alcohol
• Physical exertion or exercise within several hours of bedtime
• Eating within several hours before sleep
111
How can journaling help with sleep?
Writing worries down 45-60 minutes before bed can help with relaxation.
112
What should a person do if they cannot fall asleep within 15-20 minutes?
Get up, do a relaxing activity, and return to bed only when feeling sleepy.
113
What should be avoided to prevent negative sleep associations?
Clock watching and associating the bed with tossing and turning.
114
What is the benefit of strong light exposure in the morning?
At least 40 minutes of bright light exposure after waking can help regulate the sleep-wake cycle.
