The Normal Sleep Flashcards
(149 cards)
1
Q
defined as a physiological state of partial unconsciousness that is reversible, cognitive and perceptual disengagement from and to the environment are seen during this temporary unconsciousness, and from which the arousal is possible in response to any internal or external stimuli.
A
sleep
2
Q
sleep’s effect on the body
A
Diminished activity of the skeletal muscles
Depressed metabolism
3
Q
sleep is a state of unconsciousness that is _____, and this differentiates it from coma.
A
reversible
4
Q
how to wake a sleeping patient properly
A
wake patient up inflict pain by pressing the nail bed and sternal rubbing
5
Q
the person is not aware of the environment during sleep, so he does not ______ most stimuli during sleep.
A
perceive (although he may sense it)
6
Q
Perception is different from –
A
sensation
7
Q
when a sensory stimulus is consciously recognized it is considered as
A
perceived.
8
Q
a sleeping person cannot take any conscious decision –
A
rather he reacts on instinct.
9
Q
This explains why patients suffering from _____ when aroused forcibly often commit violent acts.
A
sleep-walking
10
Q
It says that a person may be aroused with any
A
internal or external stimuli.
11
Q
Internal stimuli that may arouse a person include
A
pain, anxiety or dyspnea.
12
Q
External stimuli are often
A
auditory or tactile in nature.
13
Q
are active during sleep unlike other organs
A
Brain, heart, and lungs
14
Q
will continue functioning to keep respiration, heart rate and blood pressure normal during sleep
A
Brainstem
15
Q
Lack of sleep leads to
A
drowsiness, lack of concentration, impaired memory and physical performance, reduced ability to perform basic functions
16
Q
functions of sleep
A
restoration
energy conservation
17
Q
Recovery or recuperation from illness
A
Restoration
18
Q
restoration During NREM would promote
A
physical growth and healing
19
Q
During REM stage, it is an important role in restoration of brain processes like
A
Attention span
Learning and memory
Emotional healing
Performing basic social skills
20
Q
Increased energy use during wakefulness or wakeful hours must be offset by decreased energy consumed during sleep
A
energy conservation
21
Q
Restore physical growth and healing of the body
A
energy conservation
22
Q
Energy conservation theory
A
NREM declines with age
Energy requirement declines with age
23
Q
Sleep has many important parameters:
A
the total duration of sleep
maintenance of sleep
at what time of the day we fall asleep
24
Q
Two main Stages of Sleep
A
NREM- non-rapid-eye-movement
REM -rapid-eye-movement
25
3 stages of NREM
N1
N2
N3
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Transition stage between drowsiness and sleep, drifting or floating sensations
n1
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light sleep
n1
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Sudden muscle contraction or hypnic myoclonia
n1
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n1 duration
10-12 minutes
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patient is easily awaken
n1
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n1 waves
Alpha, theta, vortex wave
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Light sleep, arousal is more difficult
n2
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Lower heart rate, blood pressure, respiratory rate, temperature due to the start of energy restoration and relaxed body, snoring may occur
n2
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n2 waves
K complex, spindles, theta waves
35
deep sleep
n3
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no eye movement
n3
37
Vital signs are lowest in this stage, 20-30% lower, O2 consumption is low, very difficult to awaken
n3
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stage Important for mental and physical restoration
nrem
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Bed-wetting, night terrors, sleep walking, or common sleep disorders may occur
n3
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Temporary paralysis of most skeletal muscles, brain metabolism is increased to 20%, breathing rate fluctuates, irregular heart rate, snoring may or may not be present
rem stage
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If a person is very tired, REM is ____; more rested, ____ REM
low, higher
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rem how many minutes after N1?
70 to 90 minutes
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rem duration is only about
5-30 minutes
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You can remember dreams in this stage unlike dreams in deep sleep
rem
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rem waves
Has theta waves, no delta, k complex, and spindles; has saw tooth pattern
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total sleep time of an infant is around
18–20 hours,
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mid-adolescence sleep time
(6–8 hours),
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During old age, sleep reduces to
5–6 hours/day.
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Regarding continuity, infants have _____ and they tend to wake up multiple times.
fragmented sleep
50
Children often go to bed
early at night
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Children often go to bed early at night, however, during adolescence, they develop a
phase delay.
52
refers to delayed bed-time and wake time.
Phase delay
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Aging also influences the _____ of sleep
electrophysiology
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Children have a high proportion of _______, which reduces as the person grows old.
