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Neurology - Sleep - Physiology , Path and Pharm (*Sleep Cycles
non-REM…
Neurology - Sleep - Physiology , Path and Pharm
*Sleep Cycles
- non-REM and REM sleep
- sleep controlled by SCN = suprachiasmatic nucleus and melatonin release from pineal gland
at night, BATs SSPParKKling Teeth Drink Blood
B = beta waves
--> awake
A = alpha waves
--> awake, but relaxing, eyes closed
T = theta waves
--> theta for BOTH N1/N2 = 1/2 sleep cycle non-REM
--> N2 = second sleep cycle non-REM
SSPParKKling = sleep spindles and K complexes
Teeth = in N2 the sleep spindles also have TEETH grinding
--> N2 = teeth grinding
Drink = delta waves
--> N3 = third sleep cycle non-REM
--> N3 = night TERRORS and bed wetting
Blood = beta waves
--> in REM sleep you go back to Beta waves
--> looks like you are awake
*Night Terrors vs Nightmares
- night terrors happen in N3 stage (non REM)
--> parasomnia = not fully awake when talking with you
--> can NOT be consoled
--> no dream content ever
--> at the beginning 1/3 of night when more non-REM sleep
- nightmares happen in REM sleep
--> CAN be consoled
--> fully awake when talking with you
--> at the last 2/3 of night when more REM sleep
--> DOES have dream content
-
*Sleep disorders
- narcolepsy
--> decreased orexin = hypocretin
--> daytime sleepiness is KEY
- sleep terrors
--> different than nightmares
--> N3 REM sleep
--> delta waves (BATs SparKKling Teeth Drink Blood)
*Narcolepsy
- irresistable naps or sleeps during the day
- plus 1 of the following REM related symptoms:
--> cataplexy, hallucinations (hypnagogic/hypnopompic),sleep paralysis
- "HIPPY POMPOUS NARC"
--> Narcolepsy has hallucinations = hypnogogic and hypnopompic
--> GOING to sleep and POMPOUS wake up NARC
- In Narcs ... CATAPLEXY = Orexin / hypocretin 1 is LOW
-
*Sleep Apnea
- mostly from neuromuscular cause
- 3 subtypes
- OSA = obstructive sleep apnea
- Central Sleep apnea
- Obesity hypoventilation syndrome
*OSA = Obstructive Sleep apnea
- many very important associated symptoms and findings
- HTN
- daytime somnelensce, not REFRESHED sleep
- morning headaches
- PAH common
--> RV HF following PAH
-
Tongue Anatomy and OSA
- all motor to tongue from CN 12 = hypoglossal
--> "up and out and roll"
- exception is CN 10 control styloglossal for lifting the tongue to swallow
Notes:
- vagus nerve = CN 10 makes OSA worse
--> since it lifts the tongue against the oropharynx
- CN 12 = hypoglossal makes OSA better since lowers tongue
OSA and Sequalae
- OSA causes systemic HTN and
- chronic OSA causes pulmonary HTN
--> leads to right HF
- also at risk for other heart conditions like A-fib and CAD
-
-
OHS = Obesity hypoventilation syndrome
- key to differentiate Obesity HS from other apneas is the obesity is main factor and causes restriction and hypoventilation
--> ALL day
--> constant low O2 and high CO2 from lung restriction
*Changes in Sleep Patterns - Differentials
- normal changes in sleep due to aging
Sleep Changes in *Aging
Sleep time latency
- the length of time from full wakefulness to sleep
--> normally to the stage N1 of the non-REM sleep stages
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