Define: Human Circadian Cycle Awake EEG Sleep Latency Sleep Efficiency

Human Circadian Cycle = _25 hrs_ Awake EEG = _beta & alpha waves_ Sleep Latency = time it takes to fall asleep (\<10 min) Sleep Efficiency = time sleeping/time spent trying to sleep (100%)

Human Sleep Requirement Newborn Adolescent Adult Older adult

Newborn = 16-18 Adolescent = 9-10 Adult = 8 Older adult = 7-8

REM Sleep What % of total sleep? How long? What happens physiologically?

_25%_ of all sleep Every 90 min Each REM episode = 10-40 min Longer episodes – 2nd half of night BP, pulse rate, respirations – increase Penile & clitoral erection Skeletal muscle paralysis EEG – small, irregular brain waves Dreaming occurs

Stage 1 NREM Length Breathing HR BP Temperature Blood flow to brain EEG Ability to wake sleeper

Lasts about 10 min Breathing – slow & even HR – regular BP – decrease Temperature – decrease Blood flow to brain – decrease EEG – brain waves smaller, slower, irregular _Sleeper easily awoken _

Stage 2 NREM Length Bodily functions EEG Ability to wake sleeper

Lasts about 20 min Bodily functions continue to slow Even if eyes are opened, sleep cannot see EEG – larger brain waves, occasional quick bursts of activity _Sleeper can be awakened by sounds _

Stage 3 NREM Length EEG Ability to wake sleeper

Begins about 30-45 min after sleep is initiated EEG – brain waves are slow & large Up to 5X as large as in Stage 2 _Sleeper is much less easy awake, requiring loud noise or active attempts to wake _

Stage 4 NREM Bodily functions EEG Ability to wake sleeper

Bodily functions decline in the deepest state of rest EEG – brain waves are large, slow & make a jagged pattern _Sleeper experiences oblivion – if awakened, very disoriented _

Sleep & Sleep Disorders Flashcards by Michelle Cancel

**Normal sleep **

What are the 2 sleep states?

What are the primary sleep neurotransmitters?

2 sleep states
- REM (rapid eye movement)
- Non-REM sleep
Primary sleep NTs
- REM: ACh
- NREM: serotonin

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Define:

Human Circadian Cycle
Awake EEG
Sleep Latency
Sleep Efficiency

Human Circadian Cycle = 25 hrs
Awake EEG = beta & alpha waves
Sleep Latency = time it takes to fall asleep (<10 min)
Sleep Efficiency = time sleeping/time spent trying to sleep (100%)

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Human Sleep Requirement

Newborn
Adolescent
Adult
Older adult

Newborn = 16-18
Adolescent = 9-10
Adult = 8
Older adult = **7-8 **

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REM Sleep

What % of total sleep?
How long?
What happens physiologically?

25% of all sleep
Every 90 min
Each REM episode = 10-40 min
Longer episodes – 2nd half of night
BP, pulse rate, respirations – increase
Penile & clitoral erection
Skeletal muscle paralysis
EEG – small, irregular brain waves
**Dreaming occurs **

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What % of Stages 1, 2, 3 & 4 are Non-REM sleep?

Stage 1 = 5% sleep
Stage 2 = 45% sleep
Stage 3 & 4 = 25% sleep
- Most deep sleep (1st half of night)

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Stage 1 NREM

Length
Breathing
HR
BP
Temperature
Blood flow to brain
EEG
Ability to wake sleeper

Lasts about 10 min
Breathing – slow & even
HR – regular
BP – decrease
Temperature – decrease
Blood flow to brain – decrease
EEG – brain waves smaller, slower, irregular
_Sleeper easily awoken _

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Stage 2 NREM

Length
Bodily functions
EEG
Ability to wake sleeper

Lasts about 20 min
Bodily functions continue to slow
Even if eyes are opened, sleep cannot see
EEG – larger brain waves, occasional quick bursts of activity
_Sleeper can be awakened by sounds _

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Stage 3 NREM

Length
EEG
Ability to wake sleeper

Begins about 30-45 min after sleep is initiated
EEG – brain waves are slow & large
- Up to 5X as large as in Stage 2
_Sleeper is much less easy awake, requiring loud noise or active attempts to wake _

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Stage 4 NREM

Bodily functions
EEG
Ability to wake sleeper

Bodily functions decline in the deepest state of rest
EEG – brain waves are large, slow & make a jagged pattern
_Sleeper experiences oblivion – if awakened, very disoriented _

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How does sleep change with aging?

Decreased REM
Decreased Stage 3 & 4 sleep
Increased night-time awakenings – decreased sleep efficiency

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How does sleep change with depression?