N3 (deep sleep)
55
Sleep is dependent upon two processes:
Homeostatic and Circadian
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These processes together decide when we will fall asleep and also the other characteristics of sleep, such as depth, duration, maintenance, and proportion of sleep stages.
Homeostatic and Circadian
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the two processes together decide when we will fall asleep and also the other characteristics of sleep, such as
depth, duration, maintenance, and proportion of sleep stages.
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also known as “S”
Homeostatic
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process makes us feel sleepy depending upon the duration of wakefulness
Homeostatic
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The longer the period of wakefulness, the _____ the sleep pressure
higher
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this process regulates the proportion of deep sleep (N3 sleep)
homeostatic
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this process regulates the proportion of deep sleep (N3 sleep) - the longer the period of wakefulness, the _____ the proportion of deep sleep.
higher
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The homeostatic process is dependent upon two major areas of the brain:
VENTROLATERAL PREOPTIC NUCLEUS (VLPO)
MONOAMINERGIC NUCLEI
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the sleep-promoting area
VENTROLATERAL PREOPTIC NUCLEUS (VLPO)
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which sends inhibitory signals through the GABAergic neurons to the wake-promoting area of the brain.
VENTROLATERAL PREOPTIC NUCLEUS (VLPO)
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Wake-promoting area
MONOAMINERGIC NUCLEI
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part of the reticular activating system (RAS).
MONOAMINERGIC NUCLEI
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The activity of both wake-promoting and sleep-promoting areas is modulated through another group of neurons, _____
the hypocretin neurons
69
that are present in the lateral and posterior hypothalamus.
the hypocretin neurons
70
decides whether to sleep or be awake
Hypocretin neurons
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modulate the activity of the other two areas of the brain in such a manner that only one state of consciousness, that is, wakefulness or sleep prevails
the hypocretin neurons
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Damage to the hypocretin neurons leads to a condition known as
narcolepsy
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a person is not able to maintain either states and experiences bouts of sleepiness during wakefulness
narcolepsy
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Overwhelming daytime drowsiness, difficulty in staying awake for long periods of time
narcolepsy
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known as process “C”
Circadian Process
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is dependent upon environmental light.
Circadian Process
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Certain other factors can also regulate this process:
• Food
• Emotions
• social activity
• Exercise
Circadian Process
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Certain other factors can also regulate circadian process:
• Food
• Emotions
• social activity
• Exercise
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Factors that affect the circadian rhythm
zeitgebers
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Rhythmically occuring natural phenomenon which acts as a cue in the regulation of the body’s circadian rhythm
zeitgebers
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is the strongest factor which can entrain the circadian rhythm.
LIGHT
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Environmental light falls on the retina and through the _______ (glutaminergic in nature), it sends signals to the
retinohypothalamic tract (RHT)
suprachiasmatic nucleus (SCN).
83
The SCN one of the nuclei of hypothalamus and acts as the _____ circadian clock.
‘master clock’
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During the dark, SCN sends signals to the ______ to secrete melatonin.
pineal gland
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is a hormone that is released into the blood and circulated to the various organs of the body.
Melatonin
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responsible for making us sleep
Melatonin
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The SCN also sends signals to the VLPO through the _______ and thus can activate it.
dorsomedial hypothalamus (DMH)
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In the presence of environmental light, melatonin secretion _______. This is why during the dark, we feel sleepy.
stops
89
To fall asleep, it is important that both the homeostatic and circadian processes are in the
same phase.
90
If homeostatic and circadian process are not synchronized, then we may feel
difficulty in falling asleep or staying awake.
91
factors affecting sleep
age
illness
environment
fatigue
lifestyle
emotional stress
smoking
diet
medication
92
If patient has weight loss, sleeping time will be
decreased
93
Hypnotics disrupt _____; lowers ____
N3 and NREM
REM
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causes insomnia and nightmares
Beta blockers (anti-hypertensive medications)
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can suppress REM stage
Narcotics
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characterized by theta waves in EEG; slow eye movement, and diminution of muscle tone
n1
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theta waves, sleep spindles, and K complexes in EEG; absent eye movements and low muscle tone
n2
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more than 20% of epoch has delta waves
n3
99
is characterized by low-voltage, mixed-frequency activity in EEG, rapid eye movement, and muscle atonia
rem sleep
100
normal sleep cycle
awake
n1
n2
n3
n4
n3
n2
rem
n2
101
These stages follow a characteristic pattern in normal persons where NREM and REM sleep keep alternating at an interval of
90–120 min.
