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Sleep Neurobiology Exam 2
N/A
193
Psychology
Graduate
11/15/2009

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Term
what are the three main pain processing domains in the CNS?
Definition
sensory, affective, cognitive
Term
What regions comprise the sensory processing center of pain in the CNS?
Definition
thalamus, primary and secondary somatosensory cortex, posterior insula
Term
what regions comprise the affective processing center of pain in the CNS?
Definition
anterior insula, anterior cingulate cortex, amygdala
Term
what regions comprise the cognitive processing center of pain in the CNS?
Definition
anterior insula, anterior cingulate cortex, amygdala, pre-frontal regions
Term
mechanisms underlying FM?
Definition
problem with sensory processing (hyperreactive insula, higher Glutamate levels than normal), decreased descending analgesia (absent or attenuated DNIC, brainstem activations with conditioning stimulus seen in controls but not FM patients)
Term
deficiency of descending analgesic activity in FM patients?
Definition
opioids are ineffective or marginally effective because of decreased opioid receptor binding; noradrenergic/serotonergics are in lower levels in CSF, and all drugs that raise BOTH serotonin and epinephrine are effective
Term
chronic pain may be what kind of disease?
Definition
neurodegenerative disease: decreased gray matter in DLPFC and thalamus, the more pain the more neurodegeneration there has occured
Term
biopsychosocial continuum
Definition
neurobiological: abnormal sensory processing, decreased analgesic activity, autonomic dysfunction, psychiatric disorders, HPA dysfunction, peripheral nociceptive input; psychosocial factors: general distres, psychiatric comorbidities, cognitive factors, maladaptive illness, secondary gain issues
Term
in fibromyalgia, what do pharmacological therapies address?
Definition
symptoms
Term
in fibromyalgia, what is used to treat symptoms?
Definition
pharmacological therapies
Term
in fibromyalgia, what do nonpharmacological therapies address?
Definition
dysfunction; functional consequences of the symptoms
Term
what are the functional consequences of the fibromyalgia symptoms?
Definition
increased distress, decreased activity, isolation, poor sleep, maladaptive illness behaviors
Term
fibromyalgia is primarily a ___________ disease a) peripheral b)neuropathic c) central
Definition
central, a neural disease
Term
T/F: FM is a polygenic disorder
Definition
True
Term
In FM, there is a deficiency of _____________________-_______________ activity, or excess levels of __________________ neurotransmitters
Definition
NE-5HT ; excitatory
Term
lack of ________ and __________ leads to increase in pain, in FM patients AND normals
Definition
sleep; exercise
Term
loss of what kind of sleep leads to FM-like symptoms?
Definition
stage 4 NREM sleep
Term
T/F: how FM patients think about their pain (cognition) may influence their pain levels directly
Definition
True
Term
T/F: treatments aimed at the periphery (drugs, injections...) in FM are effective
Definition
FALSE!!!
Term
different FM patients need different treatments
Definition
TRUE
Term
what kind of treatments are effective in FM patients?
Definition
those that raise NE and serotonin, or lower levels of excitatory nm's
Term
what other kind of therapies are effective for FM?
Definition
sleep hygiene and other behavioral interventions for biological reasons
Term
summary of getting rid of pain in FM
Definition
increase: ser, NE, opioids, exercise, sleep Decrease: glutamate, substance P, nerve growth factor, catastrophizing, external locus of control
Term
T/F: disturbed sleep is uncommon in psychiatric disorders
Definition
FALSE; it is very common
Term
psychiatric disorders are common in sleep disorder patients
Definition
Term
brain systems involved in sleep overlap a lot with brain systems involved in psychiatric disorders
Definition
Term
what brain areas decrease metabolism during NREM sleep relative to waking?
Definition
parietal and temporal
Term
what are the brain areas that show the largest declines in activity during NREM sleep?
Definition
thalamus-cortical networks that are associated with attention, consciousness, and executive function
Term
what network does REM sleep selectively activate?
Definition
anterior paralimbic network
Term
what brain areas does the anterior paralimbic network consist of?
