Behavioral Block 3-R

ptheodore's version from 2015-11-09 14:30

Sleep Disorders

Question Answer
Which stage of NREM Sleep do we spend 45% of total sleep time?N2 (stage 2)
Which stage of NREM sleep do we spend 25% of total sleep time?N3 (stage 3 & 4)
EEG becomes progressively synchronized rhythmic activityNREM
Higher muscle tone, absence of eye movements & Absence of conscious thoughtsNREM
Desynchronized EEGREM
Saccadic eye movementsREM
Sexual arousal & DreamingREM
Which sleep pattern begins with pontine activity?REM Sleep
Which stage of the NREM Sleep lasts 1-7 mins, People usually claim they were not asleep if “woken”, Alpha waves predominateN1 (stage 1)
Is the first true stage of sleep (i.e., light sleep) & EEG shows sleep spindles (12-14 Hz) and K-complexes (~0.8Hz)N2 (stage 2)
Moderately deep sleepN3 (stage 3)
Decreased heart rate and respirationN3 (stage 3)
Difficult to wake upN3 (stage 3)
Which stage of the NREM Sleep EEG is characterized by Sleep spindles & Delta waves (1.6-4Hz) Stage 3 (N3)
EEG is dominated by slow, large amplitude, delta wavesStage 4 (N3)
Muscle tone is only slightly decreasedStage 4 (N3)
Reflexes are intact (sleep-walking (paranesia) can occurN3
Only a degree of delta waves activity & Disorders (night terrors, somnambulism) occur duringN3
Quick, random eye movements & Somatic inhibition (“paralysis”)REM Sleep
Paradoxical sleepREM Sleep
Most vivid dreams occur duringREM sleep
Which sleep pattern associated with the following characteristics, 3-5 cycles per night, REM cycles increase in length, 25% of total sleep (but decreases with age) and 90-120 mins in totalREM Sleep
It occurs during REM sleep (i.e., very variable temperature, not homeothermic)Poikilothermic regulation
Poikilothermic regulation occurs duringREM sleep
REM rebound occurs duringREM Sleep
Loss of REM sleep one night increases REM sleep the following nightREM Rebound
Pulse, respiration, BP, all increase to awake levels (or even higher) duringREM sleep
Controlled by the hypothalamic suprachiasmatic nucleus (SCN)Circadian rhythms
Broadly decreases as NREM deepens, But rises compared to wakefulness during REM sleepSympathetic activity
Changes in pulse and BP are primarily determined by the ANS, BP decreases (“nocturnal dipping”)Cardiovascular
Is less adaptive during sleepVentilation and respiratory flow
Suppressed during REM and NREM sleepCough reflex
Response is lower in NREM sleep than during wakefulness and decreases further during REM sleepHypoxic ventilatory
Arousal response to respiratory resistance is lowest in N3
Significant reduction in blood flow and metabolism in NREMCerebral blood flow
Blood flow and metabolism in REM sleep isincreased in the limbic system and visual association areas
Growth hormone secreted after sleep onset
Thyroid hormone secretion late evening
Melatonin increases inlate evening
Which NT Increases sleep efficiency and REM sleepIncreased ACh
Which NT Decreases sleep efficiencyIncreased DA
Which NT increases sleep efficiency and N3Increased 5-HT
Which NT decreases sleep efficiency and REM sleepIncreased NE
Ratio of total sleep time and total “in bed” timeSleep efficiency
Period from turning out lights to Stage II sleepSleep latency
Period between onset of sleep and the first REM periodREM latency
Persistent difficulty falling asleep or staying asleepPrimary Insomnia
Problems falling asleepSleep onset (initial) insomnia
Problems staying asleepSleep maintenance (middle) insomnia
Early morning awakening with difficulty getting back to sleepLate insomnia
Difficulty falling asleep, maintaining sleep, or waking early for at least 3 months + at least 3 nights per week are clinical features of which sleep disorder?Primary Insomnia
Preferred approach (Mayo) CBT, Deconditioning (sleep in other bed, change habits), Massage, Meditation & Cognitive therapy are the psychological treatments forPrimary Insomnia
Benzodiazepines is the drug for which sleep disorder?Primary Insomnia
Excessive daytime sleepiness (EDS) despite normal main period of sleep, or excessive sleeping through the main periodPrimary Hypersomnia
Narcolepsy (spontaneous falling asleep), Sleep deprivation & Stimulant withdrawal are common causes forPrimary Hypersomnia
Self reported excessive sleepiness despite a main sleep period lasting at least 7 hours with at least one of the following, Recurrent periods of sleep, or lapses into sleep on the same day, A prolonged main sleep episode of more than 9 hrs that is non-restorative, & Difficulty being fully awake after abrupt awakening are clinical characteristic forPrimary Hypersomnia
Treatment for Primary Hypersomniaamphetamines or sometimes SSRI’s
Periods of extreme daytime sleepiness (EDS) and sudden “sleep attacks” lasting a few seconds to several minutesNarcolepsy
People may fall asleep at any time; When having a conversation, Playing sports (despite elevated arousal), Eating & DrivingNarcolepsy
Do not sleep much more in 24hrs than normal sleepersNarcoleptics
Low levels of the hyptohalamic hypocretin lead to which sleep disorderNarcolepsy
Muscular weakness triggered by strong emotions such as (laughter, anger and surprise)Cataplexy
Associated with loss of hypocretin producing cellsCataplexy
Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day, At least 3 times a week for 3 months or moreNarcolepsy
Medical treatment for NarcolepsyModafinil and sodium oxybate
Antidepressant effective in controlling Cataplexy
The following characteristics, Maintain a regular sleep schedules, Avoid alcohol, caffeine, smoking before bedtime, Avoid large, heavy meals just before bedtime, Maintain a comfortable warm bedroom & Exercise will help controlling which sleep disorder?Narcolepsy
loss of hypocretin permanentCatalplexy
At that time my job was as an auditor; we wore computers on our hips and would inventory stores by counting each everything we saw on the shelves. Countless times I would be walking down an aisle counting and someone would call my name or I would bump into something. I would jump out of my skin, and then, and only then realize I had been asleep! I had just counted thousand of dollars worth of products and did not realize it or could I recall counting them. The real clincher is, the count was wrong and needed to be recounted the majority of the timeNarcolepsy
Transient, generalized, inability to move or speak during the transition from sleep to wakefulness, Occurs with ~60% of narcoleptics, Frequently after arousal from REM sleepSleep Paralysis
Cortical awakening before termination of REM-related atonia & Represents intrusion of REM sleep atonia into wakefulness are causes ofSleep Paralysis
Vivid, dreamlike hallucinations at sleep onsetHypnagogic hallucination
Ditto, but at sleep offsetHypnopompic hallucinations
Excessive relaxation of pharyngeal muscles causes snoring or even restriction/collapse of the upper airway Obstructive Sleep Apnea Hypopnea
Excessively shallow breathingHypopnea
Breathing repeatedly stops and starts without obstruction (less common than OSA)Central Sleep Apneas
Causes repeated episodes of apneas and hypo-apneasCheyne-Stokes breathing pattern
Caused by variability in respiratory effortRepeated episodes of apneas and hypo apneas
Failing to breathe rapidly enough or deeply enoughObesity hypoventilation syndrome
Obesity hypoventilation syndrome is also known asPickwickian Syndrome
A sleep disorder which characterized by Low Sp02 and high blood CO2Pickwickian syndrome
Sleep is delayed two hours or more from normal resulting in sleeping and waking later, Overall normal amount of sleep, just offset Delayed Sleep Phase Syndrome (DSPS)
Opposite of Delayed Sleep Phase Syndrome (DSPS) & Often comorbid with depressionAdvanced Sleep Phase Syndrome (ASPS)
Disorganized sleep-wake pattern, that are variable throughout the 24 hour periodIrregular Sleep–Wake Type
Free-running circadian rhythms that drift (sometimes in line with true circadian rhythms of 25hrs)Non-24-hour Sleep-Wake Type
What are the two types of circadian Rhythm disorders?Irregular Sleep–Wake Type & Non-24-hour Sleep-Wake Type
Sleep walking (somnabulism) occurs duringN3
Night terrors involve non-specific feelings of terror occurs duringN3
Involves repeated awakenings due to nightmares, Detailed recall of extremely frightening dreamsNightmare disorders
Which sleep disorder is normally associated with somatic inhibition?REM Sleep Disorders
During which sleep disorder Inhibition of motor neuron activity occurs?REM Sleep Disorders
This pathway does not work properly so somatic motor neurons are not inhibitedREM Sleep
Acting out dreams, grunting thrashing, Usually in men 60 yrs and olderREM Sleep disorders
Normally found during REM sleep, is not functioning properly in REM behavior disorderThe atonia or sleep paralysis
REM Sleep Disorders are Effectively treated withClonazepam (benzodiazepine)
An urge to move legs accompanied/caused by unpleasant sensations, Worsens during periods of rest or inactivity, Symptoms partially or totally relieved by movement, & Worse in the evening or night or present only at night Restless Leg Syndrome
Which sleep disorder Accompanied by at least one of the following; Fatigue or low energy, Daytime sleepiness, Cognitive impairments, Mood disturbance, Behavioral problems, Impaired academic or occupational function, & Impaired interpersonal/social functioningRestless Leg Syndrome
Involuntary contractions of leg muscles, Extension of toes, Flexion of ankle and kneeNocturnal myoclonus (periodic limb movement syndrome)
Most often associated with a wide variety of nervous system disorders, such as MS, Parkinson's, Alzheimer‘s, or CJDNocturnal Myoclonus
Grinding or clench teeth at night Sleep Bruxism
The followings are characteristics of which sleep disorder; Considered a sleep-related movement disorder, High rate of comorbidity with snoring and sleep apnea, Can result in worn teeth, facial pain, and headaches, & Causes unknown, but stimulants, age, stress are factorsSleep Bruxism
Infancy and childhood disorder charactherized by repetitive movements immediately prior to sleep onset and into N1Jactatio Capitis Nocturnis
Body rocking while on the hands and knees, Head banging, & Head rollingJactatio Capitis Nocturnis
Ranges from mumbling to complicated short dialogues or conversations, most commonly in males & children, can result from stress, depression & sleep deprivationSleep Talking