patho 20.1 anxiety and sleep disorders

s/sx of anxiety

irritable, restless, difficulty concentrating, increased heart rate and blood pressure, elevated respiratory rate (breathlessness), due to increased sympathetic activity

limbic system components

amygdala, hippocampus, hypothalamus

limbic system function

has neurotransmitters, related to fear and creation of memories

main neurotransmitters in anxiety

norepinephrine and epinephrine, dopamine, serotonin, GABA

role of nor/epi in anxiety

causes signs and symptoms, released when signal is transmitted at synaptic cleft

dopamine role in anxiety

energizing, stored at synaptic cleft released when signal is transmitted

serotonin role in anxiety

calming neurotransmitter that decreases with anxiety

GABA role in anxiety

gamma amniobutyric acid, calming neurotrasmitter decreased in anxiety

untreated anxiety over time results in

worsening of symptoms due to no relief from stimulating neurotransmitters and depletion of calming neurotransmitters

breakdown of anxiety neurotransmitters

monoamine oxidase (MOA), enzyme that works in post synaptic cleft, can be repackaged and reused with each impulse, where medications target

situational anxiety

common and normal, ex. stage fright, test anxiety

generalized anxiety

more pronounced and difficult to control

panic disorders

episodes of anxiety with intense apprehension and fear

PTSD

exaggerated stress response of HPA axis in response to an extreme event

common signs of PTSD

avoidance causing decreased relationships and isolation, hyperarousal, nightmares or intrusive reliving of the event stimulating sympathetic response

importance of sleep

has restorative properties, lack of sleep can lead to more stress and activation of sympathetic nervous system

melatonin

sleep hormone secreted from pineal gland near hypothalamus, controls circadian clock

length of normal sleep cycle

90 mins

5 stages of sleep

drowsy, light sleep, moderate sleep, deep sleep, REM

drowsy stage of cycle

ready to fall asleep, eyelids close

light sleep stage of cycle

heart rate slows, temperature decreases, muscle activity and relaxation occurs

moderate sleep stage of cycle

forms deep sleep with stage 4

deep sleep stage of cycle

brain wave activity changes, difficult to arouse

REM stage of cycle

rapid eye movement, rapid irregular respirations, increased hr and bp (stages 2-4 can repeat many times before getting to REM)

increased stress on the body causes

increased cortisol, increase weight gain and immunosuppression

types of dyssomnias

insomnia, circadian rhythm disorder, narcolepsy, obstructive sleep apnea

dyssomnia

abnormal sleep cycle pattern

types of parasomnias

nightmares/sleep terror, sleep walking (somnambulism)

insomnia

difficulty insisting or maintaining sleep, can be caused/worsened by caffeine, nicotine, medication, stress (cortisol, nor/epi)

circadian rhythm disorder

disturbances of the sleep-wake cycle such as jet lag and night shift workers

narcolepsy

excessive daytime sleepiness even with good sleep at night

obstructive sleep apnea

intermittent periods of apnea that interfere with sleep cycle, causes sleep to be less restorative

non pharmacologic approach to anxiety

talking, counseling, relaxation, yoga, positive imagery, exercise

non pharmacologic approach to sleep

regular sleep/wake pattern, reduce noise and lights, control tmerpature, warm bath, reading or prayer before bed, do not exercise within 1 hour of bedtime

things to avoid to promote sleep

alcohol, caffeine and stimulants, heavy meals right before bed, stressful topics, augments, exciting books