What are the two sleeps states?
Which neurotransmitters are dominant in each state?
Rapid eye movement (REM) sleep: acetylcholine
Non-REM sleep: Serotonin
In which state of sleep are the following EEG patterns seen?
Sleep spindles- Stage 2
Delta waves- Stages 3 & 4
Alpha waves- Awake
Theta waves- Stage 1
K complexes- Stage 2
Beta waves- Awake
How long is the typical circadian cycle?
What is sleep latency?
What is sleep efficiency?
Time it takes to fall asleep
time sleeping/time spent trying to sleep
(should be close to 100%)
How much sleep is needed as
an older adult?
a newborn- 16-18 hours
an adolescent- 9-10 hours
an adult- 8 hours
an older adult- 7-8 hours
How frequently does it occur.
What physical changes occur?
How much of sleep does it comprise?
10-40 minutes every 90 minutes. REM sleep episodes get longer the longer you sleep.
Increased BP, pulse, respirations; skeletal muscle blockade; genital erections.
~25% of total sleep
How is sleep divided among stages 1-4 and REM?
Stage 1- 5% of total sleep
Stage 2- 45% of total sleep
Stage 3/4- 25% of total sleep (mostly occurs at beginning of the night)
REM- 25% of total sleep (mostly occurs towards the end of the night)
What general trends occur as a sleeper moves from stage 1 to stage 4 sleep?
quality of sleep
Sleep becomes deeper and sleeper is much harder to awaken
Body functions slow down through stage 4 (lower temp, HR, RR, etc)
EEG waves become larger, more erratic.
What happens to sleep as we age?
How much sleep is needed as we age?
Decreased REM, decreased stages 3/4, and increased night-time awakenings.
Older adults need about as much sleep as young, middle aged adults! (~8 hours)
What sleep changes are seen in depression?
Decreased REM latency (REM w/in 45 min)
Increased total REM
Decreased stages 3/4
What are dyssomnias?
What are parasomnias?
Dyssomnias-abnormal timing, quality, amount of sleep
Parasomnias- abnormal behaviors associated with sleep
What are some timing dyssomnias?
What are some quality dyssomnias?
What are some amount dyssomnias?
-Circadian rhythm sleep disorder
- restless legs syndrome
What are four sleep disorders classified as parasomnias?
REM sleep behavior disorder
What the four core symptoms of narcolepsy?
How is a narcoleptic's sleep architecture different?
Sleep attacks/daytime sleepiness
Cataplexy (50% of cases)
Decreased latency, REM latency, and overall REM
What deficiency is narcolepsy typically associated with?
What treatments are most effective?
Hypocretin (AKA orexin)
scheduled daytime naps
psychostimulants (methylphenidate, modafinil)
What are the two varieties of circadian rhythm sleep disorder?
What are appropriate treatments?
Advanced- patients are driven to go to sleep early, get up early
Delayed- patients stay up late and wake up late
Light therapy (at night for advanced, in morning for delayed)
melatonin before bed
What are symptoms of restless leg syndrome?
What treatments are available?
Uncomfortable sensation in legs
Repetitive leg jerking
Frequent night-time awakenings
Levodopa, carbidopa, ropinirole
What is the difference between central sleep apnea and obstructive sleep apnea?
What treatment is appropriate for both?
What treatments are appropriate for obstructive sleep apnea?
Central sleep apnea is lack of respiratory drive, obstructive is collapse of windpipe.
CPAP (positive pressure breathing machine) is appropriate for both.
Weight loss, uvulopalatoplasty/tracheostomy are appropriate for obstructive sleep apnea
What are the symptoms of insomnia?
What behavioral treatments can be effective?
Difficulty falling/staying asleep
1 month duration
No caffeine after noon
What is Bruxism?
When does it occur?
How is it treated?
Occurs during stage 2 sleep
Treated with dental appliances worn at night
What sleep disorders can occur during stage 3/4 sleep?
Do patients recall the experience?
Sleep terrors, sleep-walking
No, the patients almost never have any recall of the episodes
What are features of REM sleep behavior disorder?
What diseases is REM sleep behavior disorder associated with?
How is it treated?
Muscle movement while dreaming, but with memory of dreams after waking
Associated with Parkinson's and Lewy Body dementia
treated with melatonin, low dose benzodiazepines