Psychopharmacology: Antipsychotics and Antidepressants
211 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which statement about classical antipsychotic chlorpromazine is true?

  • It causes sedation and can cross the blood-brain barrier. (correct)
  • It improves negative symptoms of schizophrenia.
  • It activates 5HT2 receptor types.
  • It activates D2 receptors.

    • What causes extrapyramidal symptoms (EPS) in classical antipsychotics such as chlorpromazine?

  • Blocking H1 receptors.
  • Activating muscarinic receptors.
  • Blocking muscarinic receptors.
  • Blocking D2 receptors. (correct)

    • Which statement about clozapine is false?

  • It antagonizes mesolimbic D2 receptors.
  • It is effective against negative symptoms.
  • It is ineffective against positive symptoms. (correct)
  • It is less likely to cause extrapyramidal symptoms.

    • Why are selective serotonin reuptake inhibitors (SSRIs) like fluoxetine not recommended during the manic phase of bipolar disorder?

    <p>They can exacerbate manic symptoms.</p> Signup and view all the answers

    Which of the following is a correct indication for the use of fluoxetine?

    <p>Management of anxiety disorders.</p> Signup and view all the answers

    What is a key mechanism of action of SSRIs like fluoxetine?

    <p>Selective blockers of 5-HT uptake</p> Signup and view all the answers

    Which of the following statements about MAO inhibitors is incorrect?

    <p>Moclobemide irreversibly inhibits MAO(B)</p> Signup and view all the answers

    Which clinical sign is not typically associated with Parkinson's disease?

    <p>Dyskinesia</p> Signup and view all the answers

    Which statement regarding L-dopa is true?

    <p>It is decarboxylated in the periphery.</p> Signup and view all the answers

    Which drug class is correctly matched to a likely side effect?

    <p>Levodopa/dyskinesia</p> Signup and view all the answers

    Why are SSRIs often preferred in treating depression?

    <p>They have lower toxicity and fewer adverse effects.</p> Signup and view all the answers

    Why are dopamine agonists not typically used to treat depression?

    <p>They might induce unwanted behaviors.</p> Signup and view all the answers

    What is the role of CBT when treating depression alongside medication?

    <p>It may enhance the effectiveness of drugs.</p> Signup and view all the answers

    How long does it typically take for SSRIs to show a therapeutic effect?

    <p>2-6 weeks</p> Signup and view all the answers

    What is the primary outcome of using MAO inhibitors?

    <p>Prevent the breakdown of serotonin</p> Signup and view all the answers

    What are the three main sections of the brainstem?

    <p>Midbrain, Pons, Medulla Oblongata</p> Signup and view all the answers

    Which artery is primarily responsible for supplying the anterior part of the brain?

    <p>Anterior Cerebral Artery</p> Signup and view all the answers

    What is the role of the thalamus in the brain?

    <p>Acting as a relay station for sensory information</p> Signup and view all the answers

    What does a Transient Ischaemic Attack (TIA) signify?

    <p>Temporary interruption of blood flow to the brain</p> Signup and view all the answers

    Which structure is found below the thalamus?

    <p>Hypothalamus</p> Signup and view all the answers

    Which type of stroke is caused by a build-up of plaque in the arteries?

    <p>Ischaemic Stroke</p> Signup and view all the answers

    In a scenario where a patient has only right facial weakness, which artery is likely affected?

    <p>Left Middle Cerebral Artery</p> Signup and view all the answers

    What is the significance of the Circle of Willis?

    <p>It connects anterior and posterior circulations of the brain.</p> Signup and view all the answers

    What are the potential consequences of a haemorrhagic stroke?

    <p>Rupturing of a blood vessel leading to brain bleeding</p> Signup and view all the answers

    If a patient experiences global motor weakness on the left side of their body, this indicates which type of stroke?

    <p>Brainstem Stroke</p> Signup and view all the answers

    What role do the cerebellar peduncles serve in the brain?

    <p>They transfer signals in and out of the cerebellum.</p> Signup and view all the answers

    What input does the inferior cerebellar peduncle primarily carry?

    <p>Incoming vestibular and proprioceptive fibers.</p> Signup and view all the answers

    Which structure provides the main connection from the cerebellum to the cerebrum?

    <p>Superior cerebellar peduncle.</p> Signup and view all the answers

    How does the basal ganglia primarily influence movement?

    <p>By initiating and planning movement.</p> Signup and view all the answers

    What is the function of the thalamus in relation to the basal ganglia?

    <p>It receives sensory inputs and relays them from the basal ganglia.</p> Signup and view all the answers

    What phenomenon occurs as a result of 'disinhibition' in the direct pathway of the basal ganglia?

    <p>Increased excitability of the cortical neurons.</p> Signup and view all the answers

    What is typically conveyed through the middle cerebellar peduncle?

    <p>Voluntary movement impulses from the cerebrum.</p> Signup and view all the answers

    What does the cerebellum create to assist the motor cortex in movement?

    <p>A blueprint for the best way to coordinate movements.</p> Signup and view all the answers

    Which of the following components is NOT part of the basal ganglia?

    <p>Thalamus.</p> Signup and view all the answers

    What type of signals do the neurons in the striatum primarily use to convey excitatory impulses?

    <p>Glutamate.</p> Signup and view all the answers

    What role do arachnoid granulations play in the central nervous system?

    <p>They drain CSF into the venous blood supply.</p> Signup and view all the answers

    Which of the following is the most common cause of acute bacterial meningitis?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What is a characteristic feature of acute bacterial meningitis?

    <p>Decreased consciousness.</p> Signup and view all the answers

    Which statement about subacute meningitis is true?

    <p>Mycobacterium tuberculosis can be a causative agent.</p> Signup and view all the answers

    Which of the following factors has contributed to the decline in incidence of certain types of meningitis?

    <p>Development of vaccines.</p> Signup and view all the answers

    What are the midline cranial nerves located in the midbrain?

    <p>Cranial nerves 3 and 4</p> Signup and view all the answers

    Which structure is associated with the medial motor syndromes?

    <p>Corticospinal tract</p> Signup and view all the answers

    In the case of a right medial stroke, which symptom would most likely occur?

    <p>Left leg weakness</p> Signup and view all the answers

    Which type of paralysis is characteristic of upper motor neuron lesions?

    <p>Spastic paralysis</p> Signup and view all the answers

    What happens to muscle tone in lower motor neuron lesions?

    <p>Decreased muscle tone</p> Signup and view all the answers

    Which structure is located dorsal to the pons?

    <p>Cerebellum</p> Signup and view all the answers

    Which is NOT a characteristic of upper motor neuron lesions?

    <p>Hypotonia</p> Signup and view all the answers

    What is the primary role of cerebrospinal fluid (CSF)?

    <p>To provide nutrition for brain structures</p> Signup and view all the answers

    How do inferior, middle, and superior peduncles connect to the cerebellum?

    <p>They connect the cerebellum to the brainstem</p> Signup and view all the answers

    What does a positive Babinski sign indicate?

    <p>Upper motor neuron damage</p> Signup and view all the answers

    Which cranial nerve is primarily associated with lateral eye movement?

    <p>CN 6</p> Signup and view all the answers

    How does denervation atrophy differ in upper and lower motor neuron lesions?

    <p>Occurs immediately in lower motor neuron lesions</p> Signup and view all the answers

    Which syndrome is characterized by pain and temperature sense disruption?

    <p>Spinothalamic tract syndrome</p> Signup and view all the answers

    What type of reflex is associated with lower motor neuron lesions?

