week 2

Question 1

obstructive sleep apnea pathophys

Answer 1

collapse of upper airways with diaphragm still moving

paralysis of genioglossus muscle during REM sleep

Question 2

areas of brain damaged by OSA

Answer 2

mammillary bodies = short term memory loss
hippocampus = spatial orientation
insular cortex = sympathetic disregulation (increases SNS tone)
cerebellar deep fastigial nuclei = abnormal sympathetic outflow = HTN
hypothalamus = disrupts metabolic glucose control
anterior cingulate gyrus = DEPRESSION

Question 3

OSA and diabetes

Answer 3

86% of type 2 DM have OSA
increased brain injury
glucose levels increase with interrupted sleep

Question 4

OSA & depression

Answer 4

damage to anterior cingulate gyrus
gray matter and axon bundle
- causes depression

Question 5

Narcolepsy

Answer 5

defective balance of REM sleep & wakefulness
cataplexy = muscle paralysis = can have emotional triggers
-sleep paralysis
-hypnagogic hallucinations
-short REM sleep latency (4-5 min)
-dysrupted night time sleep
mech = hypocretin (orexin) = cell loss

Question 6

central sleep apnea

Answer 6

cheyne-strokes breathing
change from rapid breathing to stopping
loss of coordination between matching peripheral CO2 with central chemoreceptors –> Brain Damage

Question 7

pharmacotherapies for insomnia

Answer 7

benzos = short term or intermediate (tolerance occurs to hypnotic effects)
Triazolam, Temazepam = short half life, little hang over
non benzos = Zolpidem, Zaleplon, Esszopiclone
Ramelton = melatonin receptor agonist
Antidepressants = sedative effects
antihistamines = 1st generation - doxlamine & diphenhydramine (benadril)

Question 8

N-acetyl transferase

Answer 8

enzyme that catalyzes reaction for serotonin to melatonin in pineal gland

Question 9

regulation of N-acetyl transferase

Answer 9

NE mediated sympathetic innervation from superior cervical chain ganglia

Question 10

pineal gland

Answer 10

location of melatonin synthesis

located within the 3rd ventricle = releases melatonin into CSF

Question 11

ramelteon

Answer 11

melatonin receptor agonist

tx: insomnia

Question 12

melatonin

Answer 12

lipophilic hormone produced in pineal gland at night
synthesis controlled by postganglionic sympathetic fibers that innervate the pineal gland
stimulated by darkness and inhibited by light

Question 13

sleep stages

Answer 13

quiet sleep = N1, N2, N3

REM sleep

Question 14

quiet sleep

Answer 14

restorative sleep
night terrors, bed wetting, sleep walking @ N3 (no memory)
N2 = sleep spindles & K complexes
N3 = slow waves

Question 15

REM sleep

Answer 15

Ach = main NT in REM sleep
NE decreases REM sleep
muscle atonia (paralysis)
rapid eye movements (PPRF activity)
dreaming, autonomic storm - transient hyper & hypotension, penile erection, HR & RR increase)

Question 16

sleep cycle changes during course of the night

Answer 16

quiet sleep phases decrease & fewer large slow waves (N3 stage)
REM sleep phase increases

Question 17

control of quiet sleep

Answer 17

forebrain

Question 18

control of REM sleep

Answer 18

dorsolateral pons

pontine lesions cause loss of REM sleep atonia

Question 19

effects of age on sleep

Answer 19

neonates = more time in REM sleep and more total sleep
elderly = decreased REM & decreased total sleep & less continuous (wake up more)
decreases melatonin synthesis

Question 20

amygdala

Answer 20

activated during fear and involved in expressing fear and emotions and relaying it to others