Definition
anterior paralimbic cortex, ventral striatum, basal forebrain, basal ganglia, pre-motor, primary sensorimotor cortex, cerebellum, insular cortex, mesial temporal cortex (hippocampus, amygdala, uncus = emotion), brainstem reticular formation
Term
"REM sleep is associated with activation of a primal neural network in which the __________ is monitored, inherent __________ conflicts detected, maybe by relating current behavior to emotional memories, then behavioral __________ to the conflicts are either newly developed, modified, or rehearsed
Definition
self; conflicts; responses
Term
what regions does REM sleep activate that play important roles in emotional behavior?
Definition
limbic, and anterior paralimbic
Term
Depression: what EEG alterations occur during REM?
Definition
short REM latency, increased REM sleep (increased eye movements per REM period), increased duration of first REM, increased percentage of REM
Term
Depression: what EEG alterations occur during NREM sleep?
Definition
decreased amount and percentage of NREM, decreased spectral power (?)
Term
Depression: what sleep continuity disturbances occur?
Definition
prolonged sleep latency, increased time of wake, early morning awakening
Term
Depression: monoaminergic/cholinergic imbalance hypothesis -> what does this hypothesis entail?
Definition
in normal REM, brainstem monoaminergic systems, 5HT, NE cease firing to allow brainstem Cholinergic cells to activate the cortex during REM sleep -> in depression, there is a reduced monoaminergic function, allowing greater cholinergic firing, disinhibiting REM sleep... or directly increased cholinergic activity
Term
REM is a ___________ activator
Definition
limbic
Term
depressed patients have increased _______ sleep
Definition
REM
Term
depressed patients showed greater wake-to-REM activation in what cortical areas?
Definition
bilateral dorsolateral prefrontal, left premotor, left parietal... as well as in the reticular formation (noncortical)
Term
during what sleep state is altered limbic/anterior paralimbic function accentuated in depression?
Definition
REM sleep
Term
what are the two major sleep-related hypotheses related to depression, and what do they consist of?
Definition
monoaminergic/cholinergic imbalance hypothesis, circadian/homeostatic hypothesis
Term
Depression: circadian/homeostatic hypothesis
Definition
advancement of circadian rhythm -> earlier REM in the night; reduced homeostatic drive -> reduced NREM -> earlier REM
Term
depressed patients show LESS of a decline in metabolism from wake to NREM in what brain area?
Definition
prefrontal
Term
what happens to sleep after recovery of depression, and how does this depend on the treatment type?
Definition
sleep improves, no matter what the treatment is
Term
antidepresseants affect sleep how?
Definition
increase monoaminergic tone, thereby inhibiting cholinergic tone, thereby inhibiting REM sleep, so more NREM sleep
Term
what has a transient anti-depressant effect?
Definition
acute sleep deprivation
Term
Bipolar disorder: what happens to sleep during manic episodes?
Definition
reduced need for sleep
Term
bipolar disorder: what happens during a depression episode?
Definition
hypersomnia
Term
bipolar disorder: what can loss of sleep trigger?
Definition
manic episode
Term
bipolar disorder: what happens to patients in remission?
Definition
hypersomnia, same as in depression episodes
Term
Bipolar Disorder: T/F, EEG's are disturbed
Definition
FALSE! bipolars have relatively normal REM and delta sleep
Term
schizo: what is their sleep cycle like?
Definition
highly variable, often found in bed during the day
Term
schizo: what kind of EEG disturbances take place?
Definition
reduction of SWS, which is correlated with changed prefrontal cortex function; disturbed sleep continuity, increases and decreases in REM disturbances
Term
anxiety: what kind of sleep disturbances?
Definition
difficulty initiating sleep, difficulty maintaining sleep, sleep is not restful
Term
anxiety: what kind of EEG disturbances?
Definition
long latency of sleep onset, decreased sleep maintenance, decreased sleep of stages 3&4 NREM, BUT no changes in timing, duration, or intensity of REM (so REM is unaffected)
Term
post traumatic: what kind of sleep disturbances?
Definition
repeated post-traumatic dreams in over half of patients, disturbance in sleep continuity
Term
post-traumatic: what kind of EEG disturbances?