    <p>Hyporeflexive</p> Signup and view all the answers

    What is the primary role of the substantia nigra pars compacta in the basal ganglia pathways?

    <p>Storage of dopamine</p> Signup and view all the answers

    Which of the following is an effect of acetylcholine on the basal ganglia pathways?

    <p>Suppresses the indirect pathway</p> Signup and view all the answers

    What causes hemiballismus in patients?

    <p>Subthalamic lesion</p> Signup and view all the answers

    Which medication is considered the first-line treatment for Parkinson's disease?

    <p>Levodopa</p> Signup and view all the answers

    How does carbidopa function in the treatment regimen for Parkinson's disease?

    <p>Inhibits peripheral breakdown of levodopa</p> Signup and view all the answers

    Which structure acts as an intermediary in the indirect pathway by receiving signals from the striatum?

    <p>Globus pallidus externus</p> Signup and view all the answers

    What is the role of monoamine oxidase in the context of dopamine regulation?

    <p>Breaks down dopamine in the presynaptic neurons</p> Signup and view all the answers

    Which ventricle is directly connected to the third ventricle via the interventricular foramen?

    <p>Lateral ventricles</p> Signup and view all the answers

    What type of movement characterizes hemiballismus?

    <p>Involuntary flinging movements</p> Signup and view all the answers

    Which structure directly supplies inhibitory signals to the thalamus in the indirect pathway?

    <p>Globus pallidus internus</p> Signup and view all the answers

    In which disorder is the degeneration of the substantia nigra particularly prominent?

    <p>Parkinson's disease</p> Signup and view all the answers

    What separates the dura mater and pia mater in the central nervous system?

    <p>Arachnoid mater</p> Signup and view all the answers

    What is the primary purpose of cerebrospinal fluid (CSF) in relation to the brain?

    <p>Acts as a shock absorber and buoyancy support</p> Signup and view all the answers

    Which of the following structures is responsible for connecting the third and fourth ventricles?

    <p>Cerebral aqueduct</p> Signup and view all the answers

    What is the primary function of the external auditory canal?

    <p>It amplifies sound waves by 10-15dB</p> Signup and view all the answers

    Which condition refers to the complete absence of the external ear?

    <p>Anotia</p> Signup and view all the answers

    How does the tympanic membrane respond to sound waves?

    <p>By vibrating at the same frequency as the incoming sound wave</p> Signup and view all the answers

    What is a common consequence of excessive earwax in the external auditory canal?

    <p>Blockage that prevents sound from reaching the tympanic membrane</p> Signup and view all the answers

    What is the appearance of a healthy tympanic membrane when viewed with an otoscope?

    <p>Grey or pearly and intact</p> Signup and view all the answers

    What is the primary role of the ossicular bones in the middle ear?

    <p>To vibrate and amplify sound pressure</p> Signup and view all the answers

    What is a potential consequence of fluid accumulation in the middle ear?

    <p>Increased resistance to tympanic membrane movement</p> Signup and view all the answers

    How does the size difference between the eardrum and the stapes affect sound amplification?

    <p>It amplifies sound pressure significantly</p> Signup and view all the answers

    What condition occurs when there is bony formation in the middle ear?

    <p>Otosclerosis</p> Signup and view all the answers

    What is the main function of the Eustachian tube in relation to the middle ear?

    <p>To maintain equal pressure between the ear and the environment</p> Signup and view all the answers

    What type of fluid fills the scala media of the cochlea?

    <p>Endolymph</p> Signup and view all the answers

    Which part of the cochlea allows for the detection of variable frequencies?

    <p>Basilar membrane</p> Signup and view all the answers

    How does the foot of the stapes contribute to hearing?

    <p>It transmits vibrations into the perilymph.</p> Signup and view all the answers

    In what way does the cochlea function like an acoustic prism?

    <p>It breaks down different sound frequencies.</p> Signup and view all the answers

    What characteristic of hair cells in the organ of Corti is essential for sound transduction?

    <p>Presence of stiff tectorial membrane</p> Signup and view all the answers

    What is the main purpose of tip links in hair cells?

    <p>Facilitate the entry of potassium ions during depolarization.</p> Signup and view all the answers

    Which compartment of the cochlea is rich in sodium?

    <p>Both scala vestibuli and tympani</p> Signup and view all the answers

    What frequency range defines normal human hearing capabilities?

    <p>20 - 20,000 Hz</p> Signup and view all the answers

    What happens to excess sound energy within the cochlea?

    <p>It exits through the round window.</p> Signup and view all the answers

    What role do outer hair cells play in hearing?

    <p>They help fine-tune the tension of the basilar membrane.</p> Signup and view all the answers

    How is the electrochemical gradient maintained in inner hair cells?

    <p>Via active potassium-pumping cells.</p> Signup and view all the answers

    What is the charge of endolymph compared to perilymph?

    <p>Endolymph is more positive, perilymph is negative.</p> Signup and view all the answers

    What is the role of supporting cells in the organ of Corti?

    <p>They provide structural support to hair cells.</p> Signup and view all the answers

    What happens to the cochlea's structure to fit within the head?

    <p>It is coiled to maintain a compact form.</p> Signup and view all the answers

    What does the Weber test specifically assess for in hearing loss?

    <p>Comparison of hearing between the two ears</p> Signup and view all the answers

    Which structure is primarily responsible for providing nutrients to the inner cornea?

    <p>Aqueous humour</p> Signup and view all the answers

    In the Rinne test, what indicates a negative result for conductive hearing loss?

    <p>Sound is heard through bone longer than air</p> Signup and view all the answers

    What condition results from an accumulation of aqueous humour causing increased intraocular pressure?

    <p>Glaucoma</p> Signup and view all the answers

    Which of the following structures must light pass through to reach the retina?

    <p>Cornea</p> Signup and view all the answers

    How does sensorineural hearing loss differ from conductive hearing loss during a Weber test?

    <p>Sound lateralizes to the healthier ear</p> Signup and view all the answers

    What is a notable feature of the vitreous humour?

    <p>It contributes to intraocular oxygen distribution</p> Signup and view all the answers

    What role does the canal of Schlemm play in the eye?

    <p>Drains aqueous humour from the eye</p> Signup and view all the answers

    What is the primary refractive power of the cornea?

    <p>43 diopters</p> Signup and view all the answers

    What happens to the lens when viewing distant objects?

    <p>It thins out.</p> Signup and view all the answers

    What occurs when the ciliary muscles contract?

    <p>Lens becomes thicker.</p> Signup and view all the answers

    What is a key function of the lens in the eye?

    <p>Focus light onto the retina</p> Signup and view all the answers

    What type of lens is needed to correct myopia?

    <p>Concave lens</p> Signup and view all the answers

    What primarily causes visual impairments due to cloudy structures in the eye?

    <p>Absorbing or reflecting light rays</p> Signup and view all the answers

    Which of the following is not typically a symptom of a corneal ulcer?

    <p>Cloudy lens appearance</p> Signup and view all the answers

    What is the function of the iris in the eye?

    <p>To control pupil diameter.</p> Signup and view all the answers

    What is the primary source of nutrition for the outer layer of the cornea?

    <p>Tear gland secretions</p> Signup and view all the answers

    What happens to sound perception in the presence of conductive hearing loss?

    <p>It is reduced in air conduction but normal in bone conduction</p> Signup and view all the answers

    Why does aging affect the lens of the eye?

