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Flashcards in Sleep Deck (33)
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1
Q
NREM stages
A
see screen shot of chart in folder
2
Q
Sleep Latency
A
-Time from full wakefulness to sleep
-Interval is related to sleepiness, the quicker people fall asleep, the shorter the interval
-Once asleep, normal individuals enter NREM sleep and pass in success throughout the four stages.
-Typically NREM is 90-12 minutes, then enter initial REM period
-Interval between falling asleep to the first REM period is REM latency
-90 minute NREM-REM cycles, 4-5 times per night
3
Q
NREM, ANS activity
A
decrease

-progressively greater depths of unconsciousness
-slower, higher-voltage EEG patterns
-Eye rolling slowly
-Repositioning movements of the body, relative normal muscle town, and preserved deep tendon reflexes
4
Q
REM, ANS activity
A
increase (increased pulse, elevated BP, raised intracranial pressure, increased cerebral blood flow, greater muscle metabolism and in men, erections)
-Except for eye movements and normal breathing, people in REM sleep remain immobile with paretic, areflexic and flaccid

-EMG : no electrical activity from muscles
-EEG: intense activity, similar to EEK during wakefulness
5
Q
Why REM sleep is called as activated or paradoxical sleep.
A
discrepancy between intense ANS activity and the immobile body
6
Q
REM-induced ANS activity has been implicated
A
increased incidence of myocardial infarctions and ischemic strokes that strike between 6 am and 11 am.
7
Q
Light and dark cycles regulate the sleep-wake cycle in large part through their effect on the pineal gland’s synthesis and release of _______
A
melatonin

-melatonin regulates the suprachiasmatic nucleus, which has melatonin receptors on its surface
8
Q
Darkness promotes synthesis of
A
melatonin and its release into the plasma. Melatonin concentration rise at night. Both natural/artificial light suppresses melatonin synthesis and release
9
Q
Given it's reaction to light/dark, altered melatonin concentration may play a role in _______
A
seasonal affective disorder
10
Q
Melatonin, as medication increases ____________
A
sleepiness and REM sleep. It aids in the treatment of insomnia, jet lag, and possibly the delayed sleep phase syndrome
11
Q
_________ occupies a greater portion of sleep time
A
REM sleep
12
Q
REM induced paralysis
A
Sometimes REM is so abundant and forceful that its final period briefly spills into wakefulness.
In those cases, REM induced paralysis leaves people momentarily unable to move
13
Q
Neonatal sleep pattern
A
Neonates sleep 16-20 hours per day with a 50% spent in REM sleep
14
Q
Elderly sleep pattern
A
night time sleep is relatively short and fragmented by multiple brief awakening, especially early morning, have decreased total REM time, NREM sleep shrinks
15
Q
Dyssomnias
A
Either impair initiating or maintaining sleep (falling asleep or staying asleep) or cause excessive daytime sleepiness.
16
Q
Intrinsic Sleep Disorders –
A
Narcolepsy, Sleep Apnea Syndrome, Periodic Limb Movement, Restless Leg Syndrome, Kleine – Levin Syndrome
17
Q
Extrinsic Sleep Disorder –
A
inadequate sleep hygiene, hypnotics, stimulants, alcohol and toxin dependency
18
Q
Circadian Rhythm Disorders –
A
Time Zone Change (Jet Lag), shift work, delayed sleep phase
19
Q
Narcoleptic tetrad
A
-Excessive daytime sleepiness

-Cataplexy (transient muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror)

-Sleep paralysis

-Sleep hallucinations
20
Q
Narcolepsy criteria
A
1 of the following, 3x/week for the past 3 months:
(episodes of cataplexy)
1. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
2. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.
21
Q
Narcolepsy, could be from what deficiency?
A
Hypocretin deficiency
22
Q
Sleep Apnea criteria
A
Either one of these:

1. polysomnography showed at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms: Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.

2. polysomnography showed at least 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.
23
Q
Levels of sleep apnea
A
1. Mild: Apnea hypopnea index is less than 15.
2. Moderate: Apnea hypopnea index is 15–30.
3. Severe: Apnea hypopnea index is greater than 30
24
Q
Periodic Limb Movement Disorder
A
-Episodes movements of the limbs (predominately legs) during sleep.
-primarily during 1 and 2 of NREM sleep
** > 55 years old
-Can occur with restless leg syndrome and apnea

**Treatment – benzodiazepines and dopaminergic agents can suppress movements
25
Q
Restless Legs Syndrome
A
-Involuntary movements of the feet and legs, largely in response to an irresistible urge to move or unpleasant sensations.

-mostly in early stages of sleep

-Unpleasant sensations, such as burning and aching, deep in patient’s feet and legs

-May develop in some young pregnant women, mostly in individuals >45 years.

-genetic cause
26
Q
What may be responsible for RLS?
A
Decreased D2 receptor binding in the striatum may be responsible for the movements.
27
Q
Treatment for RLS
A
-dopaminergic medications suppress the movements, reduce the urge to move
-decrease D2 receptor binding, dopamine precursors (L-dopa) and dopamine agonists (ropinirole)
28
Q
Kleine-Levin Syndrome
A
periodic hypersomnia, affects predominately *adolescent males
29
Q
Hypersomnia episode
A
Recurrent 1-2 week episodes of sleep (hypersomnia). Pts typically have six episodes, during which they intermittently awaken to eat great quantities of food and display hypersexuality, irritability and other atypical behavior. When awake, they are confused, withdrawn and apathetic.

-No overt neurologic/psychiatrist disorder, endocrine or physiological findings
30
Q
Extrinsic Sleep Disorders
A
Personal, social, or drug- and alcohol-related factors imposed on the brain
31
Q
Parasomnias
A
Intrude in normal deep, slow-wave NREM sleep
-Confusional Arousals
-Sleepwalking
-Sleep Terrors
-Nightmares (with REM sleep)
-REM Sleep Behavior Disorder (with REM sleep)
-Bruxism
-Enuresis (girls over 5 and boys over 6- meds are DDAVP, imipramine)
32
Q
Last resort treatment for Parasomnias Arousal Disorders
A
benzodiazepines, imipramine, or paroxetine
33
Q
REM sleep behavior disorder
A
-some people have the ability to move and preserve normal muscle tone during REM sleep.
-Affected individuals hit, thrash, and make running movements during sleep as they are dreaming.
-Men older than 65 years old, may injure self or bed partner
-Psychotropics (TCA, SSRIs, mirtazapine) suppress REM sleep but induce REM sleep behavior disorder
-Treatment: benzodiazepine such as clonazepam