Definition
sleep continuity, increased periodic limb movements, variable REM disturbances, recurring nightmares that arise either out of REM or NREM early in the night
Term
alcoholism: acutely, what does alcohol do in terms of sleep onset?
Definition
helps with sleep onset, BUT leads to continuity problems later at night
Term
alcoholism: chronically, what does alcohol cause?
Definition
sleep problems that persist YEARS into alcohol abstinence
Term
alcoholism: EEG disturbances
Definition
acutely: increase in sleep, reduced REM and delta; chronically: disturbances in continuity, increased alpha waves during NREM; abstinence: short sleep times, problems with continuity, loss of delta sleep
Term
alcoholism: what is a predictor of relapse back into drinking?
Definition
increased REM sleep
Term
insomnia: does NREM brain metabolism increase or decrease?
Definition
increase relative to controls - hypermetabolism
Term
there is cerebral hypermetabolism in insomniacs both in wake and NREM sleep relative to normals
Definition
Term
insomnia: what is NOT turning off in terms of their cerebral hypermetabolism?
Definition
there is less of a decrease in postRX activity than in PreRX in arousal promoting areas (so arousal promoting areas are more active in insomniacs... pontine RAS)
Term
what arousal systems do not deactivate in wake-to-sleep in insomniacs?
Definition
ARAS, hypothalamus, thalamus, insular cortex, mesial temporal cortex, cingulate cortex
Term
what do invertentions do in insomniacs?
Definition
decrease prefrontal cortex activity, which leads to decrease in ARAS basal forebrain and hypothalamus activity, which leads to decrease in limbic system and VM prefrontal cortex activity
Term
definition of narco
Definition
EDS, REM sleep abnormalities, and is typically associated with cataplexy and other REM sleep phenomena, genetically based, dysfunction in sleep state boundary control
Term
what are the three classifications of narco?
Definition
narco with cataplexy, narco without cataplexy, narco due to a medical condition
Term
prevalence of narco?
Definition
1/4000, 20-60/100.000
Term
it is estimated that what percentage of total narco's are actually diagnosed?
Definition
35%
Term
T/F: there is a greater incidence of narco in men than in women
Definition
FALSE! equally prevalent in men and women
Term
narco and familial effects?
Definition
risk of 1st degree relatives is 1%, which is 10-40 fold increase in risk compared to overall risk
Term
what is the usual onset of narco?
Definition
15-25 year olds, and is very unsually for its onset in less than 10 or older than 55
Term
narco: what is the tetrad? and its prevalence in narco patients?
Definition
EDS, cataplexy, hypnagogic hallucinations (hallucinations just before falling asleep), sleep paralysis; 10-15%
Term
narco: what is the pentad?
Definition
EDS, hypnagogic hallucinations, cataplexy, sleep paralysis, disturbed sleep
Term
characteristics of EDS?
Definition
continuous sleepiness and fatigue, lifelong with some fluctuations, sleep attacks that last 20min or less in 70%, automatic behaviors in 40%
Term
characteristics of cataplexy
Definition
sudden bilateral loss of muscle tone, consciousness is preserved, provoked by emotions (usually positive ones, or anticipation), usually in face and neck, injury is common, twitches and jerks, brief
Term
characteristics of sleep paralysis
Definition
inability to move or speak while awake, falling asleep, or awakening (in 40-80% of narco patients), last several minutes, may end with sensory stimulation
Term
what are hypnagogic hallucinations?
Definition
hallucinations while falling asleep
Term
what are hypnapompic hallucinations?
Definition
hallucinations while waking from sleep
Term
characteristics of hallucinations in narcos
Definition
hypnagogic, hypnapompic, prevalent in 40-80%, visual hallucinations are quite common, somatosensory hallucinations are less common, episodes last less than 10 min
Term
disturbed nocturnal sleep in narcos
Definition
in 60-80% of patients, may present itself as sleep onset insomnia, high incidence of other sleep-related disorders
Term
memory disturbances occur in 50% of narco patients
Definition
Term
what features are associated with narco?
Definition
OSA, periodic leg movements, RBD, depression, sex dysfunction, obesity
Term
what parameters are used to diagnose narco?