    <p>The lens becomes stiff and loses elasticity.</p> Signup and view all the answers

    Why does vision impair in cases of cataracts?

    <p>The lens becomes opaque</p> Signup and view all the answers

    What is the role of LASIK surgery?

    <p>To reshape the cornea for better light focus.</p> Signup and view all the answers

    How does pupil size affect image clarity?

    <p>A smaller pupil creates a sharper image.</p> Signup and view all the answers

    What is the result of poor image focus on the retina?

    <p>A blurry image.</p> Signup and view all the answers

    What is hypermetropia?

    <p>Inability to see nearby objects clearly.</p> Signup and view all the answers

    How are sound frequencies processed in the auditory system?

    <p>Specific hair cells respond to different frequencies along the basilar membrane.</p> Signup and view all the answers

    What type of lens is required for hypermetropia?

    <p>Convex lens</p> Signup and view all the answers

    Which muscles in the ear help protect the inner ear from loud noises?

    <p>Tensor tympani and stapedius</p> Signup and view all the answers

    What is the primary function of the superior olivary complex in the auditory pathway?

    <p>Initiate sound localization</p> Signup and view all the answers

    What advantage does the ciliary muscle provide in focusing?

    <p>It alters lens thickness via suspensory ligaments.</p> Signup and view all the answers

    Why is reading in low light difficult?

    <p>The lens cannot accommodate properly, leading to scatter.</p> Signup and view all the answers

    How does loudness perception occur in the auditory system?

    <p>Through the amplitude of sound waves</p> Signup and view all the answers

    What must occur for the pupil to constrict in bright light?

    <p>Circular muscles of the iris contract.</p> Signup and view all the answers

    What distinguishes conductive hearing loss from sensorineural hearing loss?

    <p>Conductive is related to transmission issues in outer/middle ear, while sensorineural is related to inner ear or nerve damage.</p> Signup and view all the answers

    In the auditory pathway, where does synapsing first occur after cochlear signaling?

    <p>Medial geniculate nucleus</p> Signup and view all the answers

    Which visual cortex stream is primarily involved in object recognition?

    <p>Ventral stream</p> Signup and view all the answers

    What initiates the opening of mechanically gated potassium channels in hair cells?

    <p>Movement of tip links due to vibration of the basilar membrane</p> Signup and view all the answers

    What happens when a sudden loud sound occurs?

    <p>The hair cells undergo a strong contraction that may cause damage.</p> Signup and view all the answers

    What is one of the key roles of the inferior colliculus in the auditory system?

    <p>It allows for short circuit processing of sound without cortical involvement.</p> Signup and view all the answers

    What is the main disadvantage of bone conduction compared to air conduction in hearing?

    <p>Bone conduction does not transmit sound waves effectively through the outer ear.</p> Signup and view all the answers

    Which of the following is NOT typically a consequence of sleep deprivation?

    <p>Heightened immune response</p> Signup and view all the answers

    What is the primary cause of hearing loss observed with continued exposure to loud sounds?

    <p>Inability of hair cells to recover from vibration stress</p> Signup and view all the answers

    Which statement about the auditory pathways is true?

    <p>Auditory impulses from both ears reach both sides of the brain.</p> Signup and view all the answers

    What is the primary reason the fovea and macula are avascular?

    <p>To maximize photoreceptor density and avoid blocking light</p> Signup and view all the answers

    During the early stage of diabetic retinopathy, which part of the visual field is primarily affected?

    <p>Peripheral vision</p> Signup and view all the answers

    Which cones are responsible for detecting red light?

    <p>L cones</p> Signup and view all the answers

    What is the function of the lateral geniculate nucleus in the visual pathway?

    <p>To relay visual information to the occipital lobe</p> Signup and view all the answers

    What role do the hair cells in the organ of Corti play in hearing?

    <p>Transduce sound vibrations into electrical signals</p> Signup and view all the answers

    How is inadequate sleep correlated with public health issues?

    <p>Contributes to various physical health problems and accidents</p> Signup and view all the answers

    What percentage of Australian adults reportedly experience some form of inadequate sleep?

    <p>40%</p> Signup and view all the answers

    Which type of visual field information crosses at the optic chiasm?

    <p>Nasal visual field information</p> Signup and view all the answers

    What is a common test used to detect color blindness?

    <p>Ishihara cards</p> Signup and view all the answers

    What outcomes can occur from nerve issues related to auditory mechanisms?

    <p>They can result in either conductive or sensorineural hearing loss.</p> Signup and view all the answers

    What is the estimated financial cost of inadequate sleep in Australia for 2016-2017?

    <p>Approximately $66 billion</p> Signup and view all the answers

    What do rods primarily help us perceive?

    <p>Black and white vision</p> Signup and view all the answers

    What key function does the optic radiation serve in the visual pathway?

    <p>It carries visual signals to the occipital lobe</p> Signup and view all the answers

    What is the primary function of the sympathetic nervous system in relation to pupils?

    <p>Pupillary dilation</p> Signup and view all the answers

    Where do sympathetic nerves originate in the central nervous system?

    <p>Thoracolumbar region</p> Signup and view all the answers

    Which type of photoreceptor is more sensitive to light?

    <p>Rods</p> Signup and view all the answers

    What occurs when light is shone into a patient's left eye and results in the right pupil constricting?

    <p>An intact reflex arc in both eyes</p> Signup and view all the answers

    What mechanism allows rhodopsin in rods to trigger a response to light?

    <p>Hyperpolarization in response to light</p> Signup and view all the answers

    Which area of the retina is responsible for the highest visual acuity?

    <p>Fovea</p> Signup and view all the answers

    Which type of convergence allows for high visual acuity in the retina?

    <p>Cones have a low convergence ratio</p> Signup and view all the answers

    What is a blind spot in the retina caused by?

    <p>Absence of photoreceptors on the optic disc</p> Signup and view all the answers

    How do parasympathetic impulses cause pupillary constriction?

    <p>Via the circular muscles of the iris</p> Signup and view all the answers

    If light reaches the brainstem but the right eye does not constrict, what type of issue is this considered?

    <p>Efferent issue on the right</p> Signup and view all the answers

    What type of vision do rods primarily facilitate?

    <p>Black and white vision in dim light</p> Signup and view all the answers

    What is the pathway for the parasympathetic fibers to reach the pupil?

    <p>Brainstem to the ciliary ganglion</p> Signup and view all the answers

    Which statement best describes the role of the retina in vision?

    <p>It processes visual information before generating action potentials</p> Signup and view all the answers

    What is the main purpose of placing electrodes on the scalp during an EEG?

    <p>To measure electrical potential differences in the brain</p> Signup and view all the answers

    Which of the following EEG frequency bands is associated with deep sleep?

    <p>Delta waves</p> Signup and view all the answers

    What is the typical latency for a young adult to fall asleep?

    <p>10-30 minutes</p> Signup and view all the answers

    During which sleep stage are sleep spindles primarily observed?

    <p>N2</p> Signup and view all the answers

    How often do sleep cycles typically repeat throughout the night?

    <p>90 minutes</p> Signup and view all the answers

    How does stimulation impact tongue muscle activity in obstructive sleep apnoea?

    <p>It increases tongue muscle activity.</p> Signup and view all the answers

    What does an EEG trace display on its axes?

    <p>Voltage vs. time</p> Signup and view all the answers

    What characterizes Periodic Limb Movement Disorder (PLMD)?

