Sleep

Question 1

What are the stages of the sleep cycle?

Answer 1

• Stages 1-4 of the NREM sleep

- REM sleep

Question 2

What occurs in NREM sleep?

Answer 2

• it is said to be DEEP sleep
• period of REDUCED HR, cerebral BLOOD FLOW, BP, tidal volumes
• Partial muscle relaxation

Question 3

How is the EEG pattern for NREM sleep?

Answer 3

• synchronised, RHYTHMIC EEG activity

Question 4

What occurs in REM sleep?

Answer 4

• increased BRAIN activity (similar to when ONE’s AWAKE)
• increased CEREBRAL blood flow
  -impaired THERMAL regulation
  -atonic muscles
  (except diaphragm and extraocular m)

Question 5

At what stage does Narrative dreaming occur and why is that convenient?

Answer 5

• during REM
• because its the stage at which MUSCLES in the body are ATONIC; therefore one wouldn’t be able to ACT out in their sleep

Question 6

Which stage is important?

Answer 6

The 4 NREM stages

• time of deep sleep
• only time where lost sleep is REGAINED
• allows RECOVERY of cortex after a LONG day

Question 7

When is REM sleep important?

Answer 7

it is important for early brain development- not needed for HIGHLY functioning brain

Question 8

What changes occur throughout to one’s sleep cycle as you grow older?

Answer 8

• neonates: 50% REM sleep (shorter cycles)

- elderly: REDUCED REM latency (INCREASED awakenings)

Question 9

What is the role of REM with memory storage?

Answer 9

• REM sleep CONSOLIDATES memory and “deletes” unnecessary memory

Question 10

What other physiological role does REM sleep hold true, esp. with Elderly people?

Answer 10

• maintains IMMUNOCOMPETENCE (why older people become more become more frail)

Question 11

What physiological process is NREM involved in?

Answer 11

• PROTEIN synthesis

- cell division and growth

Question 12

What controls the circadian rhythm?

Answer 12

• appetite, body T*, hormone secretions

- LIGHT entrains the body clock(by using the retinal GANGLION cells)

Question 13

Does sleep have any physiological role in muscle processing?`

Answer 13

• sleep helps with TISSUE repair; cell division peaks during sleep
• GH increases during NREM sleep

Question 14

What occurs with lack of sleep?

Answer 14

• PREFRONTAL effects such as one gets IRRITABLE
• have VISUAL ILLUSIONS
• microsleeps and LOSS of concentration

Question 15

What exact function is impaired in the Prefrontal cortex?

Answer 15

• routine and logical tasks are not affected!

- ALERTNESS is affected

Question 16

What occurs with sleep deprivation?

Answer 16

• more LETHARGIC
• wgt loss (despite eating more)
• skin ulceration and injury
• ?hypothermia/reduced immunity

Question 17

Sleep is a deadly killer in ______

Answer 17

RTAs

Question 18

Most suitable hours of sleep?

Answer 18

7-7.5 hrs

Question 19

How much is a mid-afternoon nap of 15mins worth?

Answer 19

90mins overnig[ht sleep

Question 20

What are the 2 types of Parasomnias?

Answer 20

NREM and REM

Question 21

What are the signs and symptoms of NREM parasomnias?

Answer 21

• non-dreamin
• confusional arousals
• sleep walking, TERRORS
• BRUXISM—grind teeth
• RESTLESS LEGS

Question 22

What is seen in REM parasomnia? And in whom?

Answer 22

• in latter 1/3 of night
• Nightmares
• sleep paralysis
• at any age; in children with PTSD or ANXIETY disorder.

Question 23

Which parasomnia precedes Parkinson’s Disease?

Answer 23

REM parasomnias

Question 24

What occurs in Narcolepsy?

Answer 24

• involuntary solmonence when EATING/TALKING
• HARD TO RESIST
• CATAPLEXY (70% of pts)
• hypnagogic halluncinations
• sleep paralysis
• RBD

Question 25

When is the age of ONSET for narcolepsy ?

Answer 25

50% of adults have symptoms teenager

Question 26

What is Narcolepsy a/w?

Answer 26

- REM sleep Behaviour d/o (RBD)

Question 27

What IVX are done for Narcolepsy?

Answer 27

- sleep test (Overnight Polysomnography) - Multiple sleep Latency test (4 twenty-five min NAPS schedules 2 hrs apart )-------record EEG, muscle activity and eye movement recorded

Question 28

How may a LP indicate nARCOLEPSY ?

Answer 28

LOW CSF hypocretin levels (<110pg/ml)

Question 29

Name examples of REM sleep behaviour d.o.

Answer 29

D.t to LOSS of muscle paralysis during REM sleep (seen usually); person will start to act out! - kick/ punch/slap in bed whilst still asleep - shout/ leap out - act out actions of dreams they clearly RECALL

Question 30

RBD is often seen in what demographic. | Which 2 conditions often present with RBD?

Answer 30

- in men (<50 y.o) | - PARKINSON's and MULTIPLE SYSTEM ATROPHY

Question 31

How to differentiate epilepsy from NREM/ REM sleep behavioural disorder?

Answer 31

- conducting a Polysomnography and EEG montage | - eyes are OPEN during an epileptic seizure accompanied by a post-ictal state of confusion

Question 32

Name the 3 types of dissociative disorders.

Answer 32

1. Dissociative d.o of MOvement 2. Dissociative AMNESIA 3. Dissociative IDENTITY disorder

Question 33

What are some symptoms of dissociation?

Answer 33

- amnesia - depersonalisation - derealisation - identity Confusion - indentity alteration - loss of FEELINGS - losing control of BODY movements

Question 34

What occurs with dissociative amnesia?

Answer 34

- pt does NOT remember things that have happened to them (memory LAPSE) - related to a traumatic event

Question 35

How is dissociative disorder different from a psychotic patient?

Answer 35

- Dissociative patients are AWARE

Question 36

What is obstructive sleep apnea?

Answer 36

- sleep d.o that causes you to stop breathing during sleep | - --random closure of airway > SNORING or CHOKING noises

Question 37

What may contrubute to obstructive sleep apnea?

Answer 37

- sleeping on your back | - tongue falls back, narrowing the airway