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Flashcards in Sleep Disorders Deck (32):

Sleep as an active process

Brain remains active while sleeping


5 stages of sleep

Stage 1, stage 2, stage 3, stage 4, REM


Stage 1 of sleep

Transition between sleep and awake
Person doesn't know if he/she is awake or asleep
Hypnogogic hallucinations: dreams that happen while partially awake


Stage 2 of sleep

Shallow sleep
Brain slows down


Stage 3 of sleep

Transition between shallow sleep and deep sleep


Stage 4 of sleep

Deep sleep
Makes person feel rested when he/she wakes up
Hard to arouse- if person is awakened, then is really groggy


REM (rapid eye movement) sleep

Paradoxical: person is firmly asleep, but brain is active as if awake
Body is paralyzed to prevent acting out dream


Way brain cycles through sleep stages

1 -> 2-> 3 -> 4 -> 3 -> 2 -> REM -> 2 -> ...
Cycle between REM stages lasts about 90 minutes
5-8 cycles per night


Objective methods of assessing sleep

Polysomnography (most common method): hook person up to several machines to measure brain waves, heartbeat, muscle movement, temperature, sounds produced, etc.
Actigraphy: measure movement during sleep


Subjective method of assessing sleep

Ask person how he/she is sleeping
Doesn't always line up with objective (may actually sleep just fine)



Difficulties in amount, quality, or timing of sleep



Abnormal behavioral and physiological events during sleep


Insomnia disorder

Difficulty initiating or maintaining sleep
Impairment during day
Unrelated to another condition


Epidemiology of insomnia

A good subset of people experience insomnia (30-45%), but only a small number experience insomnia not due to anything else (1-10%)
Sex: twice as common in females
Age of onset: young adult to middle age


Contributing factors to insomnia

Unrealistic expectations about sleep
Exaggerated belief about the negative impact of sleep difficulties
High levels of arousal
Poor sleep habits (staying up too late and sleeping in, drinking caffeine before bed)
Altered perception of sleep


Medications used to treat insomnia

Benzo/non-benzo hypnotics (Ambien): help to fall asleep, but don't give good sleep; addictive
Antihistamines (benadryl)
Melatonin (hormone that controls circadian rhythym)


CBT treatments for insomnia

Reduce cognitive arousal prior to going to bed
Tell self to stay awake (makes person fall asleep)
Train person to associate bed with sleep (don't do anything in bed other than sleep)
Fix sleep hygiene
Train person to spend as much time in bed as needed to sleep


Hypersomnolence disorder

Excessive sleepiness despite having had adequate sleep
Unrelated to another condition
Treatment: give person stimulant to help him/her stay awake



Falling asleep at inappropriate times
One of the following:
Cataplexy episodes (sudden loss of muscle tone while awake; often in response to strong emotions)
Hypocretin deficiency
Rapid transition to REM or falling asleep too rapidly


Sleep paralysis

Symptom of narcolepsy
As person is waking up, paralysis system stays on: person can't move


Hypnopompic hallucinations

Symptom of narcolepsy
Like hypnogogic hallucinations (people with narcolepsy also have these), but happen as person is waking up


Treatments for narcolepsy

Treating sleepiness: give stimulant
Treating cataplexy: give anti-depressant


Sleep apneas

Stop breathing during middle of night
Gasping for air, increasingly louder snoring
2 types: obstructive (throat closes while sleeping), central (breathing stops for reason other than throat closure)


Treatments for sleep apneas

Weight loss
Hook person up to mechanical device such as CPAP (pushes air down throat to keep it from closing)


Circadian rhythm disorders

Disturbed sleep due to alteration/misalignment of circadian system with life's demands
Can cause sleepiness or insomnia


Types of circadian rhythm disorders

Delayed sleep phase syndrome (person's body wants to be awake late)
Advanced sleep phase syndrome (person's body wants to go to sleep early)
Shift work type (shift work for a long period of time can screw up circadian clock)


Treatments for circadian rhythm disorders

Bright light to trick the brain into resetting system
Sleep medications (especially melatonin)


Types of parasomnias

REM related: nightmare disorder, REM sleep behavior disorder
Non-REM related (occur during stage 4 sleep): sleep terrors, sleep walking


Nightmare disorder

REM related disorder
Repeated nightmares that are well remembered
Oriented and alert upon waking


REM sleep behavior disorder

REM related disorder
Paralysis system doesn't work, so person acts out dream
Oriented upon waking
Treatment: protect person (ex- sleep in restrictive sleeping bag)


Sleep terror

Non-REM related disorder
Episodes of abrupt terror arousals: person wakes up terrified, doesn't remember why he/she is afraid, and can't go back to sleep
Don't remember dream: wake up from stage 4 sleep
Common among children and decreases into adulthood



Non-REM related disorder
Episodes of rising from bed during sleep and walking around
Generally blank face, unresponsive, and hard to arouse
No dream imagery recalled