    <p>Repetitive limb movements every 20-40 seconds during sleep.</p> Signup and view all the answers

    Which of the following best describes the structure of sleep architecture in a typical young adult?

    <p>Consistent order of stages throughout the night</p> Signup and view all the answers

    What trend is associated with age-related changes in sleep?

    <p>More frequent awakenings</p> Signup and view all the answers

    What is the most common sensation reported in Restless Leg Syndrome?

    <p>Creepy-crawly feelings in legs.</p> Signup and view all the answers

    Which statement is true regarding the treatment of insomnia related to parasomnias?

    <p>Improving sleep hygiene may help.</p> Signup and view all the answers

    What physiological measurement is made using a pulse oximeter?

    <p>Oxygen saturation</p> Signup and view all the answers

    What type of brain activity is primarily detected during REM sleep?

    <p>Theta waves similar to wakefulness</p> Signup and view all the answers

    What happens during REM behavior disorder?

    <p>They act out vivid or violent dreams.</p> Signup and view all the answers

    What is a potential trigger for increased episodes of sleepwalking?

    <p>Sleep deprivation.</p> Signup and view all the answers

    How is sleep typically scored in polysomnography?

    <p>In 30-second sequential epochs</p> Signup and view all the answers

    Which electrode placement system is used to standardize electrode positioning?

    <p>International 10-20 system</p> Signup and view all the answers

    Which of the following is NOT a type of parasomnia?

    <p>Nightmare disorder.</p> Signup and view all the answers

    What characterizes the theta wave activity observed in N1 sleep?

    <p>Low frequency with moderate amplitude</p> Signup and view all the answers

    Which condition is associated with low iron levels as a potential cause?

    <p>Restless Leg Syndrome.</p> Signup and view all the answers

    Which metric indicates good sleep efficiency?

    <p>85% or greater of time spent asleep</p> Signup and view all the answers

    What is the main characteristic of sleepwalking?

    <p>Involves complex behaviors while asleep.</p> Signup and view all the answers

    What is recommended for managing REM behavior disorder in individuals?

    <p>Remove dangerous objects from the bedroom.</p> Signup and view all the answers

    What is one primary function of sleep as indicated in the consensus statements?

    <p>To enhance survival and adaptation</p> Signup and view all the answers

    According to surveys, how many hours of sleep do most individuals feel they need to function optimally during the day?

    <p>7 to 9 hours</p> Signup and view all the answers

    Which of the following is a recognized method for objectively measuring sleep?

    <p>Polysomnography (PSG)</p> Signup and view all the answers

    What is sleep deprivation known to be linked with as per the findings discussed?

    <p>Adverse health outcomes</p> Signup and view all the answers

    Which sleep stage is associated with brain plasticity and memory consolidation?

    <p>REM sleep</p> Signup and view all the answers

    What trend has been observed in the average amount of sleep people get on weekdays?

    <p>Decreasing over time</p> Signup and view all the answers

    What happens to sleep amounts after a period of sleep deprivation according to the study mentioned?

    <p>Participants sleep more than their normal amounts</p> Signup and view all the answers

    What is a subjective method for evaluating sleep quality?

    <p>Pittsburgh Sleep Quality Index</p> Signup and view all the answers

    Which group of people might need more than 9 hours of sleep on a regular basis?

    <p>Individuals recovering from sleep debt</p> Signup and view all the answers

    What characteristic of wake time is suggested to be a good measure of sleep adequacy?

    <p>Quality of wake time</p> Signup and view all the answers

    What aspect of sleep is acknowledged in the 'crazy big brother study' conducted in the early 2000s?

    <p>Post-deprivation recovery leads to excessive sleep</p> Signup and view all the answers

    What does actigraphy typically utilize to assess sleep?

    <p>Accelerometers measuring movement</p> Signup and view all the answers

    What phenomenon did the early research suggest regarding developmental changes in sleep needs over time?

    <p>Research is ongoing into sleep needs throughout adulthood</p> Signup and view all the answers

    What is the primary form of sleep that is restorative and occurs during non-REM (NREM) sleep?

    <p>Stage 3 NREM</p> Signup and view all the answers

    What is the primary anatomical feature that contributes to the occurrence of obstructive sleep apnoea?

    <p>Poor anatomy of the upper airway</p> Signup and view all the answers

    Which of the following factors is NOT typically associated with an increased risk of developing OSA?

    <p>Female gender</p> Signup and view all the answers

    What does the Apnea Hypopnea Index quantify in relation to obstructive sleep apnoea?

    <p>Number of apneas and hypopneas per hour</p> Signup and view all the answers

    What are the potential neurocognitive sequelae of untreated obstructive sleep apnoea?

    <p>Waking hypersomnolence and mental health issues</p> Signup and view all the answers

    Which type of therapy is considered first-line treatment for obstructive sleep apnoea?

    <p>Continuous positive airway pressure therapy (CPAP)</p> Signup and view all the answers

    What is a common side effect experienced by patients who use CPAP therapy?

    <p>Intolerance or discontinuation of use</p> Signup and view all the answers

    How does alcohol or sedative use before bedtime affect sleep apnoea?

    <p>It can worsen sleep apnoea symptoms</p> Signup and view all the answers

    What is a potential outcome of untreated obstructive sleep apnoea on cardiovascular health?

    <p>Increased risk of hypertension and stroke</p> Signup and view all the answers

    What type of device is a buzz-POD classified as in the treatment of sleep apnoea?

    <p>High-tech positional trainer</p> Signup and view all the answers

    Which type of oral appliance is designed to manipulate the position of the mandible to restore airway patency?

    <p>Mandibular advancement device</p> Signup and view all the answers

    What is a critical characteristic of central sleep apnoea compared to obstructive sleep apnoea?

    <p>It involves an intention to stop breathing</p> Signup and view all the answers

    Which of the following is a method used to measure sleep position for treating obstructive sleep apnoea?

    <p>Accelerometry based devices</p> Signup and view all the answers

    What impact does repeated exposure to hypoxia and hypercapnia have in obstructive sleep apnoea?

    <p>Cardiovascular and neurocognitive consequences</p> Signup and view all the answers

    Study Notes

    Classical Antipsychotics

    • Chlorpromazine is a typical antipsychotic that is sedating and can cross the blood-brain barrier.
    • Classical antipsychotics block D2 receptors, which is why they are associated with extrapyramidal symptoms (EPS).
    • Chlorpromazine is poorly responsive to negative symptoms of schizophrenia as it does not alter activity in the mesocortical area.
    • Classical antipsychotics block 5HT2 receptors, except for haloperidol, which does not block them.

    Atypical Antipsychotics

    • Clozapine is an atypical antipsychotic that is effective against negative symptoms of schizophrenia.
    • Clozapine antagonises mesolimbic D2 receptors, which is how it treats positive symptoms of schizophrenia.
    • Clozapine antagonises prefrontal cortex 5HT2 receptors, which is how it treats negative symptoms.
    • Clozapine is associated with fewer extrapyramidal symptoms (EPS).

    Antidepressants

    • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are first-line treatment for depression and anxiety.
    • SSRIs are not appropriate for acute use, but they can be used for the treatment of anxiety.
    • Monoamine oxidase inhibitors (MAOIs), such as moclobemide and tranylcypromine, are last-line treatments for depression due to their side effects.
    • MAOIs increase intracellular levels of serotonin by inhibiting its breakdown.
    • Tranylcypromine can cause the cheese reaction when tyramine stimulates sympathetic activation and noradrenaline release.