102
Sleep starts with NREM sleep, and after approximately _____, the first episode of REM sleep appears.
90 min
103
This cycle continues throughout the night and during a 7–8 h sleep, an average healthy person has _____ cycles of NREM and REM.
4–5
104
the first half of the night is characterized by a high proportion of
N3 sleep.
105
REM sleep is regulated by the process “C” and it is predominantly seen during the
second half of the night
106
Stage of wakefulness, recorded when patient is awake and alert with eyes open
beta
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Relatively low voltage or amplitude and a frequency greater than 13 Hz.
beta
108
Known as “busy waves” of the brain
beta
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Relatively high voltage or amplitude and a frequency of 8-13 Hz
alpha
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Known as the “relaxed waves” of the brain
alpha
111
Recorded when individual is awake, but drowsy state, eyes are closed
alpha
112
Commonly seen during stage 1 sleep and REM stage
alpha
113
Bursts of alpha waves are seen during briefe awakenings from
sleep-called arousals
114
Relatively low frequency of 4-7 Hz and low amplitude of 10 micro-volts
theta
115
Known as “drowsy waves” of the brain
theta
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Individual is awake, but relaxed and sleepy
theta
117
Seen during stage 1, REM and stage 2
theta
118
Slowest of the four types of brain waves
delta
119
Frequency of less than 4 Hz and high amplitude (>75 uV) broad waves
delta
120
Known as the “deep sleep waves”
delta
121
Associated with a dreamless state, patient is not easily aroused
delta
122
Seen primarily during N3
delta
123
Intermittent high-amplitude, biphasic waves of at least 0.5 second duration that signal the start of stage 2 sleep
k complex
124
Consists of a sharp negative wave (upward deflection) followd by a slower positive wave (downward deflection), that is 0.5 seconds
k complex
125
Seen during stage 2 and sometimes in stage 3
k complex
126
are often superimposed on K complexes
Sleep spindles
127
Sudden bursts of EEG activity in the 12-14 Hz frequency (6 or more distinct waves) and duration of 0.5 to 1.5 seconds
sleep spindles
128
Mark the onset of stage 2, may be seen in stage 3 and 4 but it does not occur in REM
sleep spindles
129
Notched-jagged waves, frequency in the theta range (3-7 Hz)
sawtooth
130
Commonly seen during REM sleep, not part of criteria of REM sleep, but can be used to identify REM
sawtooth
131
Sharp negative (upward deflection) EEG waves, often in conjunction with high amplitude and short (2-7 Hz) activity
vertex
132
Amplitude of many vertex sharp waves are greater than 20 uV and may be as high as 200 uV
vertex
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Usually seen at end of stage 1
vertex
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alpha, theta, vertex
n1
135
k complex, spindles, theta
n2
136
delta
n3
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theta, sawtooth
REM
138
Absence of muscle tone during REM sleep (paralysis)
atonia during rem
139
is characterized by low voltage mixed frequency activity and sawtooth waves in EEG.
rem
140
REM sleep is modulated by_______situated in the brainstem.
laterodorsal tegmental/ pedunculopontine tegmental (LDT/PPT) cholinergic nuclei
141
_______ depolarize thalamic neurons leading to cortical activation that is important for _____
laterodorsal tegmental/ pedunculopontine tegmental (LDT/PPT) cholinergic nuclei
generation of dreams.
142
s in ventomedial medulla that secrete GABA and glycine on the anterior horn cells in spinal cord leading to profound atonia.
GABAergic cell
143
develops during REM sleep, leading to multiple ramifications that are clinically important.
Profound muscle atonia
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by producing atonia in upper airway muscles, in particular,______ it narrows the caliber of the upper airway and increases risks for ______
genioglossus, hypopnea
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largest muscle mass that makes up the tongue
genioglossus
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sudden muscle weakness when a person is awake),
cataplexy
147
a sign of nacolepsy
cataplexy
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absence of atonia during REM sleep leads to the
REM sleep behavior disorder.
149
is produced by the _________ in the spinal cord and the _____- on cells of the sub-dorsolateral tegmental nucleus.
atonia
glycine-mediated (glycineric) inhibition of the anterior horn cells
hypoglossal nerve by the REM
