Step 2 Psychiatry Normal Sleep and Sleep Disorders Chp. 16

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Non-REM?: slow of EEG pattern
a lot of Muscle Tone
No eye movement
What is non-REM?: brain is inactive
body is active
Non-REM STages? 1,2,3,4: 6-8 hours sleeping
What wave in EEG and distribution % stage 1?: Tetha Waves

alpha disappears, 5%
Steage 2?: k complexes/sleep spindles
45%
What is the longest stage we sleep in?: Stage 2
When does delta waves happen?: Stage 3 and stage 4
What % of sleep is spent in stage 3?: 12%
WHat % of sleep is spent in stage 4?: 13%
What is REM?: aroused EEG pattern

Penile Erections

Saccadic Eye Movements (dreaming)

Generalized Muscular ATONY (except middle-ear and eye muscles)
How long do we stay in REM?: 25%
What is the slowest waves in sleep?: Delta

Ala-Deltas go real slow
Anothe name for Stage 3,4 sleep?: Delta Sleep

Slow wave sleep

Deepest Stage

Hardest to arouse

Dissapear in the elderly
What is the easiest to wake up?: REM
What two stages do we wake up?: REM
or Stage 2
If you remember your dream what did you wake up in?: REM Stage
What is characteristic of REM throught the night?: the REM stages are longer as the night progresses

gets longer 1st REM 15-20
Last REM 30-40 minutes
Where do you find more rem?: 2nd half of the night
What is REM Latency?: From the moment you fall asleep to the 1st REM period

average 90 minutes
What are two things that affect REM latency?: Depression
(shortens 60 min.)

Narcolepsy (start REM after 10 min.)
What is sleep latency?: moment you go to bed to the moment you fall asleep

about 10-15 min.
People with insomnia what happens to sleep latency?: Sleep Latency increases
(longer)
If you are very tired what happens to sleep latency?: shortens

immediately fall asleep
Total sleep time changes w/ age?: baby sleeps 14-16 hours of sleep
Adolescents sleeps 8-10 hours

Elderly 4-5 hours/day

Total sleep time decreases with age
What happens to REM in age?: REM decrease with age

Everything decreases with age
What are the neurotransmitters of sleep?: SAND Mr. Sandman bring us our sleep

Serotonin increase (Initiates Sleep)
Acetylcholine increase (Dreaming REM)
Norepinephrine increases (REM)
Dopamine increase (arousal wakefulness
What Neurotransmitter causes induction of sleep?: Serotonin increase
What neurotransmitter causes REM dreaming?: Acetylcholine and Norepinephrine increase
What neurotransmitter wakes us up/arouses the person from sleep?: Dopamine increase
What is precursor of serotonin?: Tryptophan

(turkey sandwich and milk)

induces sleep
What does bromocriptine in sleep?: Dopamine agonist

sleeping less
it arouses you
wake up sooner
What does Haloperidol do to sleep?: Dopa antagonist

decreases DOPA
causes sleep
What do benzodiazepines do in sleep? What stage do they block?: blocks stage 4

increase sleep latency

can't give benzos more than 2 weeks
What does alcohol intoxication do to sleep?: supresses REM

sleep deprived
What happens w/ barbiturate intoxication and sleep?: supresses REM
When you are in withdrawal for barbiturate/alcohol?: REM Rebound

dream more
What happens w/ major depression and REM?: 1st rem starts sooner at 60 min.
also longer 1st REM

suppresion of DELTA
no 3,4 stages

early morning awakening
What is narcolepsy?: Patient that falls asleep suddenly

licence suspended

falls asleep when talking to friends
When question says he feels refreshed when awakening?: clue for narcolepsy
Narcolepsy has 4 things associated with it?: 1) sleep attack
2) cataplexy (pathognomonic)
3) hallucinations
hypogogic and hypnopompic
4)Sleep Paralysis (cant' move)

G gogic going to sleep
P waking uPPP!
What is cataplexy?: sudden loss of muscle tone

vs. syncope (no loss of consciousness)
Theory behind cataplexy?: enter REM

falls to ground

What triggers it
1) loud noise
2) stress
What is the tx of narcolepsy?: 1)Amphetamine
Psycho-stimulants

2) TCAs
REM suppressants

3) Gets forced naps during day
How do you repressed cataplexy in narcolepsy?: TCAs

tricyclics
What are the three clues to sleep apnea?: overweight

pat. snores

feels tired all day

Wife complains about too mnay
What is Sleep Apnea defined as?: Sensation of breathing for more than 10 seconds

pathologic >5 episodes an hour
>30 episodes during the night

usually more than 300 episodes
What is apnea associated with?: depression
mood changes
daytime sleepiness

wife complains of restlessness
pat. complains of dry mouth, dry throat in the morning
headaches in morning, hypoxemia, Pulm. hypertension
What are the 3 types of sleep apnea?: 1) Obstructive
2) Central
3) Mixed
What is the MC sleep apnea?: Obstructive
What is central sleep apnea?: muscle atonia in oropharynx: nasal, tongue, or tonsil obstruction
What is central sleep apnea involved in?: Lack of respiratory effort
Tx of sleep apnea?: sleep w/ a mask
O2
PEEP

surgical correction
Pat. 70yo man trouble sleeping? 7p.m. wake up at 3:00a.m.: Tell patient to go to bed later

not insomnia
What is the MC prescription of the elderly?: Benzodiazepines

don't give, makes them more confused
What triggers insomnia?: anxiety
depression
nervousness
What is stimulus control?: You only use the bed for sleeping

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