    Parkinson’s Disease

    • L-dopa is used to treat Parkinson's disease, and it is poorly effective when used alone.
    • L-dopa is decarboxylated in the periphery and has a short half-life.
    • Dopamine agonists are associated with impulse control disorders, such as gambling and compulsive sexual behaviour.

    Cerebral Hemispheres

    • The cerebral hemispheres develop from the telencephalon.
    • The four main lobes of the brain are:
      • Frontal lobe
      • Parietal lobe
      • Temporal lobe
      • Occipital lobe

    Cerebellum

    • The cerebellum develops from the metencephalon, alongside the pons.
    • The cerebellum coordinates skeletal muscle contraction to ensure precise and stable movement.
    • The cerebellum connects to the pons, midbrain, and medulla oblongata through the cerebellar peduncles.

    Brainstem

    • The brainstem has three sections:
      • Midbrain
      • Pons
      • Medulla oblongata

    Arterial Supply of the Brain

    • Vertebral arteries branch from the subclavian arteries and ascend to the brainstem.
    • The vertebral arteries join to form the basilar artery, which continues up the brainstem and bifurcates to form the circle of Willis.
    • The circle of Willis gives off the posterior cerebral, middle cerebral, and anterior cerebral arteries.
    • The anterior communicating artery joins the anterior cerebral arteries.
    • The posterior communicating arteries join the middle and posterior cerebral arteries.
    • The internal carotid arteries also join the circle of Willis.

    Stroke

    • A stroke is an interruption of blood flow to the brain or brainstem for more than 24 hours.
    • A transient ischemic attack (TIA) is an interruption of blood flow to the brain for less than 24 hours.
    • Thrombolytic therapy must be administered within 4 hours of an ischemic stroke.

    Rule of 4s

    • The rule of 4s helps to differentiate cortical from brainstem strokes.
    • There are four motor syndromes and four sensory syndromes that indicate brainstem strokes.
    • The motor syndromes are:
      • Medial longitudinal fasciculus
      • Motor tract of the upper motor neuron
      • Medial lemniscus
      • Motor nuclei of cranial nerves (divisible by 12)
    • The sensory syndromes are:
      • Spinothalamic tract
      • Spinocerebellar tract
      • Sympathetic chain
      • Sensory CN nuclei (not divisible by 12)

    Upper Motor Neuron (UMN) vs Lower Motor Neuron (LMN) Lesions

    • An UMN lesion is to the brain or spinal cord.
    • An LMN lesion is to the anterior horn cell or the nerve from there to the muscle.

    Basal Ganglia

    • The basal ganglia is a network of nuclei that plan and initiate movement.
    • The basal ganglia includes the:
      • Caudate nucleus
      • Putamen
      • Globus pallidus
      • Subthalamus nucleus
      • Substantial nigra
    • The thalamus is not part of the basal ganglia, but it is the sensory centre that receives inputs from it.

    Direct Pathway of the Basal Ganglia

    • The direct pathway of the basal ganglia initiates movement.
    • The cortex sends excitatory signals to the striatum, which then sends inhibitory signals to the globus pallidus interna (GPi) and substantia nigra pars reticulata (SNr).
    • This disinhibition causes the thalamus to send excitatory signals back to the cortex, which then initiates movement.

    Indirect Pathway

    • Cortex signals to striatum.
    • Striatum sends inhibitory signals to the globus pallidus external segment, disinhibiting the subthalamic nucleus.
    • Subthalamic nucleus sends excitatory signals to the globus pallidus internus and substantia nigra pars reticulata.
    • Globus pallidus internus and substantia nigra pars reticulata send inhibitory signals to the thalamus, preventing the thalamus from sending excitatory signals to the cortex.

    Substantia Nigra Pars Compacta

    • Substantia nigra, located in the midbrain, is the primary dopamine storage area in the central nervous system.
    • Dopamine acts as fuel for the basal ganglia pathways.
    • Substantia nigra pars compacta releases dopamine to the striatum, which binds to dopamine receptors.
    • Two families of dopamine receptors:
      • D1 Family (excitatory) - D1 & D5 - enhances the direct pathway, promoting movement initiation.
      • D2 Family (inhibitory) - D2, D3, D4 - inhibits the indirect pathway.

    Acetylcholine

    • Striatum also receives acetylcholine from the cortex, which has an opposite role to dopamine.
    • Acetylcholine enhances the indirect pathway and suppresses the direct pathway, a crucial factor in Parkinson's disease.

    Neurological Conditions

    • Substantia nigra - Parkinson's disease.
    • Striatum - Huntington's disease.
    • Subthalamic nucleus - hemiballismus/ballismus.

    Hemiballismus

    • Characterized by wild involuntary flinging movements.
    • Typically caused by a subthalamic lesion, often due to a lacunar infarct (small stroke).
    • Ipsilateral subthalamic infarct results in contralateral hemiballismus.
    • Primarily affects proximal limbs, leading to dehydration, exhaustion, and potential self-harm.
    • Usually self-limiting with symptoms resolving within weeks or months.
    • Treatment options:
      • Pharmacological: dopamine agonists.
      • Surgical: pallidotomy.
    • Diagnosis is made clinically.

    Parkinson's Disease - Pharmacology

    • Neurodegenerative disease primarily affecting the substantia nigra.
    • Substantia nigra contains dopaminergic neurons that secrete dopamine, crucial for controlled movement.
    • Normal Dopaminergic Neurons:
      • Contain dopamine vesicles in their terminals.
      • Release dopamine, stimulating or inhibiting GABAergic neurons in the striatum (caudate and putamen).
      • Dopamine binds to receptors on GABAergic neurons, influencing their activity.
      • Contain the enzyme monoamine oxidase, which breaks down dopamine.
    • In Parkinson's disease:
      • Degeneration of dopaminergic neurons in the substantia nigra.
      • Reduced dopamine production.
      • CNS neurons in the substantia nigra are protected by the blood-brain barrier.
      • Decreased dopamine in the synaptic cleft due to neuron death.
      • Monoamine oxidase continues to break down dopamine, even if it is not being produced.
      • Treatment aims to increase dopamine availability.
    • Levodopa (First Line)
      • A dopamine precursor that can cross the blood-brain barrier.
      • Dopamine itself cannot cross the BBB.
      • Levodopa can be peripherally broken down by dopamine carboxylase.
      • Decarboxylase inhibitors (e.g., carbidopa) are given to prevent peripheral breakdown of levodopa.
      • Levodopa can be broken down by COMT.
      • COMT inhibitors can further prevent peripheral breakdown.
      • Inside dopaminergic neurons, levodopa is converted into dopamine by dopa carboxylase.
    • Dopamine Agonists (Second Line)
      • Bind and activate dopamine receptors, mimicking dopamine effects.
    • Monoamine Oxidase Inhibitors
      • Inhibit the enzyme that breaks down dopamine, prolonging its availability.

    Cerebrospinal Fluid (CSF)

    • Brain develops from secondary brain vesicles (swelling in neural tube).
    • Diencephalon - thalamus.
    • Telencephalon - cerebrum.
    • Metencephalon - pons, cerebellum.
    • Myelencephalon - medulla.
    • Mesencephalon - midbrain.
    • The central canal of the spinal cord and brain ventricles are derived from the hollow space within the neural tube.
    • Ventricles are filled with CSF.
    • CSF also surrounds the brain, separating it from the cranium, allowing it to float and reducing pressure.

