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Flashcards in Sleep Deck (20):
1

Consequences of short term stress

Headache
Fatigue
Difficulty Sleeping
Upset Stomach
Irritability

2

Consequences of Long Term Stress

Depression
High Blood Pressure
Abnormal Heart Rhythm
hardening of Arteries
Heart disease/attack
Ulcers
Irritable Bowel syndrome
Cramps
Constipation
Weight gain/loss
Change in sex drive
Change in sex performance
Fertility problems
Asthma flare up
Arthritiz flare-up
Acne
eczema
Psoriasis

3

Physiology of Stress

1. CRH AVP expressed in hypothalamus
2. Stimulate ACTH secretion
3. Corticosterone and noradrenaline release from adrenal gland
Counteracted by inhibitory effects from glucocorticoid receptors expressed n the hippocampus, hypothalmus, and anterior pituitary

4

Sleep Stages

Rapid Eye Movement (REM)
Where recallable dreams from

Stage 1: Light Sleep
Stage 2: First stage of real sleep
Stage 3 and 4: Deep, restful sleep

5

How much sleep do younger adults need?

7-9 hours

6

Stress and Sleep

Blocks that cascade of chemical and hormonal cascades that lead to activation of the stress pathway
Adenosine signals to the pituitary to reduce ACTH

7

Adenosine

Builds up from hydrolysis of ATP
Amount of Adenosine produces relative to amount of neural and glial processing
Sleep
Regulates hormone levels
Refreshes the mind
Promotes clearer thinking
Gives the body a chance to repair and restore itself
Reduces an individuals perception of stress

8

Light Exposure and Suprachiasmatic Nucleus

Body internal clock for sleep- suprachiasmatic nucleus
Receives light directly from eye to regulate clock

9

Light exposure and melatonin

Increase in light exposure causes decrease in melatonin
Melatonin controls sleep and wake cycles- reduction in melatonin is increased feelings of sleepiness
Also increases risk for cancer, impairs immune system, cardiometabolic consequences

10

Drugs that Promote Wakefulness

CNS Stimulants
Anphetamine (Adderall)
Methylphenidate (Ritalin)
Pemoline (Cylert)
Modafinil (Provigil, sparlon)
OTC
Pseudophedirine (Sudafed)
Phenylpropanolamine
Caffeine
Nicotine
Cocaine

11

Ideal Hypnotic

No withdrawal or tolerance
Short duraction of action
Rapid onset of symptoms
No impairment of post sleep function
Increase of recuperative sleep time

12

Sedative/ Hypnotics (Barbiturates)

Phenobarbital
Pentobarbital
Secobarbital
Amobarbital
Thiopental

13

Sedative/ Hypnotics (Benzodiazepine)

Flurazepam (Dalmane)
Quazepam (Doral)
Estazolam (Prosom)
Temazepam (Restoril)
Triazolam (Halcion)

14

Sedative/ Hypnotic (Other prescription)

Tricyclic antidepressant
amitriptyline
nortriptyline
imipramine
doxepin
Antidepressant
trazodone

15

Sedative/ Hypnotic (Other OTC, non benzo)

Zolpidem (Ambien)
Zopiclone (Imovane)
Eszopiclone (Lunesta)
Zaleplon (Sonata)

16

Zolpidem(Ambien)

Unrelated to benzodiazepine
Selectively binds to BZ1 receptor
Devoid of muscle relaxant or anticonvulsant behavior
Preserves stage 3 and 4

17

Ramelteon (Rozerem)

New class of sleep agents
Selectively binds to MT1 and MT2* receptors in the suprachiasmatic nucleus and not GABAa
Differs from zolpidem, eszopiclone, zalepone
MT- melatonin

18

Suvorexant (Belsomra)

New class of medication to treat insomnia
Selective orexin (Hypocretin)
receptor antagonist
Blocks endogenous alertness modulating molecule hypercretin

19

Drug Withdrawal

Becoming drug dependent on hypnotics means that the body has achieved a homeostasis that is dependent on this drug
During withdrawal, homeostasis is disrupted, causing both insomnia and stress
- Drugs not the best way to maintain sleep

20

Cognitive Behavioral Therapy

Bad sleep habits develop during chronic insomnia
Bedroom has cues for stress, anxiety, frustration
Strengthen association between bedtime stimuli and sleep only