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

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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

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Clinical Cases

Clinical Case

Notes:

  • note that

Clinical Case

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*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)

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*Changes in Sleep Patterns - Differentials

  • normal changes in sleep due to aging

Sleep Changes in *Aging

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Sleep time latency

  • the length of time from full wakefulness to sleep
    --> normally to the stage N1 of the non-REM sleep stages

Clinical Cases

Clinical Case

Notes:

  • note that

Clinical Case

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*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

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*Sleep Apnea

  • mostly from neuromuscular cause
  • 3 subtypes
  • OSA = obstructive sleep apnea
  • Central Sleep apnea
  • Obesity hypoventilation syndrome

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*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

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Clinical Cases

Clinical Case

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Clinical Case

Notes:

  • note that

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

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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

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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

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

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