Sleep and Sleep Disorders ☺️ Flashcards
What is the function of sleep
Energy conservation Hormone production Immune argumentation Memory consolidation Mood regulation Increase optimal performance Clear toxins (B amyloid in PD)
Sleep stages
- properties
- EEG findings
Non REM
N1 - theta
-light sleep
-transition to N1 associated with hypnic jerks
N2 - sleep spindles/Kcomplexes
- deeper sleep
- 50% of total sleep
N3 - delta
- deep sleep
- parasomnias
REM - beta
- dreaming
- loss of muscle tone, erections
- if cycle starts here, indicative of narcolepsy, depression, sleep deprivation
SWS dominates 1st 1/3
REM dominated 3rd 1/3
Physiological changes in SWS
- HR
- BP
- RR
- O2, CO2 response
- Skeletal muscle tone
- Brain O2 use, CBF
- Thermoregulation
- Sexual arousal
HR - regular BP - regular RR - regular O2, CO2 response - decreased Skeletal muscle tone - preserved Brain O2 use, CBF - decreased Thermoregulation - homeothermic Sexual arousal - decreased
Physiological changes of REM
- HR
- BP
- RR
- O2, CO2 response
- Skeletal muscle tone
- Brain O2 use, CBF
- Thermoregulation
- Sexual arousal
HR - irregular BP - variable RR - irregular O2, CO2 response - very decreased Skeletal muscle tone - absent Brain O2 use, CBF - increased Thermoregulation - poikilothermic Sexual arousal - increased
Changes in sleep pattern with age
Newborns
-Increased REM due to increased neuronal changes
As we age -SWS decreases, total sleep decreases -REM gets earlier -N3 decreases, N1,2 increases Homeostasic drive decreases, earlier bedtimes
What are intrinsic circadian rhythm disorders
- presentation
- management
Disorders that affect the circadian rhythms directly but the sleep itself is fine
- DSPD, ASPD
- Non 24hr, irregular
Can’t advance onset
Insomnia/excess sleepiness
Hx of hypnotics, alcohol, psych interventions
- phototherapy, melatonins
- psych assessment for cause, CBT
What are extrinsic circadian rhythm disorders
- presentation
- management
When biological rhythms don’t match social requirements
- shiftwork
- jetlag
Insomnia, increased sleepiness with overlapping sleep and work schedule
Treatment
- distribution of rest days
- max 2-3 night shifts
- properly timed meals, melatonin
- scheduled light and dark
Short term
Long term consequences of SWD
Sleepy
Bad mood
Higher risks at work
GI issues
Sleep, mood disorders
CV, cancer risk
Alcohol/drug use
What is sleep deprivation and the consequences
Sufficient lack of restorative sleep over time => low-quality sleep, poor memory, fatigue
- increased HR variability
- decreased reflexes, increased tremors and aches
- irritability
- cognitive impairment, hallucinations, memory loss
- impaired immune system
- increased SNS activation => increased T2D and obesity risk
- alcohol becomes more potent
What is a parasomnia
Abnormal behaviors during sleep
-hard to diagnose due to decreased recall and investigations are often fine
SWS parasomnias
- examples
- properties
- management
Parasomnias associated with the 1st 1/3 of the night
Onset in childhood
- confusional arousal
- sleepwalking
- night terrors
- sleep related ED, sexsomnia
Properties
- FHx, precipitated by sleep deprivation, stress, alcohol, SA, fever
- amnesia
Reassurance, trigger avoidance, safety
CBT
Antidepressants, melatonin, clonazepam
REM parasomnias
-examples
2nd 1/2 of the night, 1-2x/night
REM
REM behavior disorder
Sleep paralysis
Medication induced nightmares (Bb, Ldopa)
RBD
- presentation
- risk factors
- investigations
- management
Decreased muscle atonia, acting out behaviors in sleep
Recall vivid violent dreams
May injure bed partner
Risk factors
- male, 50-65 with Lewy body pathology
- antidepressant use
-Hx, overnight polysomnograph
Patient education
Discontinue causative meds
Sleep separately
Clonazepam, melatonin