Definition
daily EDS for more than 3 months + cataplexy, polysomnography study, CSF hypocretin levels of less than 110picograms/ml, no medica or metal disorder, no medication can account for the symptoms
Term
what does a polysomnography study show in narcos?
Definition
sleep latency of less than 10min, REM latency of less than 20min, multiple sleep latency test shows a latency of less than 8min
Term
secondary narcolepsy can be caused by what medical conditions?
Definition
infections (sarcoidosis), post-traumatic, tumors, neurodegenerative disorders, ischemia, demyelination, paraneoplastic (disease caused by presence of cancer), Neiman-Pick type C, Coffin-Lowry syndrome, PD, myotonic distrophy, Prader-Willi
Term
what disorders are associated with cataplexy that can lead to secondary narcolepsy?
Definition
Neiman-Pick type C, Coffin Lowry, Norrie, PD
Term
what are predisposing factors for narco?
Definition
mutations in DQB1 0602 (present in more than 90% of narcos with cataplexy), mutations in DR2/DRB1 1501
Term
what genes are protective against narco?
Definition
DQB1-0501 and DQB1-0601
Term
what major groups of drugs are used in the pharmacological treatment of narco?
Definition
stimulants, tricyclics, GHB
Term
narco: what do stimulants do?
Definition
increase DA transmission by increasing releasing and blocking reuptake
Term
narco: examples of stimulants used to treat it?
Definition
modafinil, dextroamphetamine, methylphenidate, pemoline
Term
narco: what does modafinil do?
Definition
promotes waking, has low potential for abuse, affects catecholamines serotonin glutamate GABA orexin and histamine, DA1 and DA2 receptors are crucial for modafinil induced wakefulness
Term
narco: how do tricyclics work?
Definition
inhibit monoamine inhibition of wake-inducing cholinergic activity, blocks cholinergic histaminic and alpha-adrenergic activity; alpha-adrenergic inhibition is critical for its effectiveness
Term
narco: examples of tricyclics used for its treatment?
Definition
protriptyline, imipramine, clomipramine, nortriptyline, SSRI's
Term
narco: tricyclics are how effective?
Definition
80% of cases!
Term
narco: how does GHB work in its treatment?
Definition
increases SWS, approved for treatment of cataplexy, GHB is an endogenous metabolite of GABA, and it is thought to act as a GHB receptor agonist and a weak GABA B-receptor agonist
Term
narco: what does the theory of sleep state boundary control consist of?
Definition
there is an imbalance of decreased monoaminergic function, so there is increased cholinergic function. REM: decrease in activity of monoaminergic neurons in raphe nuclei and Locus Couraleus and increase in activity of cholinergic neurons in dorsal pontine tegmentum. wake: increased ARAS activity in NA, DA, and Ach neurons
Term
narco: what does the theory of state boundary control hypothesize happens in EDS and cataplexy?
Definition
EDS: decreased DA activity. cataplexy: decreased monoaminergic (DA and adrenergic) and cholinergic hypersensitivity
Term
is there an increase or decrease in CSF hypocretin in narcos?
Definition
hypocretin deficiency
Term
narco: what is hypocretin thought to do in normal people?
Definition
state boundary controllers, so in narcos, its deficiency leads to a loss of state boundary control
Term
what does hypocretin do?
Definition
controls energy metabolism, evokes arousal, affects GABA and glutamate secretion
Term
hypocretin projections?
Definition
hcrtr-1 receptors in VM hypothalamus, DR, and LC; hcrtr-2 receptors in paraventricular nucleus and NAcc
Term
preprohypocretin transcripts are detected in hypothalamus of controls BUT NOT of narcos
Definition
Term
sleep disordered breathing in children: characteristics
Definition
abnormal gas exchange in almost 20%, 64% have excessive periodic limb movements, leading to around 43minutes less sleep
Term
how many limb movements per hour is condiered excessive?
Definition
more than 5 periodic limb movements per hour
Term
possible roles of sleep?
