Sleep Agents

Question 1

What are the restorative purposes of sleep?

Answer 1

Energy conservation, immune function, body repair, glymphatic system

Question 2

What is the information processing purposes of sleep?

Answer 2

Development, neurogenesis, memory consolidation, pruning

Question 3

Stage one also called the drowsy period is

Answer 3

so light most people when awoken from this stage will say that they were not asleep

Question 4

Stage two has

Answer 4

sleep spindles (periodic bursts of activity resulting from interactions between the thalamus and the cortex

Question 5

Stage 3 nd 4 are called slow weave sleep and

Answer 5

are the deepest stages of sleep characterized by the development of delta waves

Question 6

REM sleep is

Answer 6

remarkably like that of the awake state but the body or at least the major muscles are paralyzed

Question 7

Non-REM sleep is characterized by

Answer 7

limited eye movement and a decrease in muscle tone and heart rate, metabolic rate and body temp decrease

Question 8

REM sleep is characterized by

Answer 8

rapid, darting movements of the eyes along with paralysis of most major muscle groups. heart and respirations increase to almost the level found when awake.

Question 9

REM latency

Answer 9

the time to the first occurrence of REM

Question 10

The lose of the ability to induce muscle paralysis

Answer 10

REM sleep behavior disorder

Question 11

Describe non-REM dreams

Answer 11

thoughts or person solving problems

Question 12

REM dreams

Answer 12

illogic, bizarre, and even hallucinatory

Question 13

Define sleep walking

Answer 13

Occurs during the first stage 4 non REM period of the night. The person will have open eyes, avoid obstacles, and have cognition clouded with no memory of the event. Best practice is to gently guide the sleepwalker back to bed.

Question 14

Define Night terrors

Answer 14

Extreme terror and an inability to be awakened. Usually in children between ages 4 and 7 and develops in the deep stages of non-REM sleep.

Question 15

Where is the Suprachiasmatic Nucleus located?

Answer 15

anterior hyupothalamus

Question 16

What does the Suprachiasmatic Nucleus do?

Answer 16

It regulates circadian rhythms using solar cues from the retina

Question 17

Without solar cue inputs how long is the Suprachiasmatic Nucleus cycle?

Answer 17

26 hours

Question 18

Why are CLOCK BMAL1, PER, and CRY significant to sleep cycle?

Answer 18

They are believed to drive the 24 hour cycling of SCN

Question 19

This specific group of neurons project to the thalamus and are responsible for awake and REM

Answer 19

Cholinergic

Question 20

These four neurons project to the hypothalamus and cerebral cortex and are active during awake cycles.

Answer 20

Noradrenergic, dopaminergic, serotonergic, and histaminergic

Question 21

This neurotransmitter is a key one in regulating wakefulness and is the ultimate target of many wake promoting drugs and sleep promoting drugs.

Answer 21

histamine

Question 22

Which receptor is best known as the target of antihistamines

Answer 22

postysnaptic histamine 1 (H1) receptor

Question 23

Stimulating the H1 receptor is likely to cause

Answer 23

wakefulness, normal alertness, and procognitive actions

Question 24

Blocking H1 receptors is likely to cause

Answer 24

sedation, drowsiness or sleep

Question 25

This receptor is best known for its action in gastric acid secretion and is the target of several anti-ulcer drugs and also exists in the brain

Answer 25

Histamine 2 (H2) receptors

Question 26

This histamine receptor is still under research as a way of blocking this receptor allowing the release of histamine to act at H1 receptors

Answer 26

H3

Question 27

The sleep/wake switch is a set of circuits located in the

Answer 27

hypothalamus

Question 28

The on switch is known as the wake promoter and is localized within the

Answer 28

tuberomammillary nucleus (TMN)

Question 29

The off switch is known as the sleep promoter and is localized within the

Answer 29

ventrolateral preoptic (VLPO) nucleus of the hypothalamus

Question 30

This key neurotransmitter in the sleep/wake switch is from the TMN

Answer 30

histamine

Question 31

This key neurotransmitter in the sleep/wake switch is from the VLPO

Answer 31

GABA

Question 32

How does the neurotransmitter GABA affect sleep/wake cycles?