Frequent awakenings – decreased sleep efficiency
Early morning awakening
Decreased REM latency – 1st REM within 45 min
Increased total REM
**Decreased Stage 3 & 4 sleep **

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Definitions

Dyssomnias

Parasomnias

Dyssomnias – abnormal timing, quality, & amt of sleep
Parasomnias – abnormal behaviors associated w/ sleep

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What are the different types if Dyssomnias?

Timing
- Narcolepsy
- Circadian rhythm sleep disorder
Quality
- Restless legs
- Sleep apnea
Amount
- Insominia
- Hypersomnia

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Key features of Narcolepsy

Sleep attacks
Hypnogogic/hypnopompic hallucinations
Cataplexy
Sleep paralysis

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Narcolepsy abnormalities in sleep architecture

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Decreased sleep latency
Decreased REM latency (<10 min)
Less REM overall

Narcolepsy

Neurobiologic factors

Epidemiological factors

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Neurobiologic factors
- Associated w/ hypocretin (orexin) deficiency
Epidemiologic factors
- Usually diagnosed in adolescence
- Significant genetic component

How is narcolepsy treated?

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Scheduled daytime naps
Psychostimulants
- Methylphenidate (Ritalin)
- Modafinil (Provigil)

What are the features of circadian rhythm sleep disorder?

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Inability to sleep at appropriate or desired times
2 types: delayed & advanced
Causes: intrinsic & extrinsic (shift work, jet lag)

How is circadian rhythm sleep disorder treated?

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Delayed sleep phase
- Melatonin 5-10 mg/hr before bedtime
- Light at desired waking time
Advanced sleep phase
- Light in the evening
Shift work
- Modafinil 100-200 mg or caffeine for alertness
- Melatonin or other hypnotic at bedtime

What are the features of restless legs?

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Uncomfortable sensation in legs
Repetitive limb jerking
Frequent night-time awakenings

Restless Legs

Epidemiology

Treatment

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Epidemiology
- Older adults
Treatment
- Anti-Parkinsonian agents
- Levodopa
- Carbidopa/levodopa (Sinemet)
- Ropinirole (Requip)

What are the features of sleep apnea?

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Cessation of breathing
CO2 increases
Frequent awakenings
Increased rate of sudden death

Sleep apnea

Associated features

Laboratory

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Associated features include:
- Snoring (if obstructive variant)
- Daytime sleepiness
- Morning headache
Laboratory: _respiratory acidosis _

What are the two types of sleep apnea?

* **Central Sleep Apnea** * _Decreased_ respiratory effort * **Obstructive Sleep Apnea** * _Normal_ respiratory effort * Airway obstruction

**Sleep apnea** Epidemiology Treatment

* Epidemiology * Central Sleep Apnea (_older_ adults) * Obstructive Sleep Apnea * _Middle-aged_ adults * Men \>\>\> Women * Associated w/ obesity * Treatment * Weight loss (if obesity present) * Continuous positive airway pressure (**CPAP**) * Medroxyprogesterone acetate * Uvulopalatoplasty/Tracheostomy

What are the features of insomnia?

* Difficulty falling asleep or staying asleep * 3X/wk or more * Duration at least 1 mo * Daytime sleepiness

**Insomnia** Epidemiology Treatment

* Epidemiology * At least _30%_ of population * Associated w/ **cognitive impairment & accidents** * Treatment * Avoid caffeine, especially in evenings * AM exercise * Develop sleep routine * Relaxation techniques * Hypnotic medication * May, however, decrease REM & delta sleep

What are the different types of Parasomnias?

* Bruxism (tooth grinding) * Night terror * Sleep walking * REM sleep behavior disorder

**Bruxism** Features Stage of Sleep Treatment

* Features * Tooth-grinding * Tooth damage & jaw pain * Occurs during **Stage 2 sleep** * Treatment: dental appliance worn at night

**Night terror** Features Stage of Sleep Population

* Features * Repetitive experiences of fright * Not easily awakened * No memory upon awakening * Occurs in **Stage 3 & 4 sleep** * Usually occurs in children

**Sleep walking** Features Stage of Sleep Treatment

* Features * Repetitive walking * Can be injured * Eyes open * No memory upon wakening * Occurs in **Stage 3 & 4 sleep** (usually 1st half of night) * Usually occurs in children * Treatment * Manipulate environment (safety)

**REM sleep behavior disorder ** Features Stage of Sleep Treatment

* Features * Motor activity while dreaming * Eyes closed * Awakens fully alert & able to recount their dream * **Occurs in REM (usually 2nd half of night)** * Associated w/ Parkinson disease & Lewy Body Dementia * Treatment * Environmental manipulation: safety * Melatonin or low-dose benzodiazepines

Sleep & Sleep Disorders Flashcards

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