Definition
restoratioin and recovery, growth, energy conservation, evolutionary compromise, memory imprinting
Term
compare NREM in adults vs children
Definition
children spend a greater proportion of the night in deep NREM sleep
Term
children spend greater proportion of sleep in NREM sleep. What does this lead to?
Definition
night terrors in the first third of the night; see most night terrors when NREM is at its highest in children
Term
what happens to total sleep duration throughout one's lifetime?
Definition
greatest when young, decreases throughout life
Term
what happens to length of REM throughout life?
Definition
greatest after birth, decreases throughout life
Term
what happens to length of NREM throughout life?
Definition
increases after birth until 2-3 years of age, then decreases
Term
describe sleep in newborns
Definition
16 hours daily, each sleep period is about 2.5 hours, all throughout the day and night
Term
describe sleep in 1-12month olds
Definition
sleep requirement decreases from 16 to 13.5 hours daily, 3-4 sleep periods a day, sleeping during the night increases
Term
describe sleep in 1-6 year olds
Definition
sleep requirement decreases from 13.5 to 11 hours a day, naps cease at 4-5 years, waking during the night is frequent
Term
describe sleep in 6-18 year olds
Definition
sleep requirement decreases from 11 to 9 hours a day, sleep deprivation increases, sleep requirement increases again during puberty?
Term
describe the difference in sleep deprivation between younger and older children
Definition
young children: more sleep deprivation on weekends than on school nights. older children: more sleep deprivation on school nights than on weekends
Term
what are some important factors that influence sleep in children?
Definition
feeding, cosleeping with parents, bedtime settling practices, child temperament, neurodevelopmental problems, psychosocial stressors
Term
what is sleep onset association disorder?
Definition
child falls asleep requiring a set of circumstances that cannot be recreated by the child or sustained during the night (presence of adult,...)... transition to sleep becomes dependent upon these circumstances, so child cannot fall asleep or return to sleep without them
Term
what are some characteristics of behavioral insomnia of childhood?
Definition
bedtime struggles, limit setting disorder, sleep onset dissociation disorder, night time fears
Term
what is the prevalence of bedtime struggles and limit-setting sleep disorder in 15-48month olds?
Definition
20%
Term
what are possible contributors to bedtime struggles/limit setting sleep disorder?
Definition
separation issues, inconsistent limit setting (parents do not agree...), difficulty settling
Term
treatment for night time fears?
Definition
reassurance, night light, professional help (rare!)
Term
treatments for behavioral insomnia of childhood?
Definition
sleep charting, bedtime management
Term
what does bedtime management consist of in the treatment of behavioral insomnia of childhood?
Definition
consisten bedtime routines, constancy in setting limits, address fears, separation from parents (systematic ignoring, scheduled awakenings, graduated schedule of parental reassurance)
Term
what are some medical causes of poor sleep in children?
Definition
colic (inconsolable crying), acute or chronic illness, medication, neurological disorders
Term
T/F: disrupted sleep schedules lead to disruption in sleep EEG's
Definition
FALSE! normal sleep, just at the wrong time
Term
what are the two types of disrupted sleep schedules?
Definition
early sleep phase: go to sleep way to early and wake up way too early; late sleep phase: go to bed way too late, wake up way too late
Term
Treatments for disrupted sleep schedules?
Definition
restrict daytime sleep, for early sleep phase: delay bedtime prograssively. for late phase: progressive advance bedtime and enforce morning awakening, OR, delay bedtime to go other way, around clock, until normal bedtime is reached
Term
what is the therapy called that is used for late sleep phase patients that cannot easily be corrected, and what does it consist of?
Definition
Chronotherapy, delaying bedtime to go around the clock until normal bedtime is reached (bedtime at 4am, then 7am, then 1pm, etc...)