Answer 32

It inhibits wakefulness

Question 33

What two neurons act as regulators of the sleep/wake switch

Answer 33

Orexin and melatonin

Question 34

What neuron do those with narcolepsy have less of?

Answer 34

Orexin

Question 35

What is the diurnal variation of depression?

Answer 35

worse in the morning

Question 36

What is one of the most common complaints among patients with mood disorders?

Answer 36

Insomnia

Question 37

How does effective treatment affect insomnia in those with a mood disorder

Answer 37

insomnia resolves

Question 38

An effective, although short-lived antidepressant is

Answer 38

sleep deprivation

Question 39

What gland secretes melatonin and is called both a clock and a calendar?

Answer 39

melatonin

Question 40

Based on recent research on melatonin in those with SAD what does it suggest as the reason?

Answer 40

neural circuits that mediate season change may be impaired

Question 41

In those with bipolar a lack of sleep can precede

Answer 41

a manic episode

Question 42

Sedative-Hypnotic drugs include benzodiazepines, barbiturates and Z drugs all of which act at

Answer 42

GABA A receptors to enhance the action of GABA

Question 43

When are benzodiazepines used for insomnia

Answer 43

second line hypnotics

Question 44

Which benzodiazepines are utilized for insomnia

Answer 44

flurazepam, quazepam, triazolam, estazolam, temazepam

Question 45

Why are barbiturates rarely used to treat insomnia now?

Answer 45

tolerance, dependence, high abuse potential, multiple drug interactions, fatal with an overdose

Question 46

What barbiturates are approved to treat insomnia?

Answer 46

thiopental, secobarbital, phenobarbital

Question 47

Barbiturates interact poorly with the antifungal

Answer 47

griseofulvin

Question 48

Barbiturates interact poorly with the antibiotics

Answer 48

rifampicin and rifabutin

Question 49

Barbiturates interact poorly with antileptics such as

Answer 49

carbamazepine, eslicarbazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, topiramate

Question 50

What are the signs of acute toxicity in barbiturates?

Answer 50

respiratory depression, coma, pinpoint pupils

Question 51

How do you treat Barbiturate toxicity?

Answer 51

maintain body heat, support blood pressure, activated charcoal to remove barbiturate from the body, maintain adequate oxygen

Question 52

What are the three Z drugs to treat insomnia?

Answer 52

Zolpidem (Ambien), Zaleplon (Sonata), Eszopiclone (Lunesta)

Question 53

What are the main side effects of Zolpidem (Ambien)

Answer 53

daytime drowsiness and dizziness

Question 54

What are the main side effects of Eszopiclone (Lunesta)

Answer 54

bitter aftertaste, headache, somnolence, dizziness, and dry mouth

Question 55

What are the main side effects of Zaleplon (Sonata)

Answer 55

headaches, nausea, drowsiness, dizziness, myalgia, and abdominal pain

Question 56

Which antidepressant is used at lower doses as a very effective hypnotic?

Answer 56

Trazadone

Question 57

What are the OTC antihistamines commonly used to help with insomnia?

Answer 57

Diphenhydramine and Doxylamine

Question 58

What are the adverse effects of antihistamines for insomonia?

Answer 58

less effective, tolerance develops quickly, daytime drowsiness and anticholinergic effects

Question 59

For those who suffer from initial insomnia and not sleep maintenance what is a good complementary therapy as well as prescription drug?

Answer 59

Melatonin OTC | Ramelteon (Rozerem) prescription

Question 60

What is the first line treatment in those who have insomnia due to restless leg syndrome?

Answer 60

Dopamine agonists such as ropinirole and pramipexole

Question 61

What is the second line treatment in those who have insomnia due to restless leg syndrome?

Answer 61

alpha-2-delta ligands such as gabapentin or pregabalin

Question 62

What is the only Orexin Antagonist that is FDA approved for insomnia in adults?

Answer 62

Lemborexant (Dayvigo)

Question 63

Modafinil and Armodafinil are both

Answer 63

hypersomnia and wake promoting agents

Question 64

What stimulants are there that are wake-promoting agents?

Answer 64

Methylphenidate (Ritalin, Concerta ER), Amphetamine, Caffeine, Gamma-hyroxybutyrate (Xyrem)