Sleep Disorders

Question 1

How does the Ventrolateral AND Median Preoptic Center act as the “off” switch?

Answer 1

1. It increases GABA and Galanin activity

2. It turns off Histamine based TMN (Tuberomammillary nucleus) wakefulnesss

Question 2

When does VLPO/MNPO fire?

Answer 2

aLL OR NONE FIRING during NREM

It is silent during wakefulness

Question 3

Differentiate the roles of MNPO and VLPO? Explain as a function of timing of firing

Answer 3

MNPO puts you to sleep and VLPO keeps you asleep (MNPO fires mostly as one drifts into sleep while VLPO fires while asleep)

Question 4

Where does the transmitter fibers of MNPO and VLPO project?

Answer 4

To Arousal Centers (like LC, PAG, LDT/PPT, DR, Orexins)

Question 5

What molecule peaks during REM sleep?

Answer 5

Acetylcholine

Question 6

What molecules does ACh feedback inhibits during ReM sleep?

Answer 6

5HT, NE, DA…

Question 7

During what stage of sleep is desynchronized firing similar to wakefulness observed?

Answer 7

REM

Question 8

How is REM sleep induced atonia achieved?

Answer 8

GABA and GLY are released into SC MN tracts by stimulated neurons in the medulla

Question 9

What molecule increases while awake due to ATP breakdown?

Answer 9

Adenosine

Question 10

What is Adenosine’s relationship to sleep?

Answer 10

Adenosine stimulates the VLPO sleep center and yield s inhibitory feedback to wakefulness centers

Question 11

What governs Adenosine build up?

Answer 11

Astrocytes

Question 12

When do you restore ATP?

Answer 12

DURING SLEEP

Question 13

What pathway does caffeine interfere with to prevent sleep?

Answer 13

It interferes with the homeostatic sleep drive by binding to adenosine receptors (Adenosine usually activates neurons that promote sleep )

Question 14

What stimulates melatonin release from hypothalamus? from what nuclei?

Answer 14

Lack of light, suprachiasmic nuclei

Question 15

What controls the Circadian clock and how?

Answer 15

1. Genes and proteins* cause clock to go faster or slower or be synchronized.
2. Zeitgebers (exogenous melatonin, caffeine, OH, Light, food, exercsie/activity, social interaction)

• Cycle flips back and forth because it takes 24 hours to build up enough concentration of the proteins
  examples: CRY, CLK, BMAL, PER

Question 16

What are 3 common sleeping pills

Answer 16

Antihistamine
Blood Pressure Pills
GABA agonists

Question 17

Going to bed at the same time, getting rid of stimuli such as a clock ina room and cold T is a form of Psychotherapy known as…

Answer 17

Sleep Hygiene

Question 18

What are some key diagnosing factors of Insomnia?

Answer 18

• Patient has difficulty initiating or maintaining sleep
• Patient wakes up early morning
  Non-restorative sleep for 1 month
• Next day consequences of being tired upon awakening
• No organic, psychologic, or substance causes

Question 19

Sleep Deprivation leads to decrease of brain activity in what lobe? what are the effects?

Answer 19

Frontal Cortex has reduced activity (72 hours deprived> 67% less activity)

In addition to prefrontal cortex, decrease is also seen in the Ant. Cingulate Gyrus and Thalamus.

Question 20

What sleep disorder is characterized by excessive daytime sleepiness or inability to maintain wakefulness?

Answer 20

Hypersomnia

Question 21

What is the typical prescription for Insomnia?

Answer 21

Sleeping Pills and Sleep Hygiene

Question 22

What is the typical prescription for Hypersomnia?

Answer 22

Stimulants and wakefulness hygiene

Question 23

Should you block or push up RAS in Hypersomnia? Insomnia?

Answer 23

Push up, Block

Question 24

Should you block or promote Orexin and SCN system in Hypersomnia?

Answer 24

Promote

Question 25

What are the key clinical manifestation in patients suffering from Narcolepsy?

Answer 25

- Daily Sleep attacks x 3 months (Falling asleep with no warning) - Cataplexy (sudden loss of muscle tone) leading to drop attacks (sometimes triggered by huge emotional output) - Hallucinations - No REM latency (no delay) - Sleep Paralysis is common- eyes open, can't move like a seizure

Question 26

Contrast Hypnopompic and Hynogogic

Answer 26

Pompic- upon/right before awakening | Gogic- upon/right before sleeping

Question 27

What is treatment for Narcolepsy?

Answer 27

Stimulants and Sleep Hygiene (very effective to sleep for 2 hours every 20 minutes)

Question 28

What are some secondary diseases that result from breathing related sleep disroders?

Answer 28

Insomnia and Hypersomnia

Question 29

What are the two types of apnea?

Answer 29

Central: Brainstem forgets to signal bereathing Obstructive: airway atrophy blocks air from passing tissues Increased age and weight are RF for obstructive apnea

Question 30

What is a typical prescription for breathing related sleep disorders?

Answer 30

Avoid sedatives Take CPAP (mask that keeps airways open) Wear Dental devices ( mouth guards that keep jaw pushed forward) Surgery as a last resort to keep open airway via carving out tissues

Question 31

What drugs must you NOT give to apnea patients?

Answer 31

GABA , sleeping pills, and ALCOHOL b/c it will cause death as patients will lose breaths in sleep

Question 32

Jet Lag disorder is an example of what sleep disorder?

Answer 32

Circadian Rhythm Sleep Disorder (Delayed Type- fall asleep way too late and wake up way to o late)

Question 33

How does Circadian Rhythm Disorder lead to in/hypersomnia?

Answer 33

Sleep-wake cycle mismatch, shift , or synchrony

Question 34

In Advanced type, which patients are most common and when do they sleep/wake?

Answer 34

elderly patients often go to bed too early and wake up too early

Question 35

What is prescribed to patients of Circadian Rhythm Sleep disorder?

Answer 35

Sleep Scheduling, Benzodiazepines, Melatonin, exercise(in the morning), stimulants, or light therapy, sleeping pills

Question 36

Patients suffering from Nightmare Disorder/ Dyssomnia have what symptoms

Answer 36

Nocturnal Myoclonus- Periodic Limb movement, restless leg syndrome (creeping sensations-conscious movement)

Question 37

The disorder with long, frightening dreams occurs in what population most and often during what stage of sleep?

Answer 37

Children, during REM sleep

Question 38

Sleep Terror Disorder/sleepwalking disorder is characterized by what manifestations?

Answer 38

- Awake, disoriented, not consolable - No memory - 1st 1/3 night - NREM 9stage 3/.4 - SELF LIMITING

Question 39

Sleeping Pills often cause which disorder

Answer 39

Sleepwalking

Question 40

When dooes sleep walking mostly occur?

Answer 40

during 1st 1/3 of night, NREM (stage 3 or 4)

Question 41

Which sleep disorder is associated with teeth grinding? During what stage of sleep does this occur?

Answer 41

Sleep Related Bruxism, Stage 2

Question 42

What sleep disorder is characterized by loss of atonia uring REM?

Answer 42

REM sleep behavior disorder

Question 43

Which diseases are treated with Doopamine (D2) receptor agonists?

Answer 43

Restless Leg Syndrome and REM Sleep Behavior Disorders

Question 44

Somniloquy normally occurs in which population and durng what stage of sleep?

Answer 44

In children, and during all stages of sleep

Question 45

Sleep Paralyisis is characterized by an inabillityto move during which part of the sleep/wake cycle?

Answer 45

just prior to fallin g asleep or upon awakening