Term
examples of parasomnias
Definition
nightmares, night terrors, sleepwalking, sleep talking, rhythmic head and body movements, bruxism
Term
characteristics of nightmares
Definition
waking from REM, prevalence of 20-50% in 3-5y/olds; awakening is crucial (differentiates from night terrors, from which one does not wake)
Term
characteristics of night terrors (pavor nocturnus)
Definition
PARTIAL arousal from deep NREM (nightmares are during REM), inconsolable agitation, familial predisposition, treated by alleviating stressors and rarely with benzodiazepines
Term
characteristics of sleep walking
Definition
PARTIAL arousal from deep NREM, incidence of 40% in 6-16y/o, semi-purposeful activities, eyes usually open, treat by protecting environment and addressing whatever precipitates sleepwalking
Term
characteristics of sleep talking
Definition
arousal from REM or NREM sleep, prevalence of 8% in 5y/o, prevalence of 50% in sleepwalkers
Term
common rhythmic movements in children?
Definition
bead banging, head rolling, body rocking
Term
when do rhythmic movements occur in children?
Definition
near sleep onset, last less than 15min, and are most common in 8-14 month olds
Term
characteristics of bedwetting?
Definition
more common in boys, familial, improves with age (15% in 5yo to 2% in 14yo), affects 5-7 million US children
Term
causes of bedwetting?
Definition
reduced bladder capacity in children, failure to arouse from sleep when bladder fills
Term
treatments for bedwetting?
Definition
minimize fluid intake late in the day, avoid brown drinks (colas, teas, coffee, cocoa), go to bathroom before bed and during planned awakening, enuresis alarm, bladder training exercises, mostly outgrown (15% per year), medications
Term
what are some medications for the treatment of bedwetting?
Definition
imipramine, desmopressin, oxybutinin
Term
there is a correlation between periodic limb movement disorder and ADHD in children
Definition
117/129 moderate to severe PLMD sufferers were diagnosed with ADHD
Term
how does sleept restriction (5 hours of sleep per night) affect sleep latency in normals?
Definition
baseline latency is of 18 minutes; after 7 days, latency is increased to below 8min (considered pathological when below 10, narcoleptic when below 8!)
Term
OSA has what consequences on children?
Definition
growth delay, failure to thrive, learning and behavioral problems, EDS, cor pulmonale (failure of heart's right ventricle)
Term
what are the nighttime clinical features of childhood OSA?
Definition
snoring, restless sleep, unusual positions, excessive sweating, enuresis
Term
what are the daytime clinical features of childhood OSA?
Definition
grogginess, irritability, morning headache, sore throat, mouth breathing, somnolence, problems in learning attention and behavior
Term
physical features of childhood OSA?
Definition
adenoid facies (long face and open mouth due to overgrown adenoids), overgrown tonsils, atypical craniofacial anatomy
Term
treatments of childhood OSA?
Definition
surgical: adenotonsillectomy, UPPP (removal of uvula, soft palate, tonsils, adenoids, pharynx... some or all of these), tracheostomy (widening of airway). nonsurgical: CPAP, weight reduction in the case of obesity, palatal expander, nasal steroids
Term
how many persons suffer from insomnia?
Definition
1/3
Term
how many persons suffer from OSA?
Definition
1/30
Term
how many persons suffer from narco?
Definition
1/3000
Term
what other effects does OSA have on personal life?
Definition
cardiovascular health, productivity, motor vehicle accidents, mental health, inflammation, immunity, quality of life
Term
T/F: fall-asleep crashes kill more young americans than alcohol related crashes
Definition
True
Term
methods to study sleep
Definition
Epworth sleepiness Scale, Polysomnography, Multiple Sleep Latency test
Term
Epworth Sleepiness Scale: how does it work?
Definition
in each of the presented scenarios, rate from 0-3 (0=would never doze, 3=high chance of dozing); interpretation: 9 and up, seek advice of sleep specialist immediately. 10 and up, sleep disorder very likely
Term
some problems with epworth sleepiness scale?
Definition
subjective, OSA might not become apparent, might not correlate with objective measures, such as pathologies or sleepiness
Term
what are the three core measurements of a polysomnogram?
