Sleep

Normal sleep

__ is defined as the cyclic temporary and physiologic loss of consciousness that is readily, promptly, and completely reversed with appropriate stimuli

Rule of three

3 weeks w/out food

3 days w/o water

3 hours in extreme environments

3 minutes w/o oxygen

Fatigue reasons

• Chronotype: are you an early bird or night owl?

If your a night owl and don't fall asleep early enough to get your 7-8 hours of restful sleep, your fighting your natural circadian rhythm.

• Fragmented sleep/ snooze alarm

• Bedroom environment/ blue light

• Spouse behavior

• Alcohol / caffeine

STOP-BANG questionnaire

S = Snoring

T= Tiredness

O = Observed apnea

P = Pressure (HTN)

B = BMI (>35)

A = Age (>50yo)

N = Neck circumf (>40cm)

G = Male gender

Snore

(S) have you been told that you

Tired

(T) are you often __ during the dya

Observed

(O) Has anyone ___ you stop breathing while sleeping

Pressure

(P) do you have or are you being treated for high blood pressure

BMI

(B) is your __ more than 35 kg/m2

Age

(A) is your __ 50 or older

Neck

(N) is your __ circumference greater than 17" if male or 16" if female

Gender

(G) is your __ male

One

Each positive score is __ point in stop bang

0-2

low risk for obstructive sleep apnea

3-4

intermediate risk for obstructive sleep apnea

5-8

high risk for obstructive sleep apnea

Epworth Sleepiness Scale (ESS)

An index of sleepiness during the day as perceived by patients, derived from the answers to 8 questions

sleep study

Only a __ interpreted by a medical sleep

specialist in conjunction with a medical exam can rule in or out benign snoring

Polysomnogram

__ (sleep study) may be hospital

based or take home models are becoming

increasingly popular

C-PAP

Highly effective, low compliance treatment

MAD

Slightly lower effect, high compliance treatment

Mandibular Advancement Device

This custom made oral device is indicated for sleep apnea if CPAP cannot be used. Brings mandible forward to open airway

2 am

Deepest soee0

4:30 am

Lowest body temp

6:45 am

sharpest blood pressure rise

7:30

Melatonin secretion stops

2:30

Best coordination

Suprachiasmatic nucleus

__ regulates the Circadian Rhythm

hr circadian rhythm

Your 24 /__ is one of two factors determining wake and

asleep

adenosine

Second is sleep pressure due to a buildup of __ which turns down the effect of wake promoting regions of the brain

Caffeine

the most widely used psychoactive stimulant in the world blocks

the adenosine effect

Orexin

A neurotransmitter associated with narcolepsy

Adenosine

Sleep cycle

a period of sleep lasting about 90 minutes and including one or more stages of NREM sleep, followed by REM sleep

sleep cycle stage 1

interim between consciousness and sleep

5-15 mins

How long between stage 1-2

Sleep cycle stage 2

Heart rate slows, brain does less complicated tasks (non rem)

15 mins

How long between stage 2-3 (non rem-delta)

Sleep cycle stage 3

Body makes repairs (delta stage)

Sleep cycle stage 4

Body temperature and blood pressure decreases

90 minutes

How much time between first feeling sleepy to rem

Sleep cycle stage 5

REM, paradoxical sleep, but voluntary muscles are paralyzed, dreaming occurs, triggered by the pons, 15-30 minutes, visual cortex and limbic system are active

4-6

how many sleep cycles per night

Sleep disturbed breathing snoring

Upper airway resistance also related to GERD- vacuum created (can turn into obstructive sleep apnea)

Apnea

breathing cessation with decreased air flow of 70% or greater for 10 seconds or more

Hypopnea

reduced breathing by

30% or more lasting 10 sec or

more with O2 desaturation of 4%

or greater

Apnea hyponea index (AHI) is calculated by

Number of Apneas plus

Hypopneas per hour defines the

5-15

Moderate AHI index

15-30

Severe AHI index

Insomnia

recurring problems in falling or staying asleep

- treatment but no cure (sedatives, antihistamines, antidepressant)

Benefits of sleep

fatigue

One person dies every hour in a traffic accident due to __, greater than deaths from alcohol and drugs combined.

dementia

Longer naps during the day could be a sign of early

__

Alzheimers

Older adults that napped at least once for over an hour

had a 40% higher chance of developing __

disease than those that did not nap or napped for less

than 1 hour per day

Depression; Melatonin

__ can cause a decrease in Seratonin which helps with moods, thinking. Seratonin is a precursor to __, the neurotransmitter that promotes sleep

Dementia tests

The sage test

Mini cog test

Mini mental test

Montreal cognitive assessment

inflammatory

Sleep supports normal production of stem cells which are the building blocks of the immune system. Good sleep reduces the body's __ burden

Obesity

A major cause of OSA

Ghrelin

hormone secreted by empty stomach; sends "I'm hungry" signals to the brain

Leptin

A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.

ghrelin

Sleep deprivation increases __, increases appetite,

especially carbohydrates

bulimia nervosa

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

anorexia nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves

Telomeres

dna at tips of chromosomes which is difficult to replicate, protect and worsen with lack of sleep

testosterone

In men, decreased sleep results in

decreased __ levels and

ages a man 10-15 /yrs

Type two Diabetes

Decreased sleep results in increased

eating (ghrelin). Body can not handle increased sugar

in the blood with an increased

probability of developing

Ozempic

semaglutide (Glucagon-Like Peptide-1 (GLP-1) agonist; antidiabetic)