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Benefits of proper mount of sleep ✔✔- Improves memory
- Improves learning
- Improves concentration
- Improves health in general
Does the body shut down when we sleep? ✔✔no, sleep is an active process. We are just not conscious of what happens in our bodies.
What controls the sleep-wake cycle? ✔✔It is primarily controlled by the interaction of the Sleep Homeostatic Drive (Accumulation of adenosine and "somnogens" such as cytokines) and the Intrinsic Circadian Timekeeping System (The effect of light and darkness on the sleep wake cycle and timely release of hormones)
How many types of sleep are there? ✔✔There are two. NREM and REM
NREM is broken into how many stages? ✔✔3 stages.
- N1 which is light sleep. Usually the first stage of sleep.
- N2 still fairly light sleep and covers the majority of sleep we get during the night.
- N3 Deep Sleep (AKA slow wave sleep)
Physiological Variables in NREM sleep ✔✔- Heart rate is regular
- Respiratory rate is regular
- BP is regular
- Skeletal muscle tone is preserved
- Brain O2 consumption is reduced.
- Response to CO2 is the same as wake
- Response to O2 is the same as W
- Penile tumescence, vaginal engorgement is infrequent
- Temperature is homeothermic
Homeothermic ✔✔having a body temperature that is constant and largely independent of the temperature of its surroundings. Stable body temperature of about 98.6F/ 37 C
Physiological variables during REM sleep ✔✔- Heart rate is irregular
What is NREM sleep believed to be for? ✔✔NREM sleep is believed to help restore the body/
What is REM sleep believed to help? ✔✔REM sleep is believed to help restore the mind
When do we obtain the best sleep? ✔✔When it is consolidated
Does the amount of sleep we need throughout the life cycle changes? ✔✔Yes, it does.
Infant sleep ✔✔- Not born with same sleep functions as adults.
- Sleep stages are not fully developed.
- Quite sleep- NREM like
- Active Sleep- REM like
- Indeterminate sleep (mixed)
Infant 0-3 months ✔✔-Trace alternant pattern of quite sleep (NREM)
-Continuous medium activity (active sleep and wakefulness)(REM)
- Sleep onset REM is common and may continue up to 6 months of age
- Sleep is approximately 50% quite sleep, 50% active
- Cycle between active and quite sleep about every 45-60 minutes.
Transitions may be difficult to identify.
What is the cycle of sleep in an infant 0-3 months? ✔✔Sleep is approximately 50% quite (NREM) and 50% Active (REM).
Infant 0-3m. what is the timing for the cycle between active (REM) and quite (NREM) ✔✔The cycle between active (REM) and quite (NREM) is about 45-60 minutes.
Infant 0-3,. Are the cycle changes easy to identify? ✔✔Transitions between the cycles can be difficult to identify.
Newborns need how many hours of sleep? ✔✔Between 16-18 hours per day
What kind of sleep do newborns have? ✔✔sleep is polyphasic
By 12 months of age, REM sleep equals about 30% of total sleep time. The decrease in REM slowly continues during childhood until REM % reaches the adult level.
12 months of age and REM sleep ✔✔By 12 months of age, REM sleep equals about 30% of total sleep time. The decrease in REM slowly continues during childhood until REM % reaches the adult level.
Pediatric sleep ✔✔Refers to early to middle childhood
During pediatric sleep (early to middle childhood) ✔✔- slow, consistent change in EEG patterns occur
- Sleep cycles about every 90 minutes by 5 years of age
- REM sleep is 20-25% of total sleep time by 3-5 yrs of age.
How much sleep does a 0-2 month old need? ✔✔12-18 hours
How much sleep does a 3m- 1 yr old need? ✔✔12-15 hours
How much sleep does a 1-3 yr old need? ✔✔12-14 hours
how much sleep does a 3-5 yr old need? ✔✔11-13 hours
how much sleep does a 5-12 yr old need? ✔✔10-11 hours
how much sleep does a 12-18 year old need? ✔✔8-10 hours
How much sleep do adults need? ✔✔7-9 hours
What happens to sleep by age 10? ✔✔Sleep becomes monophasic; duration of about 10 hours.
What is monophasic sleep? ✔✔One period of sleep
What happens to the circadian phase during adolescence? ✔✔Circadian phase delay (later bedtimes)
What happens to sleep in older age? Geriatric ✔✔- Sleep time is decreased
- Biphasic pattern may re-emerge
- 40-50% N
- 20-25% N3 (decreases with age)
- 20-25% REM
How much time of their lives do adults spend sleeping? ✔✔Adults spend about 1/3 of their lives sleeping
During sleep, what changes does the body undergo? ✔✔Some systems show reduced activity, others increased activity. Important changes occur in the endocrine/hormone system and with temperature regulation, as well as changes in the autonomic nervous system such systems under involuntary control e.g heart rate, respiration.
Geriatric sleep ✔✔- Less hours needed
-Insomnia complains
- Overall increase in sleep complaints
- Medication effects
Sleep homeostat and circadian rhythm connection ✔✔- Light is a time giver
- Light is carried by retinohypothalamic tract (RHT) to the Suprachiasmatic nucleus (SCN).
- Coordinated by the SCN, light inhibits melatonin secretion during the dark cycle.