Definition
EEG, EOG, EMG
Term
PSG: describe REM
Definition
desynchronized, low voltage, mixed frequency
Term
PSG: describe stage 1 NREM
Definition
light sleep, at sleep onset and transitions throughout night, slow rolling eye movements, more than 50% is theta activity (3-7Hz), relatively high muscle tone
Term
PSG: describe stage 2 NREM
Definition
spindles (high frequency bursts .5-3sec), K-complexes (sharp slow waves with (-) then (+) deflection .5sec or longer, background acitivity is theta in nature (3-7Hz), high muscle tone
Term
PSG: describe stage 3 NREM
Definition
SWS, high voltage slow waves (delta waves comprise 20-50%), slightly reduced muscle tone
Term
PSG: describe stage 4 NREM
Definition
SWS, high voltage slow waves (delta waves comprise more than 50%), slightly reduced muscle tone
Term
where are PSG leads placed?
Definition
three of them: frontal (delta), central (theta), occipital (alpha)
Term
describe alpha activity
Definition
high frequency (8-12Hz), occipital
Term
describe theta activity
Definition
medium frequency (4-8Hz), central vertex region, most common sleep frequency
Term
what is the most common sleep frequency?
Definition
theta activity (4-8Hz)
Term
describe delta activity
Definition
low frequency (.5-4Hz), frontal, amplitude is greater than 75mn
Term
how does EOG work?
Definition
picks up movements of eyes due to changes in in voltage relative to the fixed position of the electrode next to the eyes (cornea=(+)V, retina=(-)V
Term
suspicious PSG findings
Definition
more than 5 apneas or hypoapneas pwer hour of sleep, oxygen saturation below 90%, increases in breathing effort before arousals, more than 5 PLM's per hour of sleep
Term
describe MSLT
Definition
patients attempt to take 5 naps in a day, with two hour separations; measure sleep latency and number of REM periods
Term
types of insomnia?
Definition
adjustment insomnia, psychophysiological insomnia
Term
how does sleep affect cortisol levels?
Definition
peak exactly when you wake up, lowest when you fall asleep. with sleep deprivation, cortisol remains throughout, though not as extreme as the peak. is intimately tied with circadian rhythms
Term
how does sleep affect TSH?
Definition
circadian variation is muted during sleep; circadian rhythm functions in the release of TSH as well as its inhibition
Term
how does sleep affect GH?
Definition
surge at the beginning of sleep. during sleep deprivation, there is an attenuated increase or no increase at all
Term
how does sleep affect PRL?
Definition
sleep-related stimulation, but not circadian based, since sleep deprivation results in no change in PRL
Term
urinary potassium is synchronized with feeding, which occurs right when the animal wakes up. Does K rhythm of the kidneys follow sleep or cortisol levels?
Definition
cortisol levels
Term
how is GH released in males and females?
Definition
males: during SWS and has a specific peak, must sleep at the right time, and SWS is stimulant for GH but is not necessary. females: secreted in anticipation of sleep, before going to bed, and there are may peaks rather than one
Term
LH is secreted during sleep right at the beginning of puberty
Definition
Term
in late puberty, LH is released day and night
Definition
Term
in a child that sleeps during the day and is awake at night, when will LH will be released?
Definition
during the day (during sleep)
Term
how does sleep affect GnRH?
Definition
sleep slows GnRH pulse generation. in order to ovulate, GnRH pulse generator must be shut off once a day
Term
what does melatonin do?
Definition
inhibits SCN
Term
what effects does melatonin have?
Definition
in humans, causes sleep. in rats, causes wakefulness, because they sleep during the day
Term
the more fat, the more leptin
Definition
Term
CPAP treatment causes leptin levels to decrease, showing that hypoxia causes high leptin
Definition
Term
ghrelin works opposite leptin, and seeks to store fat and stimulate feeding
Definition
Term
sleep deprivation decreases glucose clearing abilities so that it is more readily available for use (NE)
Definition
Term
sleep deprivation decreases leptin and increases ghrelin, causing starvation feeling
Definition
Term
those who get 6 or fewer hours of sleep at night are significantly more likely to be obese than those who sleep more (low leptin, high ghrelin)
Definition
Term
agromegaly
Definition
increased GH, grow soft tissue not height, causing OSA
Term
treatment of acromegaly
Definition
octreotide therapy: decrease IGF, increase REM, increase SWS, decrease in respiratory disturbance index
Term
hyperthyroidism - leads to same condition as acromegaly -- sleep apnea
Definition
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