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  1. Sleep stages and EEG waveform
    "At Night, BATS Drink Blood"
    • Awake eyes open: beta (high freq, lowest amplitude)
    • Awake eyes closed: alpha
    • Stage 1 (light sleep): Theta
    • Stage 2 (deeper sleep; bruxism): sleep spindles and K complexes
    • Stage 3,4 (deepest, slow wave sleep; sleepwalking, night terrors, bedwetting): Delta (low freq, high amplitude)
    • REM: dreaming, loss of motor tone, possibly a memory processing function, erections, in O2 consumption: Beta
  2. Drugs effect on Sleep
    • Imipramine: dec stage 3 sleep used for enuresis
    • Alcohol, benzodiazepines, and barbiturates reduce REM and stage 3 and 4
    • Benzodiazepines used for night terrors and sleepwalking
  3. Depressed Patient
    • dec slow-wave sleep
    • inc REM early in sleep cycle (inc total REM sleep)--> dec REM latency (repeated nighttime awakenings)
    • early-morning awakening
  4. Narcolepsy
    • Excessive daytime sleepiness
    • Hypnagogic hallucinations (episodes start off w/ REM sleep)
    • Cataplexy (loss of all muscle tone following a strong emotional stimulus)
    • REM latency <10 min

    • Rx:
    • Stimulants (amphetamines, modafinil)
    • sodium oxybate (GHB)
  5. Sleep Apnea Syndromes
    • absence of respiration for extended periods during sleep
    • patient often overweight
    • risk of sudden death
    • obstructive: rasping snoring
    • central: cheyne-stokes
    • Hypoxia --> inc EPO release --> inc erythrocytosis
  6. Sudden Infant death syndrome (SIDS)
    • Unexplained death in children younger than 1 year
    • rate higher if household member smoker
  7. Insomnia
    Rx: behavioral therapy best treatment, acute relief by benzodiazepines, zolpidem, zaleplon, eszopiclone(no tolerance)
  8. Somnambulism (sleepwalking)
    • stage 4 sleep
    • if wakened, person confused and disoriented
    • blank staring face, unresponsive to efforts of others to communicate

    Rx: identify anxiety issues
  9. Enuresis (bedwetting)
    • delta sleep
    • boys 2x more than girls
    • defense mechanism of regression

    Rx: imipramine
  10. Bruxism
    • stage 2 sleep
    • patient may be unaware unless told by others

    Rx: reduce anxiety, oral devices
  11. Night Terrors
    • Stage 4
    • no memory of arousal (confused and disoriented upon awakening)
    • runs in families
    • more common in boys
    • can be a precursor to temporal lobe epilepsy
  12. Nightmares
    • REM
    • become oriented and alert upon awakening
    • common from ages 3-7
    • desensitization behavior therapy provides marked improvement
  13. Circadian Rhythm
    • Driven by suprchiasmatic nucleus (SCN) of hypothalamus; controls ACTH, prolactin, melatonin, nocturnal NE release.
    • SCN --> NE release --> pineal gland --> melatonin
    • SCN regulated by light
Card Set
disorder and stages of sleep
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