PSG: Polysomnography Board Prep ch 1

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What are the 3 mechanisms that regulate sleep?: -Homeostasis
-Circadian cycle
-Ultradian mechanism
What 3 physiologic functions regulate the circadian rhythm?: -Endocrine secretion (hormones)
-Heart rate
-Kidney action
What is the pacemaker of the sleep/wake cycle?: Suprachiasmatic nucleus (SCN)
Where is the SCN nucleus located?: In the hypothalmus
What physiologic functions relating to sleep/wake cyclic does the SCN regulate?: -Body temperature
-Endocrine function (hormones)
-Renal system (urine production)
-Blood pressure
What is the influence of light on the sleep/wake cycle?: Light reaces photoreceptors in the retina that creates signals that travel along the optic nerve to the SCN and on to the pineal gland
Where is the pineal gland located?: Behind the brain stem, under the hypothalmus
How does the pineal gland contribute to the sleep/wake cycle?: It responds to light-induced signals by switching off production fo the hormone melatonin
What do hormone levels do during the sleep cycle?: Rise and fall
When does the growth hormone peak?: During delta sleep
What is the recommended exposure for light therapy?: 10,000 lux for 20 minutes
How do our sleep stages change as we age?: Decreased delta and increased stage 2
In which stage of sleep is it most difficult to arouse someone?: Delta sleep
What part of the night is delta sleep more prominant?: First 1/3 of night
How often does REM occur during sleep?: Adults: every 90 minutes
Children: every 60 minutes
What part of the night does REM predominate?: Last 1/3 of night
What happens to REM on REM rebound?: More phasic REM
What physiological events occur in REM?: -Atonia
-Dulled reflexes (no swallow reflex)
-Increased blood pressure (up to 30%)
-Irregular heart rate
-Errataic respiration
-No thermoregulation (no sweating or shivering)
What happens to blood flow to the brain in REM?: It increases by 50 to 200% from NREM, depending on region
What happens to sleep architecture as we age?: -Decreased sleep efficiency
-More fragmentation
How much sleep does an adult need?: 7-9 hours
How much sleep does an adolescent need?: 9.25 hours
How much sleep does a newborn of 0 - 2 months need?: 1.5 to 18 hours
How much sleep does a newborn of 2 - 12 months need: 14-15 hours
How much sleep does a child of 12 - 18 months need?: 13-15 hours
How much sleep does a child of 18 months to 3 years need?: 12-14 hours
How much sleep does a child of 3 - 5 years need?: 11-13 hours
How much sleep does a child of 5 - 12 years need?: 10-11 hours
How are sleep stages indicated in a newborn?: Active (REM), quiet (NREM), and indeterminate sleep
What scoring considerations are there with newborns?: -Transition from wakt to sleep is often done through REM
-NREM-REM cycle is about 50-60 minutes
-Active, quiet, and indeterminate sleep
-Need to watch behaviors
What age does trace alternante occur?: During the first month of life
What is trace alternante?: Periods of relatively low voltage between bursts of mixed frequency activity (looks like arousals)
What sleep stage does trace alternante occur?: Quiet sleep
At what age does fully-developed EEG patterns of the NREM stages gradually emerge?: At 2 - 6 months
At what age does NREM stages consist mainly of REM?: At 2 - 6 months
At what ages are K-complexes first seen in stage 2?: 6 months
What sleep staging events occur during ages 1 - 5?: -Four sleep stages seen
-Unable to differentiate stages 3 and 4
-Spindles become symmetric (between the 2 hemispheres of the brain)
What sleep staging events occur by age 5?: -Sleep architecture of an adule
-Use R&K scoring rules
What occurs to delta sleep during ages 10 - 20?: Decreases nearly 40%
What are some symptoms of fragmented sleep in a child?: -Sleep terrors
-Enuresis
-Bedtime fears
-Nocturnal sweating
-Snoring
What are some effects of sleep disorders in a child?: -Learning disabilities
-Reading disorders
-Development delays
-Behavior delays
What are some consequences of sleep deprivation in an adult?: -Fatigue
-Pain
-Prone to tachycardia
-Memory loss
-Personality changes
What happens to the heart rate with sleep deprivation?: Tachycardia
What is the function of the cerebellum?: Helps coordinate movement (balance and muscle coordination)
What is the cerebral cortex (cerebrum) composed of?: Gray and white matter
What is gray matter?: Surface tissue of the cerebral cortex which consists of cell bodies of neurons
What is white matter?: Tissue within the cerebrum composed of groups of axons
Where is the cerebral cortex (cerebrum) located?: Rest of brain besides the cerebellum
What is the function of the cerebral cortex?: -Analyze sensory data
-Perform memory functions
-Learn new information
-Form thoughts
-Make decisions
Where is the cerebellum located?: Lower back region of brain
What are the regions of the cerebrum?: -Frontal
-Parietal (crown)
-Occipital
-Temporal (temples)
What is the function of the brain stem?: -Breathing
-Digestion
-Heart rate
-Blood pressure
-Arousal/alertness
What is the reticular formation?: Group of nerve fibers located inside the brainstem which form the central core of the brainstem