    Ventricles

    • Lateral ventricles (two sheep horn-shaped structures) are separated by the septum pellucidum.
    • Lateral ventricles extend into the cerebrum.
    • Lateral ventricles connect to the third ventricle via the interventricular foramen (of Monro).
    • The third ventricle is located in the thalamus, hypothalamus, and epithalamus region.
    • The cerebral aqueduct connects the third ventricle to the fourth ventricle.
    • The fourth ventricle is located between the cerebellum and pons.
    • An opening in the fourth ventricle allows CSF to drain into the subarachnoid space, surrounding the brain.

    Meninges

    • Dura mater - tight against the skull.
    • Pia mater - tight against the brain.
    • Arachnoid mater - spiderweb-like structure between dura and pia mater.
    • CSF drains into the subarachnoid space.
    • Arachnoid granulations extend from the arachnoid mater and drain CSF into the venous blood supply of the subdural space.
    • CSF flows to the jugular vein, heart, and lungs for reoxygenation.
    • CSF pressure exceeds blood pressure, allowing constant drainage and renewal.
    • CSF also circulates within the dura mater surrounding the spinal cord.

    Acute Bacterial Meningitis

    • Acute bacterial infection within the subarachnoid space, causing CNS inflammation.
    • Symptoms include inflammation, decreased consciousness, seizures, and raised intracranial pressure.
    • Mycobacterium tuberculosis and fungi typically cause subacute meningitis.
    • Meningitis refers to meningeal involvement.
    • Meningoencephalitis involves both the meninges and brain tissue.
    • Most common form of suppurative CNS infection.
    • Incidence has declined due to vaccinations for Haemophilus influenzae and Neisseria meningitidis.
    • Streptococcus pneumoniae is the most common cause (50%).
    • Neisseria meningitidis (25%).
    • Group B streptococcus (15%).
    • Listeria monocytogenes (10%).
    • Haemophilus influenzae.

    Outer Ear

    • The outer ear consists of the pinna and the external auditory meatus.
    • The pinna is the outer visible part of the ear, responsible for filtering sound waves and providing directional cues.
    • The external auditory meatus is a canal that amplifies sound waves by 10-15 dB, particularly around 3 kHz, the frequency of human speech.

    Middle Ear

    • The middle ear houses the ossicles: malleus, incus, and stapes.
    • These bones act as a lever system, amplifying sound pressure 22 times.
    • The middle ear also contains the Eustachian tube, connecting to the nasal cavity to regulate pressure.

    Inner Ear

    • The cochlea is the auditory part of the inner ear, a fluid-filled structure resembling a snail shell.
    • The footplate of the stapes pushes on the perilymph in the scala vestibule, triggering vibrations.
    • The cochlea is divided into three compartments: scala vestibuli, scala tympani, and the scala media (cochlear duct).
    • The basilar membrane within the cochlea is responsible for frequency discrimination, allowing different regions to vibrate maximally at different frequencies.

    Organ of Corti

    • The organ of Corti sits on the basilar membrane and contains hair cells, the receptors for sound.
    • Inner hair cells are the primary receptors, with afferent fibers from the vestibulocochlear nerve.
    • Outer hair cells, arranged in three rows, receive efferent fibers and help fine-tune the basilar membrane's tension.

    Hair Cell Transduction

    • Hair cells have stereocilia, stiff structures connected by tip links.
    • When stereocilia bend due to basilar membrane movement, tension on the tip links opens mechanically-gated potassium channels.
    • Potassium influx depolarizes the hair cell, leading to calcium channel opening and neurotransmitter release.

    Auditory Pathways

    • Auditory information is transmitted from the cochlea via the vestibulocochlear nerve (CN VIII) to the brainstem, then to the thalamus and finally to the temporal lobe for processing.
    • The auditory pathway is largely bilateral, meaning both ears send information to each hemisphere of the brain.

    Sound Localization

    • Sound localization is achieved by comparing the intensity and timing of sound arriving at both ears.
    • The superior olivary nucleus is the first place where inputs from both ears converge and begin to process sound localization.

    Hearing Impairments

    • Conductive hearing loss is due to problems with sound wave transmission to the inner ear.
    • Sensorineural hearing loss results from damage to the cochlea or the auditory nerve, impairing the conversion of sound waves to action potentials.

    Weber and Rinne Tests

    • Weber and Rinne tests are simple assessments using a tuning fork to distinguish conductive from sensorineural hearing loss.
    • Weber test involves placing a vibrating tuning fork on the skull; in conductive hearing loss, sound lateralizes to the affected ear, while in sensorineural hearing loss, it lateralizes to the unaffected ear.
    • Rinne test compares air conduction to bone conduction. In conductive hearing loss, bone conduction is equal to or greater than air conduction, while in sensorineural hearing loss, air conduction is greater than bone conduction.

    Optically Transparent Structures

    • Light must pass through the cornea, aqueous humor, lens, and vitreous humor to reach the retina.
    • These structures are avascular and rely on the aqueous humor for nutrition.
    • Any opacity in these structures can lead to visual impairments.

    Aqueous Humor

    • Aqueous humor is a clear fluid produced by the ciliary body, filling the anterior and posterior chambers of the eye.
    • It provides nutrients and oxygen to the cornea and lens and maintains intraocular pressure.

    Glaucoma

    • Glaucoma occurs when the drainage of aqueous humor is impaired, leading to increased intraocular pressure.
    • This pressure can damage the optic nerve, leading to vision loss.

    Insufficient Sleep and Its Impacts

    • The Institute of Medicine at National Academies states that insufficient sleep and sleep disorders have become a major public health issue.
    • Associated health consequences include increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.
    • Nearly 20% of serious car crash injuries are linked to driver sleepiness.

    Financial Costs of Sleep Deprivation

    • A Sleep Health Foundation study found that 40% of Australian adults experience sleep inadequacy.
    • The estimated total cost in Australia was $66.3 billion in 2016-17.
    • This includes $26.2 billion in financial costs like healthcare expenditures, productivity losses, and informal care.
    • It also includes $40.1 billion in lost well-being.

    Why Do We Sleep?

    • While the exact reasons for sleep are not fully understood, it is considered a biological necessity.
    • Animals sleep despite dangers, and complete sleep deprivation leads to death.
    • Sleep is restorative, promoting growth hormone release, brain plasticity (skill and memory formation), and flushing metabolic waste from the brain.
    • Adequate sleep is essential for proper bodily functioning and is linked to illness when lacking.

    Functions of Sleep

    • Conserve energy.
    • Enhance survival and adaptation.
    • Repair damaged tissues (Non-REM sleep).
    • Aid learning and memory consolidation (REM sleep).

    Average Sleep Duration

    • The Sleep in America poll found that people sleep an average of 6 hours and 40 minutes on weekdays and 7 hours and 7 minutes on weekends.
    • People seem to compensate for insufficient weekday sleep on weekends.
    • Average weekday sleep duration has been declining over time, indicating a shift towards a 24-hour society.

    Perceived Sleep Needs

    • Most people reported needing 7-9 hours of sleep for optimal daytime functioning.
    • The survey also found that 76% of individuals acknowledged their sleepiness and continued with their day, often relying on exercise or caffeine to combat it.

    Measuring Sleep Needs

    • Determining individual sleep needs is complex and not easily measured.
    • Factors like age, health, and lifestyle can influence sleep requirements.
    • Consult a healthcare professional for personalized recommendations.

