Sleep Disorders Flashcards
What are the 2 physiologic states of sleep
REM and NREM
What are components NREM sleep?
Stages 1-4
Starts sleep cycle
Each stage lasts 5-15 minutes
Deepest sleep
What are components of REM sleep?
High levels of brain activity
Dreaming occurs
What happens to physiologic functions in NREM?
Markedly reduced
Pulse slows 5-10 beats and is very regular
Respirations slow slightly, regular
Blood pressure lower
Seldom penile erections
Peaceful state relative to waking
What happens in stage 1 of sleep?
decreased activity from wakefulness
easily awakened
if woken up, feel like haven’t slept
may have hypnic myoclonic
what is hypnic myoclonic
feeling of falling
what happens in stage 2 sleep?
light sleep with spontaneous periods of muscle tone followed by muscle relaxation
body prepares to enter deep sleep
What happens in stage 3/4 of sleep?
deep “delta wave” sleep
repair and regeneration
builds bone and muscle
strengthens immune system
deep levels of mental functioning
associated with enuresis, somnambulance, and night terrors
what happens if awakened during stages 3-4 sleep?
often disoriented
brief arousals associated with amnesia
What happens physiologically in REM sleep?
Physiologic activity increased
Pulse, respiration, and BP high
Partial or full penile erection every REM period
Near-total paralysis of skeletal muscles
What is the most distinctive feature of REM sleep?
Dreaming
Can you dream in NREM sleep?
Yes, but usually don’t remember
How long are REM phases?
Usually about 90-100 minutes
Shorter earlier in sleep and longer after a few hours into sleep cycle
How long is the first REM period? Later? More REM periods occur when?
<10 min, 15-40 minutes each; last third of the night
Stage 4 is ____ related to REM sleep
inversely (have less stage 4 and more REM later in the night)
What does research say about serotonin and sleep?
Less serotonin–> less sleep; research has found prevention of serotonin synthesis decreases sleep
What does research/clinical say about norepinephrine?
More norepinephrine –> less sleep
Increased firing of NE neurons = less sleep
What are research/clinical findings about melatonin
Research: released in response to low light conditions
Clinical: less melatonin–> less sleep
What are research/clinical findings about dopamine?
Suppresses secretion of m….
REM sleep ____ over time
decreases
What age does REM sleep stabilize?
10 years old (20-25% sleep time is REM)
By the time you are 65+, ____ of sleep time is REM sleep and _____ is decreased
<20% (can be related to memory/cognition problems)
Stage 4 NREM
What is sleep pattern in healthy young adults?
Regular cycling between stage 1 and stage 4 sleep
Prolonged stage 4 periods earlier in sleep period
REM gradually lengthens as night goes on
What is sleep pattern generally in elderly adult
Decreased or absent deep sleep stages
More easily awakened from sleep
Less regular cycles
What does the sleep pattern in elderly adults cause?
Increased daytime fatigue and napping
Decreased quality of nocturnal sleep
How does sleep change in depressed patients?
Insomnia very common
Hypersomnia common, more in atypical depression
Increased wakefulness with more frequent wakeful periods, longer wakeful periods
Reduced sleep efficiency
Increased sleep onset latency
Reduced REM latency
Patients with depression somnogram looks similar to which population
elderly
What historical factors are important for diagnosing sleep disorders?
Problems falling asleep or staying asleep?
Excessive daytime sleepiness? (sleep apnea)
Abnormal movements or behavior during sleep?
Abnormal timing of sleep-wake cycle?
Unusal life-stressors?
Sleep environment?
What is difference between primary and secondary insomnia?
Secondary is due to other condition
What is the diagnostic criteria for insomnia?
One of more for at least a month: difficulty initiating or maintaining sleep, nonrestorative or poor quality sleep, early morning awakening
Despite adequate opportunity and circumstances for sleep
Deficits in daytime function due to impaired sleep
What are examples of deficits in daytime function that can be present due to sleep?
Impaired memory, concentration, attention
Excessive worry about sleep
Daytime somnolence, fatigue, or malaise
Depressed mood, irritability, or poor motivation
Accidents or errors while working or driving
Poor work or school performance
Tension headaches or gastrointestinal upset
What classifies as transient insomnia? Acute? Chronic?
<7 days, <30 days, 30+ days
What are causes of comorbid insomnia?
Depression or anxiety
Breathing related sleep disorder
Substance abuse or medications
What are impacts of acute alcohol intake on sleep?
Decreased sleep latency (fall asleep faster), REM sleep pattern cahnges, vivid drea,s, frequent awakening
What are impacts of chronic alcohol abuse on sleep?
Increased stage 1 and decreased REM
What are impacts of alcohol withdrawal on sleep?
Delayed sleep onset, intermittent awakening
What are impacts of smoking on sleep?
Difficulty falling asleep
What are impacts of excess stimulant (caffeine, cocaine, OTC) intake on sleep?
decreased total sleep time, delayed sleep onset
what are impacts of sedative withdrawal on sleep?
delayed sleep onset, intermittent awakening
How is comorbid insomnia treated?
Treat underlying cause/adjust medication to have SE of sedation if needed (benzodiazepines, TCAs)
nonpharmacologic treatment
Relaxation techniques
Meditation
Cognitive behavioral therapy
Regular exercise
Sleep hygiene