From where does the reticular formation get input?: Most of the sensory systems of the body and also from the cerebral motor regions
What does stimulation of the reticular formation cause?: Fibers pass to the thalamus, then cerebral cortex, which activate and alert the cortex
What is the reticular activating system (RAS)?: The upper part of the formation plus the pathways to the thalamus and cortex
What is the function of the RAS?: Aids in the maintenance of consciousness
Which system do many drugs that keep us awake or make us sleepy primarily have an effect on?: Reticluar activating system (RAS)
What is the function of neurotransmitters?: They control whether we are asleep or awake by acting on different groups of nerve cells (neurons) in the brain
Where is the reticular formation located?: Top tip of brainstem, at top of midbrain
Where is the thalmus located?: Near the center of the brain
What is the purpose of the thalmus?: -Relay station
-Generates many of the brain rhythms in NREM sleep that we see as EEG patterns
What is the hypothalamus?: Area of gray matter below the thalmus which is part of the RAS
What is the function of the hypothalamus on sleep?: -Controls NREM sleep
-May keep track of length of wake time (how large the sleep debt is)
Where is the pons located?: Brainstem
What is the function of the pons on sleep?: Critical for initiating REM sleep
How does the pons communicate with other parts of the brain?: -It sends signals to the visual nuclei of the thalamus and the cerebral cortex
-It sends signals to the spinal cord causing the temporary paralysis of REM sleep by shutting off neurons in the spinal cord
Which neurotransmitters keep some parts of the brain active while we are awake?: -Seretonin
-Norepinephrine
What produces serotonin and norepinephrine?: Neurons in the brainstem which connect the brain with the spinal cord
What is the raphe nuclei?: -Serotonin-producing neurons of the brainstem
-Component of the reticular formation
What are the neurotransmitters of NREM sleep?: -Seratonin
-Norepinephrine
What is the neurotransmitter of REM sleep?: Acetylcholine (from the pons)
What is adenosine?: A chemical that builds up in our blood while we are awake, and causes drowsiness (it gradually breaks down while asleep)
What is an action potential?: Form of information used by electrically excitable membranes to control the activity of cells and to support or suppress communication between cells
What is an action potential (simplified)?: An electrical impulse moving down a neuron
* What is an IPSP?: -Inhibitory post-synaptic potential within the synaptic gaps
-Negative uV
*What is an EPSP?: -Excitatory post-synaptic potential within the synaptic gaps
-Positive uV
*How large do the electrical potentials have to be in order to see them on the EEG?: >= 70 uV
What are action potentials the result of?: Ion (sodium, chloride, and potassium) flow through voltage-gated channels
What is the resting potential in a cell?: 60-80 uV
In a resting potential, is the cell positive or negative in relation to outside of cell wall?: Negative
In an action potential, is the cell positive or negative in relation to outside of cell wall?: Positive
What are the projections on a neuron?: Dendrites and axons
Which direction do the dendrites carry information?: Towards the cell body
Which direction do the axons carry information?: Away from the cell body
Through what process do neurons communicate with each other?: Electrochemical process
What are synapses?: Specialized connections between neurons
What are neurotransmitters?: Special chemicals formed and released at synapses
*Where are pyramidal cells located?: In the III and IV layer of the cerebral cortex
*What part of the neural process does EEG potentials come from?: Synaptic gap (between the synapses)
What is the direction of electrical impulse through a neuron?: Dendrites--> cell body--> axon--> synapse
What is the central sulcas?: The area between the frontal and parietal lobes of the brain; this is where the central leads are placed
For which physiologic functions is the frontal lobe responsible?: -Cognition and memory
-Planning
-Organizing
-Problem solving
-Selective attention
-Personalilty
-Behavior and emotions
-"Gatekeeper" for judgement and inhibition
*What part of the brain is known as the "gatekeeper"?: Frontal lobe
For which physiologic functions is the parietal lobe responsible?: Processing of sensory input (sensory discrimination) such as touch sensations and spatial orientation
For which physiologic functions is the temporal lobe responsible?: Centers for hearing and memory
For which physiologic functions is the occipital lobe responsible?: Visual information (think "ocular")
-visual recognition of shapes and colors
What is the purpose of the pyramidal cells?: Thought to be the primary cell for discharge of EEG activity
How does an EPSP effect an action potential?: It increases the possibility that the post-synaptic cell will initiate an action potential
How does an IPSP effect an action potential?: It reduces the chance that the post-synaptic cell will initiate action potential
What synaptic potentials are we recording on an EEG?: IPSP and EPSP

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