    Sleep Study

    • A study in the early 2000s had participants sleep in a lab for 14 days straight, measuring their sleep patterns with a twist.
    • Participants slept normally on day 1, were entirely sleep-deprived on day 2, and then forced to stay in bed for 13 hours each day for 9 days (7 pm to 9 am).
    • Despite initial recovery following sleep deprivation, sleep plateaued, with participants sleeping 2 hours more than their usual sleep time.
    • This highlights that many individuals may not get enough sleep.

    Sleep Needs

    • Experts convened an international gathering to form a consensus statement on sleep needs for both children and adults.
    • Adults need at least 7 hours of sleep per night for optimal health.
    • Sleeping less than 7 hours regularly is associated with various health issues: obesity, weight gain, hypertension, heart disease, diabetes, stroke, depression, increased risk of death, impaired immune function, impaired performance, increased errors, higher risk of accidents.
    • Sleeping more than 9 hours per night might be necessary for young adults, those recovering from sleep debt, and individuals with illnesses. It's unclear if sleeping more than 9 hours is harmful for others.
    • The average sleep need for optimal functioning is around 7.5 hours of sleep (not just lying in bed).
    • Sleep needs change throughout development, but research on adult changes is ongoing.
    • Assessing the quality of wakefulness is a good indicator of adequate sleep.
    • The best way to determine personal sleep needs is to evaluate how rested you feel after a vacation.

    Measuring Sleep

    • Sleep can be measured objectively and subjectively.
    • Objective measures:
      • Polysomnography (PSG): The gold standard, performed at home or in a lab, measuring sleep latency, total sleep time, sleep efficiency, awakenings, WASO (wakefulness after sleep onset), and sleep stages.
      • Actigraphy: Uses accelerometers in devices like Fitbits, Garmins, and smartwatches to detect periods of sleep and wakefulness based on movement.
    • Subjective measures:
      • Sleep diary: Records sleep and wake times, sleep latency, sleep efficiency, awakenings, sleep quality, and daytime sleepiness.
      • Self-report questionnaires:
        • Pittsburgh Sleep Quality Index (global sleep quality)
        • Epworth Sleepiness Scale (trait sleepiness)
        • Karolinska Sleepiness Scale (state sleepiness)

    Sleep Stages

    • Two distinct stages:
      • Rapid Eye Movement (REM): Originally called jerky eye movement (JEM) sleep, also known as "active," "desynchronized," and "paradoxical" sleep.
      • Non-Rapid Eye Movement (NREM): Subdivided into three (originally four) stages, also called "quiet" sleep in infants or "synchronized" sleep in animals.

    Polysomnography (PSG)

    • The gold standard sleep measurement, derived from the Greek words "poly" (meaning many), "somnus" (meaning sleep), and "graphein" (meaning to write).
    • Records multiple physiological parameters:
      • Brain waves: Electroencephalogram (EEG)
      • Eye movement: Electrooculogram (EOG)
      • Muscle activity: Electromyogram (EMG)
      • Breathing/Airflow
      • Heart rate and rhythm: Electrocardiogram (ECG)
      • Oxygen saturation: Pulse oximetry (SpO2)

    PSG Setup

    • A sleep technician applies electrodes around the head, eyes, and chin.
    • Chest bands are placed to measure breathing effort, and a cannula is placed on the nose to measure airflow.
    • An oximeter is placed on a finger to monitor oxygen levels.

    Data Collection

    • Data collection methods have evolved significantly.
    • In the 1980s, data was amplified and processed by a large unit, then recorded on paper with ink needles.
    • Present-day methods use electronic electrodes, connected to a box that transmits data to a computer for analysis.

    EEG Signal

    • EEG measures the difference in electrical potential between pairs of electrodes placed on the scalp.
    • An EEG trace displays voltage on the Y-axis and time in seconds on the X-axis.
    • The signals reflect postsynaptic potentials in multiple neurons underlying the electrode placement.
    • Signals are amplified and filtered to produce an analog or digital recording.

    Electrode Placement

    • The International 10-20 system provides a standardized grid map of the head, with electrodes placed in designated positions represented by letters and numbers.
    • This ensures consistency in electrode placement across individuals.

    EEG Descriptors

    • EEG signal is represented as a voltage versus time graph.
    • EEG waves are characterized by their amplitude (peak to peak changes in voltage) and frequency (number of waves per second).

    Brainwave Activity (EEG Frequency Bands)

    • Four most common EEG frequency bands:
      • Beta waves: 14-26 Hz, present during alert waking activity and arousal from sleep.
      • Alpha waves: 8-13 Hz, present during relaxed wakefulness, eyes closed, and arousal from sleep.
      • Theta waves: 4-7 Hz, present during sleep onset and light sleep.
      • Delta waves: 0.5-3 Hz, present during deep sleep.

    Scoring Sleep in Epochs

    • Sleep is scored in sequential 30-second epochs starting at the beginning of the study.
    • Each epoch is assigned a sleep stage.
    • If two or more stages are present within an epoch, the stage occupying the largest portion of the epoch is assigned.

    Electrophysiological Changes Across Sleep Stages

    • NREM sleep has three stages: N1, N2, and N3.
    • N1: Theta waves, EEG slowing compared to wakefulness, slow rolling eye movements, and decreased tonic activity in the EMG.
    • N2: Further decrease in muscle activity, eye rolling movements, characterized by sleep spindles and K-complexes.
    • N3/SWS (Slow Wave Sleep): Large amplitude, low frequency waves in the EEG (delta waves), further decrease in EMG.
    • REM sleep: Near-complete muscle atonia, rapid eye movements, and EEG similar to N1.

    Sleep Cycle Throughout the Night

    • When falling asleep, we typically enter N1 first, gradually progressing to N2 and N3/SWS before entering REM.
    • This cycle repeats throughout the night, lasting approximately 90 minutes each.

    Typical Sleep Architecture

    • Stages 3 and 4 are combined into stage 3.
    • REM cycles occur regularly throughout the night.
    • SWS decreases towards the early morning hours, typically more prominent in the first third of the sleep period.
    • REM sleep increases during the second half of the night.

    Normal Sleep in Young Adults

    • Takes about 10-30 minutes to fall asleep (latency).
    • Few brief awakenings.
    • Total sleep time between 7-9 hours, sleep efficiency exceeding 85% (more than 85% of time in bed is spent asleep).
    • Full alertness during the waking day is a good indicator of adequate sleep.
    • These changes are predictable:
      • More SWS (deep sleep) in younger individuals compared to adults.
      • SWS decreases with age.
      • More awakenings in older individuals (WASO - wakefulness after sleep onset).
      • Decreased arousal threshold.
      • It's unclear whether sleep need decreases or the ability to sleep decreases with age.

    Key Points About Sleep

    • Multiple methods are used to assess sleep, with polysomnography being the gold standard.
    • Sleep is categorized into two stages (NREM and REM) based on EEG, EOG, and EMG.
    • Sleep changes with age, but it remains unclear if sleep need changes.

    Sleep Disturbances

    • Getting enough sleep is crucial for health.
    • Sleep disturbances can arise from medical conditions (and medications), lifestyle factors (like shift work), and sleep disorders.

    Sleep Disorder Classification

    • Sleep-related breathing disorders
    • Sleep-related movement disorders
    • Other sleep disorders (not discussed in detail)
    • Central sleep apnea (CSA):
      • Hypercapnic CSA: Hypoventilation disorders.
      • Hypocapnic CSA: Cheyne-Stokes Respiration of Heart Failure (CSR-CSA).
    • Obstructive sleep apnea (OSA):

    Distinguishing CSA and OSA

    • Pressure recording: Each squiggle represents respiratory effort.
    • In CSA, individuals choose to stop breathing, while in OSA, they have reduced ability to maintain an open airway, but still try to breathe.

