Sleep & Sleep Disorders - Tsao Flashcards Preview

M2 Neuro/Psych > Sleep & Sleep Disorders - Tsao > Flashcards

Flashcards in Sleep & Sleep Disorders - Tsao Deck (21):


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

Delta waves

Alpha waves

Theta waves

K complexes

Beta waves



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?


25 hours


Time it takes to fall asleep 


time sleeping/time spent trying to sleep 

(should be close to 100%)



How much sleep is needed as


a newborn?

an adolescent?

an adult?

an older adult?


a newborn- 16-18 hours

an adolescent- 9-10 hours

an adult- 8 hours

an older adult- 7-8 hours


REM sleep

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

body function

EEG waves


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?


Frequent awakenings 

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

  -sleep apnea







What are four sleep disorders classified as parasomnias?




Night terrors


REM sleep behavior disorder




What the four core symptoms of narcolepsy?


How is a narcoleptic's sleep architecture different?


Sleep attacks/daytime sleepiness

Hypnogogic/hypnopompic hallucinations

Cataplexy (50% of cases)

Sleep paralysis


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


Daytime sleepiness

1 month duration


No caffeine after noon

AM exercise

Sleep routine

Relaxation techniques



What is Bruxism?


When does it occur?


How is it treated?



Tooth grinding


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