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Published byJamir Mahoney Modified over 9 years ago
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2 Phases: REM and Non-REM Sleep
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Non-REM Sleep 4 stages of progressively deeper sleep Normal muscle tone Associated with increased 5HT (serotonin) Decreased autonomic activity: Lower BP, Pulse, respirations slow
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Stage One Brief transition between wakefulness and sleep (accounts for only 5% of sleep time)
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Stage Two Light sleep Accounts for 50% of total sleep time ElectroEncephaloGram (EEG) shows some characteristic findings…
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EEG in Stage 2
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Stages 3,4 Most restful, restorative stages of sleep Aka: Delta wave sleep/ slow wave sleep Greatest proportion is in the first 1/3 to 1/2 of night
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NREM Sleep: Theories of its purpose… The decrease in metabolic demand on the brain during NREM allows glycogen stores to replenish Allows for consolidation of memories and learning
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REM (dreamland) 10-20 min. cycles consisting of: Rapid Eye Movements ElectroEncepahaloGram shows fast activity very similar to wakeful EEG pattern Suppression of peripheral muscle tone Often increased autonomic tone- ie, increased blood pressure, resp, heart rate
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REM (dreamland) Where dreaming occurs REM is marked by increased brainwave activity Thus REM-supression seen with anti-cholinergic drugs (ex. some antidepressants)
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Normal Sleep Pattern Sleep cycles between NREM and REM approx. 4-5 times/night Cycles last approx. 90min REM duration and frequency increase thru night Proportion of slow wave sleep (stages 3,4) decreases thru night
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Normal Sleep Parameters Sleep Onset Latency- the time it takes one to fall asleep, averages 10-20min REM Latency- time between sleep onset and the first REM period, averages 90-120min
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Normal Sleep Distribution REM sleep accounts for approximately 25% of total sleep time Non-REM sleep accounts for 75% of sleep time, with 25% of that spent in Stages 3,4 (most restful portion)
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Age-Related Changes Decreases in dreaming, total sleep time, REM, and slow-wave (deep sleep) Increases in early morning awakening, fragmentation, daytime napping, and phase advancement- Ie, earlier to bed, and awaken earlier
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Sleep Disorders- 2 Divisions Dyssomnias- disorders of quality, timing, or amount of sleep (quantity) Parasomnias- abnormal behaviors associated with sleep or sleep-wake transition, that often produce arousals
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Dyssomnias Primary Insomnia Narcolepsy Sleep Apnea Circadian Rhythm Sleep Disorder (jet lag, et al.) Restless Legs Syndrome (RLS) Medical/Substance related insomnia
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Primary Insomnia “Primary”, meaning no underlying medical cause Onset often with stressor or disruption to sleep schedule or environment Results from poor sleep hygiene, along with classical conditioning- Faulty learning/association of sleep environment with state of arousal
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INSOMNIA- an epidemic? Definition: “Subjective” experience of poor sleep quality or quantity that adversely affects daily functioning Extremely common complaint in general practice 30-40% adults have occasional poor sleep 15-20% adults have chronic insomnia
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Consequences of Insomnia Depression Irritability Decreased cognitive functioning Decreased productivity Injuries and accidents
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Narcolepsy A dyssomnia characterized by poor sleep quality (restless, fragmented) and dysfunction in the transitions between sleep and wakefulness Presents with Excessive Daytime Sedation (EDS)
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Narcolepsy Tetrad Classic tetrad of associated findings: 1. Sleep attacks 3. Sleep paralysis 4. Sleep hallucinations
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Cataplexy Sudden loss of muscle tone (rarely full body paralysis) caused by intrusion of REM activity into daytime wakefulness Triggered by heightened emotion Average duration: 30 seconds No loss of consciousness
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Sleep Paralysis Brief paralysis upon waking Remain alert with full eye movements Can occur in the absence of Narcolepsy (ie, normal variant)
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Sleep Hallucinations Hypnogogic hallucinations- occur during transition into sleep Hynopompic hallucinations- occur upon awakening from sleep Can occur in the absence of Narcolepsy (ie, normal variant)
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Sleep Apnea Dyssomnia characterized by poor sleep quality due to frequent awakenings (apneas) Apneas last sec-minutes Presents with excessive daytime sedation- EDS
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Sleep Apnea: Two Types Obstructive Sleep Apnea: most common Central Sleep Apnea
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Obstructive Sleep Apnea Classic- obese, middle-aged male with thick neck or enlarged tonsils Apneas- brief gasps…silence, followed by loud “resuscitative” snores, and sometimes body movements (restless) Usually unaware of snoring, arousals…but sleep partner is aware
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Central Sleep Apnea Apneas- episodic cessation of central ventilation drive Thus snoring is less common More in elderly, with underlying CNS lesions- ex. tumor, stroke
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Sleep Apnea: Consequences Depression Anxiety Morning headaches Cognitive dysfunction Hypertension
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Restless Legs Syndrome Paresthesias and/or dysesthesias in the legs, relieved by movements Usually occur in transition from wakefulness to sleep
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RLS Causes Peripheral neuropathies Peripheral vascular disease Medication side effects Anemia Pregnancy Renal failure
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Circadian Rhythm Disorders Delayed Sleep Phase Syndrome Jet Lag Accelerated Sleep Phase Syndrome Shift Work Sleep Disorder
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Psychiatric Causes of Insomnia Depression Anxiety Psychosis Substance intoxication/withdrawal
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