    Obstructive Sleep Apnea (OSA)

    • Characterized by repetitive apnoea (complete airway blockage) and hypopnea (reduced oxygen) events.
    • Example PSG recording: Blue highlight indicates apnoea events, showing a lack of airflow despite respiratory effort.
    • Oxygen levels drop significantly during apnoea, prompting arousal from sleep to restore airflow.
    • This pattern repeats upon falling back asleep.

    OSA Severity Assessment - Apnea-Hypopnea Index (AHI)

    • AHI measures the number of apneas and hypopneas per hour of sleep.
    • Mild: 5-15 events/hour
    • Moderate: 15-30 events/hour
    • Severe: Over 30 events/hour

    OSA Prevalence

    • OSA is a common condition.
    • Estimated 775,000 Australians (5% of population) have OSA.
    • 25 million (10%) people in the US have OSA.
    • OSA affects all ages and walks of life, equally likely in children and adults.
    • 85-90% of patients remain undiagnosed and untreated.

    Risk Factors for OSA

    • Obesity:
      • MRI image comparison: Individuals without OSA have a larger airway, while those with OSA have a smaller airway due to fat accumulation around the airways.
    • Other risk factors:
      • Increasing age
      • Male gender
      • Anatomical abnormalities of the upper airway (e.g., higher rates in Down syndrome due to craniofacial abnormalities).
      • Family history
      • Alcohol/sedative use, especially before bed

    How OSA Occurs

    • Anatomical abnormalities are necessary for OSA development.
    • Individuals with OSA don't snore while awake due to a compensatory negative pressure reflex, activating pharyngeal dilator muscles.
    • Attenuation of upper airway muscles in OSA leads to reduced pharyngeal dilator muscle activity, potentially causing airway collapse.
    • This results in hypoxia (low oxygen) and hypercapnia (high carbon dioxide), increased respiratory effort, and awakening to reopen the airway.
    • Frequent awakenings and exposure to hypoxia and hypercapnia contribute to OSA's consequences, including cardiovascular and neurocognitive issues.

    OSA Consequences

    • Neurocognitive sequelae:
      • Waking hypersomnolence (daytime sleepiness)
      • Decreased quality of life
      • Mental health issues, such as depression
      • Increased auto accidents and workplace accidents
    • Cardiovascular sequelae:
      • Hypertension (systemic)
      • Arrhythmias
      • Congestive heart failure, stroke, myocardial infarction.
    • Dose-dependent response: More severe OSA is associated with a greater risk of cardiovascular issues, especially in the severe category.

    OSA Treatment

    • CPAP (Continuous Positive Airway Pressure) Therapy:
      • First-line treatment.
      • A mask is placed over the face during sleep, connected to a positive pressure machine that delivers air to keep the airway open.
      • Can significantly reduce OSA symptoms and associated risks.
      • However, only around 50% of patients continue using it beyond 3 months.
    • Alternatives to CPAP:
      • Behavioral interventions: Weight loss, avoiding supine (back) sleep, avoiding alcohol or sedatives before bed.
      • Devices/techniques to encourage lateral sleeping:
        • Positional trainers:
          • Low-tech: Tennis ball in a T-shirt, DIY trainers.
          • High-tech: BuzzPOD, nightBalance, NightShift (worn on the chest or neck, using accelerometers to detect body position and provide alarms/buzzes to encourage rolling over).
      • Medical interventions:
        • Oral appliances (mandibular advancement devices):
          • Monobloc: One-piece, no opening.
          • Two-piece: Separate upper and lower plates, adjustable advancement and opening.
        • Expiratory resistance valves
        • Suction devices
      • Surgical interventions:
        • Maxillo-mandibular advancement
        • Soft tissue surgery: Nasal operation, tonsillectomy, uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatopharyngoplasty (LAUP), radiofrequency tissue volume reduction.
        • Hypoglossal nerve stimulation: Similar to a pacemaker, implanted under the skin, with a sensory lead to respiratory muscles and a stimulation lead to the hypoglossal nerve, potentially improving airway patency by stimulating tongue muscle contraction.

    • Periodic Limb Movement Disorder (PLMD):

      • Characterized by repetitive limb movements (usually legs) during sleep, occurring every 20-40 seconds.
      • Can trigger awakenings.
      • Often detected incidentally during sleep studies.
      • Treatment is usually not necessary unless sleep is disturbed or accompanied by restless legs syndrome.

    • Restless Leg Syndrome (RLS):

      • Clinically defined by an urge to move accompanied by uncomfortable sensations in the legs, typically relieved by movement.
      • Symptoms worsen in the evening and during sleep, causing sleep disruption.
      • Patients often describe the sensation as a "creepy-crawly" feeling.
      • More common in women.
      • Primary or secondary causes (iron deficiency, pregnancy, kidney failure, antihistamines, and antidepressants).
      • Treatment involves medications.

    • Parasomnias:

      • Unwanted physical events or experiences occurring as one is falling asleep, during sleep, or upon awakening.
      • Result from central nervous system activation manifesting in skeletal muscles or the autonomic nervous system.
      • NREM or REM parasomnias.

    • Types of Parasomnias:

      • NREM parasomnias:
        • Confusional arousals
        • Sleepwalking
        • Sleep terrors (night terrors)
        • Teeth grinding (bruxism)
        • Sleep sex
        • Sleep-related eating disorder
      • REM parasomnias:
        • REM Sleep Behavior Disorder (RBD)
        • Sleep paralysis

    Sleepwalking

    • Also known as somnambulism.
    • Occurs in deep sleep (SWS), resulting in walking or performing complex behaviors while asleep.
    • More prevalent in children (ages 3-7) than adults (1-15% of the general population).
    • Increased risk in sleep-deprived individuals.
    • It's dangerous to try and prevent sleepwalking, as it can be unsafe to wake them (e.g., sleepwalking drivers).
    • No specific treatment, but improving sleep hygiene can help.

    REM Sleep Behavior Disorder (RBD)

    • Acting out dreams violently or dramatically during REM sleep.
    • Results from a decreased or absent REM atonia (muscle paralysis normally present in REM sleep).
    • Can lead to injury, potentially to bed partners.
    • Predominately occurs in men, with an average onset age of 50-65 years.
    • Often associated with underlying neurological disorders (e.g., Parkinson's disease).
    • Clinical management:
      • Removing hazardous objects from the bedroom.
      • Sleeping in separate rooms from partners.
      • Medications can help manage symptoms.

    Sleep Spindle

    • A short burst of brain activity (rhythmic oscillations) that appears on the EEG, occurring prominently during stage 2 of NREM sleep.
    • They are thought to be involved in memory consolidation and neuronal communication.

    Muddiest Point

    • The exact cause of sleep disturbances can be multifaceted, involving a combination of medical, lifestyle, and sleep disorder factors.
    • The specific types of sleep disorders, their causes, and treatment options can be complex and require professional evaluation and guidance.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the roles and mechanisms of classical and atypical antipsychotics, including chlorpromazine and clozapine, as well as the fundamentals of antidepressants like SSRIs. Test your knowledge on how these medications affect neurotransmitter systems and their clinical effects in treating mental disorders. Ideal for psychology and pharmacology students.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser