WEEK 3: Sleep Physiology and Disorders [Salonga] Flashcards by Amiel Lorenzo

is a state in which the person is aware of and

responds to sensory input from the environment

wakefulness

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a state of behavioral quiescence accompanied by
an elevated arousal threshold and a species-specific sleep
posture (recumbent sleep posture, closed eyes, diminished
responsiveness to external stimuli and decrease in or
absence of movements)

Sleep

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Sleep is an active process, irreversible state of responsiveness to the stimuli of the outside world. T or F

F. sleep reversible state of unresponsiveness

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give 5 functions of sleep?

Memory consolidation
Energy conservation
Body growth
Regulation of immune function
Protective behavioral adaptation

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2 classifications in the nomenclature in the stages of sleep?

R&K and AASM

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stages of sleep in R&K

wake (Stage W)
NREM (Stages 1 to 4)
REM (stage REM)

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stages of sleep in AASM?

Wake: Stage W
NREM: Stage N1, N2, N3 (N3+N4)
REM: Stage R

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NREM and REM occur in alternating cycles, each lasting approx __________ witha total of _________ cycles

90 - 100 mins; 4-5 cycles

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in healthy adults, NREM sleep accounts for how many percent of sleep time?

75-90%

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REM sleep accounts for how many % of sleep time?

10 - 25 %

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in NREM, how many percent is accounted for each sleep time per stage?

Stage 1: 3 -5%
Stage 2: 50 - 60%
Stage 3 and 4: 10 - 20%

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newborn sleeps approximately how many hours?

16-20 hrs

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how many hrs of sleep in childhood?

10 hrs

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In the full-term newborn, sleep cycles last approximately___________ alternating through a ______ hour
inter-feeding period).

60
minutes (50% NREM, 50% REM;

3-4 h

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2 basic process in the regulation of sleep and wakefulness?

Process C (Circadian Process)
Process S (Sleep homeostasis)

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There are two circadian peaks in wakefulness: one is during _________, and another is during ___________

Sleep propensity is least during these peaks of
circadian rhythms of arousal

one
occurring (early evening) and a second peak (late
morning).

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greatest sleep propensity is during periods of?

between 3 to 5 am and early-mid afternoon between 3 to 5 pm

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is characterized by an increase in sleep pressure
following sleep deprivation that is related to the duration
of prior wakefulness followed by a decline in sleep need
as sleep accumulates.

Sleep Homeostasis

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refers to the short-lived reduction
of alertness that occurs immediately following awakening
from sleep and disappears within 2 to 4 hours.

Sleep Inertia (process W)

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2 mechanisms in the control of daily rhythm of sleep and arousal?

Suprachiasmatic nucleus of the hypothalamus (body clock)

Pineal Gland’s secretion of melatonin

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this sets the suprachiasmatic clock?

Light

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tiny endocrine gland situated at the

center of the brain

Pineal Gland

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major pineal hormone?

Melatonin

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melatonin is derived from?

Tryptophan

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light supresses/increases melatonin secretion?

supresses

2 major RF ascending pathways projections into the brain?

Dorsal pathway and ventral pathway

Trace the dorsal pathway?

Dorsal pathway → thalamus → cerebral cortex (thalamocortical system)

Trace the ventral pathway?

Ventral pathway → subthalamus and posterior hypothalamus → basal forebrain and septum → cerebral cortex

Descending RAS function?

connects to the cerebellum and to nerves responsible for the various senses; helps maintain our posture and balance in wake state

``` Most wake circuits originate in the ________ which stimulate the thalamus, hypothalamus (Hyp) and basal forebrain. These projections also inhibit sleep centers ```

Brain stem arousal | nuclei (BAN),

Centers for NREM sleep?

Forebrain (anterior hypothalamus-preoptic region, including ventrolateral preoptic area [VLPO] and basal forebrain)

neurotransmitters of NREM sleep?

serotonin and GABA; others are adenosine and norepinephrine.

control centers for REM sleep?

Pons (pedunculopontine tegmental nuclei and the laterodorsal tegmental nuclei) Brainstem reticular formation, especially oral pontine reticular formation, other brainstem (lower medullary) and spinal cord neurons

Neurotransmitters for REM sleep?

Ach!!! others include GABA and glycine

circadian pacemaker?

Suprachiasmatic nucleus

Hypothalamus control of sleep, pls trace?

SCN > Supraventricular zone, Dorsomedial nucleus > Paraventricular nucleus, lateral Hypothalamus, VLPO (ventrolateral preoptic nucleus)

``` The PVN is stimulated by the SCN, in a circadian fashion, to produce __________ ```

corticotrophin releasing factor (CRF) which acts on pituitary gland, which in turn produces ACTH > adrenal glands will then release cortisol

______is one of the factors involved in the sleep/wake cycle through a feedback system whereby it can then influence activity in the hypothalamus.

