Wakelike EEG, EMG: low chin tone (paralysis), rapid eye movements
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What % of sleep is N1?
5-10%
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What % of sleep is N2?
45-50% (longest)
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What % of sleep is N3?
15-25%
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What % of sleep is REM?
20-25%
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What hormones causes the pressure to sleep?
Adenosine
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What hormones increases the most during sleep?
Melatonin. It sustains sleep
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When does melatonin peak during sleep?
After 4 am of sleep
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Why does caffeine reduce your ability to sleep?
Is a competitive inhibitor of adenosine. Eventually, the receptors will get saturated and reach a point when increase caffeine will do nothing. Does not affect melatonin.
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What is chronotype?
Morning or night person
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What is chronotype determined by?
genetics
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Can chronotype change?
Yes, changes by age
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What decides our circadian rhythm?
Clock genes
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What are zeitgebers?
An environmental agent or event. A cue in the regulation of the body’s circadian rhythm.
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Give an example of zeitgebers.
Natural day light. During winter less light therefore feel sleepier during the day.
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What are non-photic zeitgebers?
non-environmental factors that effect sleep.
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What are examples of non-photic zeitgebers?
Jet lack – change of down zones suddenly Temperature- too clod, hot Exercise at night stops sleeping. During day it can help with sleeping during the day Stress Eating- hungry (can’t sleep) + same if too full
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What are good sleep hygiene practices?
Go to bed and get up around the same time each day.
Relaxing routine.- tech giving wake sense
No big meals before bed.
Exercise.
Bed is for sleeping only.
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What are the 2 types of insomnia?
Primary and secondary
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What is primary insomnia?
Having insomnia alone (isolates). It is not a symptoms of other illnesses
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What is secondary insomnia?
Due to co-morbid psychiatric or medical disorder or medication.
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Does the treatment of the primary illness always resolve secondary insomnia?
No
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What % of insomnia cases are primary?
25
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How is insomnia diagnosed?
Decrease in sleep quantity/quality, 3 times a week for more than 3 months.
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What is the prevalence of insomnia?
10-15% of population
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What is the first line of treatment for insomnia?
Sleep hygiene strategies- not watching tv in bed, clearing mind
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What is short-term treatment for insomnia?
Medication (less than a week)
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Why is medication a short-term treatment for insomnia?
Tolerance, very addictive
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When is medication given for insomnia?
Good for a person who can't go to sleep at all, gives them the pattern to go to sleep. Can break the cycle.
Someone with severe relapse (psychotic) for a mental disorder/ manic episode which can be revered by sleep is given medications short term to help.
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What medication is given long term to treat insomnia?
Melatonin- long term not over the counter (in America it is OTC)
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What type of insomnia does CBT treat?
Primary
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What is obstructive sleep apnea?
Firstly snoring, briefly stop breathing then wake up quickly. N3 to N1 quickly. Very tired during the day.
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What is the treatment of OSA?
CPAP Reduces risk of stroke and MIs Reduces fatigue
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What is restless leg syndrome?
Constant urge to move legs at rest, temporarily relieved with activity. Tingling in the legs.
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What is Periodic Limb Movements of Sleep?
Repetitive involuntary movements of limbs (usually legs) during sleep.
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Are “Hypnic jerks” pathological?
normal phenomenon.
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What are the 2 categories of parasomnias?
REM NREM
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Example of REM parasomnias.
REM sleep behaviour disorder (Movement, such as kicking, punching, arm flailing or jumping from bed, in response to action-filled or violent dreams, such as being chased or defending yourself from an attack). People acting out their dreams. Nightmares.
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Examples of NREM parasomnias.
Sleep walking
Sleep eating/drinking
Night terrors
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What are night terrors?
Usually in young. Do not remember them at all but will wake up screaming. Not disturbing for the person.
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What abnormality is found in REM parasomnias?
In normal REM you should be paralysed (but eyes) but in these disorders they are not so they start walking etc.
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What are the 2 types of hypersomnia?
narcolepsy + Kleine-Levin
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What is narcolepsy?
Excessive daytime sleepiness, involuntary sleep, cataplexy. Low orexin. (like going in and out of rem sleep)
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What is Kleine-Levin?
hypersomnia (sleep too much), hyperphagia (too much eating), hypersexuality episodes. Frontal lobe issue.
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