Sleep

Question 1

NREM stages

Answer 1

see screen shot of chart in folder

Question 2

Sleep Latency

Answer 2

• 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

Question 3

NREM, ANS activity

Answer 3

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

Question 4

REM, ANS activity

Answer 4

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

Question 5

Why REM sleep is called as activated or paradoxical sleep.

Answer 5

discrepancy between intense ANS activity and the immobile body

Question 6

REM-induced ANS activity has been implicated

Answer 6

increased incidence of myocardial infarctions and ischemic strokes that strike between 6 am and 11 am.

Question 7

Light and dark cycles regulate the sleep-wake cycle in large part through their effect on the pineal gland’s synthesis and release of _______

Answer 7

melatonin

-melatonin regulates the suprachiasmatic nucleus, which has melatonin receptors on its surface

Question 8

Darkness promotes synthesis of

Answer 8

melatonin and its release into the plasma. Melatonin concentration rise at night. Both natural/artificial light suppresses melatonin synthesis and release

Question 9

Given it’s reaction to light/dark, altered melatonin concentration may play a role in _______

Answer 9

seasonal affective disorder

Question 10

Melatonin, as medication increases ____________

Answer 10

sleepiness and REM sleep. It aids in the treatment of insomnia, jet lag, and possibly the delayed sleep phase syndrome

Question 11

_________ occupies a greater portion of sleep time

Answer 11

REM sleep

Question 12

REM induced paralysis

Answer 12

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

Question 13

Neonatal sleep pattern

Answer 13

Neonates sleep 16-20 hours per day with a 50% spent in REM sleep

Question 14

Elderly sleep pattern

Answer 14

night time sleep is relatively short and fragmented by multiple brief awakening, especially early morning, have decreased total REM time, NREM sleep shrinks

Question 15

Dyssomnias

Answer 15

Either impair initiating or maintaining sleep (falling asleep or staying asleep) or cause excessive daytime sleepiness.

Question 16

Intrinsic Sleep Disorders –

Answer 16

Narcolepsy, Sleep Apnea Syndrome, Periodic Limb Movement, Restless Leg Syndrome, Kleine – Levin Syndrome

Question 17

Extrinsic Sleep Disorder –

Answer 17

inadequate sleep hygiene, hypnotics, stimulants, alcohol and toxin dependency

Question 18

Circadian Rhythm Disorders –

Answer 18

Time Zone Change (Jet Lag), shift work, delayed sleep phase

Question 19

Narcoleptic tetrad

Answer 19

• 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

Question 20

Narcolepsy criteria

Answer 20

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.

Question 21

Narcolepsy, could be from what deficiency?

Answer 21

Hypocretin deficiency

Question 22

Sleep Apnea criteria

Answer 22

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.

Question 23

Levels of sleep apnea

Answer 23

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

Question 24

Periodic Limb Movement Disorder

Answer 24

• 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

Question 25

Restless Legs Syndrome

Answer 25

• 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

Question 26

What may be responsible for RLS?

Answer 26

Decreased D2 receptor binding in the striatum may be responsible for the movements.

Question 27

Treatment for RLS

Answer 27

• dopaminergic medications suppress the movements, reduce the urge to move
• decrease D2 receptor binding, dopamine precursors (L-dopa) and dopamine agonists (ropinirole)

Question 28

Kleine-Levin Syndrome

Answer 28

periodic hypersomnia, affects predominately *adolescent males

Question 29

Hypersomnia episode

Answer 29

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

Question 30

Extrinsic Sleep Disorders

Answer 30

Personal, social, or drug- and alcohol-related factors imposed on the brain

Question 31

Parasomnias

Answer 31

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)

Question 32

Last resort treatment for Parasomnias Arousal Disorders

Answer 32

benzodiazepines, imipramine, or paroxetine

Question 33

REM sleep behavior disorder

Answer 33

• 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