Cortisol

``` is considered an underlying cause of insomnia and may be related to dysfunction of the HPA axis. ```

Hyperarousal

there is thought to be reduced basal | ACTH secretion and a reduction of central CRF. hyper/hypoarousal?

Hypoarousal

hypoarousal will lead to? hyperarousal will lead to?

sleep hallucinations

Body temperature is ______in the early morning, rising throughout the morning and then staying fairly steady until it begins to ________ in the late evening.

also at its lowest ; decline again

The human sleep–wake cycle is closely age linked: pls enumerate

newborn baby sleeps from 16 to 20 h a day o child: 10 to 12 h. o total sleep time drops to 9 to 10 h by mid-adolescence and to about 7 to 7.5 h during young adulthood o gradual decline to about 6.5 h develops in late adult life

``` Relaxed wakefulness (W) with the eyes closed is accompanied in the electroencephalogram (EEG) by____________ ```

posterior alpha waves of 9 to 11 Hz (cycles per second) and | intermixed low-voltage fast activity of mixed frequency

With drowsiness, as the first stage of sleep sets in, the eyelids begin to droop, the eyes may rove slowly from side to side, and the pupils become smaller, the muscles relax and the EEG pattern changes to one of progressively lower voltage and mixed frequency with a loss of alpha waves; this is associated with slow, rolling eye movements: what stage of sleep?

N1 stage

there is the appearance of 0.5- to 2-s bursts of biparietal 12- to 14-Hz waves (sleep spindles) and intermittent highamplitude, central-parietal sharp slow-wave complexes (vertex waves) on EEG. what stage of sleep?

represents slow-wave sleep with predominant theta rhythms o The first three stages are the NREM sleep.

N3 stage 3 of sleep

deep slow wave sleep with a preponderance of delta frequency activity. Vertex waves and sleep spindles are no longer evident.

REM sleep

is associated with further reduction in muscle tone except in the extraocular muscles and with bursts of rapid eye movement thus the term rapid eye movement

REM sleep

In the first portion of a typical night’s sleep, the normal young and middle-aged adult passes successively through stages N1, N2, N3, and R (REM) sleep. t or F?

T or F? The first REM period may be brief; the | later cycles have less stage N3 sleep or none at all.

In the latter portion of a night’s sleep, the cycles consist essentially of two alternating stages—REM sleep and stage N2 (spindle– K-complex) sleep. T or F?

What stage of sleep is this EEG characteristic: posterior reactive alpha rhythm

W - awake

What stage of sleep is this EEG characteristic: diffuse theta and loss of alpha

Drowsy - stage 1

What stage of sleep is this EEG characteristic: diffuse theta

REM - predominance of dreaming

What stage of sleep is this EEG characteristic: Sleep spindles and K complexes?

Stage 2 - light sleep

What stage of sleep is this EEG characteristic: hihg voltage theta and delta activity

stage 3 and 4 (N3) - deep sleep

Much of the night’s complex visual dreaming has been found to occur in the__________, with the qualifications noted below, and dreams are recalled most consistently if the subject is awakened during this time.

REM period

Subjects are easily aroused from REM sleep, but arousing a person during stage N3 is more difficult T or F?

uncontrollable random sleep attacks

Narcolepsy

temporary cessation of breathing while sleeping usually involving loud snoring

Sleep apnea

Circadian Rhythm sleep disorder: symptoms include varying degrees of difficulty in initiating or maintain sleep, daytime fatigue, decrements in daytime alertness and performance. resolves without treatment after 2 to 7 days

jet lag type

Circadian Rhythm sleep disorder: late appearance of sleep (around 2 am) but normal total sleep time and architecture which lead to sleep onset insomnia and difficulty awakening at desired time

Delayed sleep phase type

Circadian Rhythm sleep disorder: Symptoms of insomnia or excessive sleepiness, adaptation takes 1 to 2 weeks

shift work type

Disorder that produces complaints of insomnia or excessive sleepiness ▪ Intrinsic sleep disorders ▪ Extrinsic sleep disorders ▪ Circadian Rhythm Sleep Disorders

Dyssomnias

``` Disorders that intrude into or occur during sleep but do not result in insomnia or excessive sleepiness: Arousal Disorders ▪ Sleep-wake transition disorders ▪ REM related Parasomnias ▪ Other Parasomnias ```

Parasomnias

Happens during partial arousal from stage 4 sleep o Usually begins with piercing scream  It usually occurs soon after falling asleep, during stage 3 or 4 sleep

Sleep terror

o occurs during any sleep stage | o Is more frequent among children

Somniloquy

These are disorders occurring during deep sleep

``` o 1. Sleep walking (somnambulism) o 2. Sleep terrors or night terrors (pavor nocturnus) o 3. Sleep-related enuresis o 4. Bruxism o 5. Sleep-taking (somniloquy) ```

sleep disorder associated with HLA DR2

narcolepsy

aka ekbom sndrome?

restless leg syndrme

episodic hypersomnolence aka?

Kleine levin syndrome

REM sleep disorders?

Narcolepsy Nightmare REM behavior disorder chronic paroxysmal hemicrania

Initial step in sleep disorders treatments

lifestyle changes that include a healthy diet, regular exercise and good habits

pharmacological mx:

Dieatary supplements: melatonin and L tryptophan short acting benzodiazepines z drugs: zolpedium low dse antridepressants

WEEK 3: Sleep Physiology and Disorders [Salonga] Flashcards

(75 cards)