- Damage to the SCN elimiated the circadian rhythms of many behaviors, including sleep.
- Light, via the photoreceptor melanopsin, may exert its antidepressant effect through a modulation of the homeostatic process of sleep.
- One physiological marker: core body temperature. The timing of the "nadir" or minimum temp is in the early hours of the am around 4 am (high sleep propensity), with a peak around 6 pm (low sleep propensity).
- The proportion of N3 sleep is greatest in the first sleep cycle and dissipates over the course of the sleep period.
- The propensity for REM sleep is highest in the early morning
caffeine and sleep ✔✔- works to prevent sleep by blocking adenosine. Caffeine is an adenosine receptor antagonist.
- During periods of wakefulness, adenosine levels accumulate in the basal forebrain as glycogen ( the body's principal store of energy) is depleted.
- Increased adenosine release accompanies the accumulation of the need to sleep. Thus, adenosine may be invovled in the homestatic control of sleep. With recovered sleep glycogen stores are replenished.
Cortisol ✔✔Stress hormone, under circadian control.
Low during sleep rising towards early morning waking.
Increases during the hour post awakening, steep decline over the next three hours after awakening followed by a more gradual decline over the remainder of the day, reaching the lowest point during the first half of the sleep period.
When do cortisol levels reach the lowest point? ✔✔During the first half of sleep period.
When do cortisol levels reach their highest peak? ✔✔During the early morning waking.
Prolactin ✔✔secretion highest during sleep.
GH (growth hormone) ✔✔- Peaks are associated with SWS/ N
- Peaks 90 minutes after sleep onset
- Sleep deprivation leads to decreased GH
gonadotrophic hormones ✔✔In pubertal boys and girls increase during sleep.
Nocturnal urine ✔✔during sleep, nocturnal urine volume decreases due to decrease of glomerular filtraton, alteration of renin release, water re-absorption
Physiological difference between consolidated NREM sleep and REM sleep compared to wake.
*NREM SLEEP ✔✔NREM SLEEP/ REM SLEEP
- NREM: Respiration slow and regular. / REM: Irregular breathing, increased rate, brief hypopneas
Sleep and energy balance:
Where are orexins produced? ✔✔They are produced in the hypothalamus. (Narcolepsy).
Sleep and energy balance:
Ghrelin- peptide produced by stomach ✔✔- Levels rise progressively during fasting and fall to a nadir within one hour of feeding.
- Inhibited by vagus nerve (parasympathetic)
- Links the gastrointestinal system and the hypothalamic orexigenic pathway.
Sleep and energy balance:
Anorexigenic = appetite suppressing ✔✔appetite suppressing
Sleep and energy balance:
Leptin: ✔✔Hormone released by adipocytes
Sleep and energy balance:
Leptin is released by what? ✔✔leptin is a hormone released by adipocytes.
- levels increase in response to acute caloric surplus.
- Circadian fluctuation, peaks during sleep
- Provides information about energy balance to hypothalamic regulatory centers.
- Changes associated with reciprocal changes in hunger.
Cardiovascular changes that occur during sleep drive by the dominant parasympathetic activity. Identify what normal changes are as summarized. ✔✔- Hear rate.: NREM decrease, REM - variable.
- BP: Decrease 5-14% during NREM. Fluctuates in REM.
- Cardiac output: Falls during sleep and is lower in the last REM cycle in the early morning.
Examples of stimulant medications ✔✔- Caffeine, nicotine, theophylline, CNS stimulants (methamphetamines, cocaine)
Modafinil decreases EDS
VARIATIONS IN NORMAL SLEEP: Medication
Sedative Hypnotics ✔✔All facilitate sleep. May alter sleep architecture.
Increase: TST, N2 (spindles), next day sleepiness, sense of hangover effect.
- Decrease WASO, awakenings, sleep latency
- Decreased REM with barbiturates
- Decreased N3 with benzodiazepines, slight decrease with barbiturates.
Examples: ambien (zolpidem), ativan (lorazepam), halcion (triazolam), restoril (temazepam), sonata (zaleplon), xanax (alpraxolam), nebutal (pentobarbital, benadryl (diphenhydramine), unisom (doxylamine), ethanol (ethyl alcohol).
What are some sedative hypnotics ✔✔ambien (zolpidem), ativan (lorazepam), halcion (triazolam), restoril (temazepam), sonata (zaleplon), xanax (alpraxolam), nebutal (pentobarbital, benadryl (diphenhydramine), unisom (doxylamine), ethanol (ethyl alcohol).
Antidepressants and sleep ✔✔Vary widely from stimulating to sedating.
Antidepressants and PLMS ✔✔Most antidepressants have potential to exacerbate PLMS
What does MAOI stand for? ✔✔Monoamine oxidase inhibitors. were the first type of antidepressant developed
Antidepressants:
Monoamine oxidase inhibitors ✔✔- significant reduction of REM
- Slight increase in WASO, slight decrease in TST
- Newer selective and reversible MAOI's have less pronounced effect on sleep.
Antidepressants:
Examples of Heterocyclics ✔✔Heterocyclic antidepressants:
amoxapine (Asendin)
trazodone hydrochloride (Desyrel)
maprotiline hydrochloride (Ludiomil)
Antidepressants:
