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Circadian Timing and Sleep-Wake Regulation
Terms in this set (49)
Circadian Timing System
Coordinates humoral, physiologic, and behavioral mechanisms to promote maximally effective sleep and adaptive waking behavior.
The study of the body's biological responses to time-related events.
Biological responses to medications depending on circadian timing of drug administration.
The manipulation of circadian rhythms to treat certain circadian rhythm disorders.
- hormone synthesized by the pineal gland,
- max secretion at night helps modulate circadian rhythm entrainment by the light-dark cycle.
*Inhibits brain mechanisms from producing wakefulness.
-N-acetyltransferase (acts w/serotonin)
-very light sensitive
-under circadian control
-Sleep decreases body temperature
-Wakefulness and activity will cause an increase in body temperature
Suprachiasmatic Nuclei (SCN)
-Paired Nuclei (autorhythmic nerve cell clusters) located in the hypothalamus above the optic chiasm that acts as an internal "Pacemaker" for the circadian rhythm.
-Obtains info about light from the eye, even when it is closed, as light passes through the eyelids.
*If our internal clock is running slow then the morning light automatically shifts it ahead.
Organisms that are active during the day and rest at night. Humans
Organisms that are active at night
Organisms, particularly many rodents and birds, that are active primarily at dawn and dusk
Circadian rhythm "biological clock"
Endogenous rhythm where the duration follows approximately a 24hr cycle.
Endogenous rhythms with periods shorter than a day.
An endogenous rhythm that consists of a year in length.
The synchronization and control of cardiac rhythm by an external stimulus such as light, temperature, food availability, and social interaction.
Environmental variables that are capable of entraining circadian rhythms.
An X-shaped space just in front of the pituitary gland where optic nerve fibers pass through to the brain.
A region of the brain, between the thalamus & midbrain, that functions as the main control center for the A.N. system by regulating sleep cycles, body temperature, appetite, etc., that acts as an endocrine gland by producing hormones, including the releasing factors that control the hormonal secretions of the pituitary gland.
Neurotransmitters located withing the SCN
Serotonin, neuropeptide Y, arginine vasopressin, vasoactive intestinal peptide, and GABA (their proteins are light sensitive).
Freerun or Freerunning
The state of a self-sustaining oscillation (rhythm) in the absence of effective zeitgebers or other environmental agents that may affect the period of the oscillation.
A discrete displacement of an oscillation along the time axis.
Bright Light Therapy
A rhythm (oscillator) exposed to bright light that causes one's sleep phase to be advanced or delayed. *back of neck & knee
Advanced Sleep Phase Syndrome "morning lark" ASPD
A disorder in which the major sleep episode is advanced in relation to the desired clocktime, that results in symptoms of compelling evening sleepiness, an early (6-8pm) sleep onset, and an awakening (1-4am) that is earlier than desired. Elderly. Pt complains of not being able to stay awake in early evening.
Delayed Sleep Phase Syndrome "night owl" DSPD
A disorder in which the major sleep episode is delayed by 2 or more hours of the desired bedtime. (2-6am) This causes difficulty awakening at the desired time. (10am-2pm) Work/School related issues. Child/Teen. Pt complains of not being able to fall asleep at normal hours. I
Prolactin Hormone aka Luteotrophic Hormone
A product of the anterior pituitary 199 amino acids w/ glycosylated & nonglycosylated forms. It possesses a myriad of effects with the most noticeable being lactation. Regulated by dopamine.
A functional entity capable of generating endogenous rhythmicity & of imposing this rhythmicity on one or more other entities. *A pacemaker is an oscillator, but not all oscillators are pacemakers.
SA Node, SCN
In one hemisphere of the Brain is the Ventral SCN (easily reset by external cues) & the other hemisphere is the Dorsal SCN (not easily reset).
Cells activated/reset by eating
Heart & Liver Cells
Non-24-Hour Sleep-Wake Disorder, Freerunning Disorder, or Hypernychthemeral Syndrome
-Associated with the blind.
-A rare disorder characterized by "cyclic" insomnia and/or EDS, and that these abnormalities appear to be related to lack of synchronicity between the 24-hour day-night cycle & internal body clock. A cycle of good sleep followed by a cycle of poor sleep differentiates it from other sleep disorders.
Time Zone Change Syndrome "Jet Lag"
Primary Circadian Disorders
Advanced Sleep Phase, Delayed S.P. & Non 24 Sleep-Wake
Secondary Circadian Disorders
Jet Lag, Shift Work Disorder, & Irregular Sleep-Wake Disorder
D.S.P.S. Diagnostic foundation
-2 night PSGN performed at normal social sleep times, with intervening MSLT started 2 hrs upon wakening the 1st morning.
-Sleep diary & actigraphy
*The MSLT will show shorter sleep latencies on the morning naps than on afternoon naps.
*Reduced REM latency
A.S.P.S. Diagnostic foundation
- sleep logs & actigraphy over several days.
-2 consecutive PSGN with an intervening MSLT.
- 1st night performed over the patient's habitual sleep period & the MSLT 2 hours after awakening.
-The 2nd night should begin at the patient's desired bedtime and wake times.
Jet Lag (Time-zone change syndrome)
Crossing several time zones disrupts synchronization of biologic clock & external stimuli, causing sleep disturbance, daytime malaise, irritability, performance impairment, GI disturbances, & menstrual irregularities.
Shift Work Sleep Disorder
-Sleep disruption, chronic fatigue, and gastrointestinal symptoms.
-Morning light on the way home may keep the biological clock set to real world time
-Rarely can be improved by adjusting to the work time schedule
-History and symptomology is sufficient to diagnose
Irregular Sleep-wake Disorder
-Rare, diffuse brain dysfunction, or possibly clinically depressed.
-Fragmented sleep/wake cycle
-3+ short sleep cycles in a 24-hour period
Non-24hr Diagnostic foundation
-PSGN over several days (w/fixed times)
-sleep diary & actigraphy
*progressively longer sleep latencies & less TST, but normal sleep architecture.
-lack of CNS activation
-No respiratory effort
- at least 10 seconds
-apnea index, at least 5 per hour
-thorax and abdomen move in opposite directions
-increased upper airway resistance.
Cheyne-Stokes Breathing (chainee)
-crescendo-decrescendo sequence separated by central apneas.
-bilateral cerebral hemispheric lesions
-brain stem lesions
- non-rhythmic respiration of irregular rate, rhythm, and amplitude during wakefulness with or without O2 desaturation that becomes worse during sleep.
-Prolonged inspiration with increase in the ratio of inspiratory time to expiratory time.
-A short inspiration time & prolonged expiration (reduced inspiratory-expiratory time ratio).
Nucleus Tractus Solitarius
-cell group in the brain stem that receives viscerosensory information.
-divided CAUDAL and ROSTRAL
-a vertical column of grey matter embedded in the medulla oblongata
-receives vagal sensory information from cardiorespiratory and subdiaphragmatic organs of the gastrointestinal tract.
Neurologic causes of hypersomnia
Brain tumor, Stroke, Encephalitis, Encephalopathies, including Wernicke's encephalopathy, Post-traumatic hypersomnolence, MS, Neurodegenerative disorders (Alzheimer's, multiple system atrophy, Parkinson's )
Neuromuscular disorders (myotonic dystrophy)
Cerebral trypanosomiasis ("African sleeping sickness")
Tx of sleep disturbances in Alzheimer's & dementias
-Institute regular sleep schedule as much as possible
-Eliminate alcohol and caffeine in the evening
-Try an intermediate-acting benzodiazepine or zolpidem for no longer than 3 times/wk to treat insomnia
-Reduce or eliminate medications that may contribute to sleep disturbances/sleep-related respiratory dysrhythmias
-Treat associated depression w/ a sedative antidepressant
-Treat associated conditions that may interfere with sleep (pain caused by arthritis and other causes)
-Discourage patients from taking daytime naps
-Encourage regular exercise (walking)
-For extreme agitation, use small doses of haloperidol (0.5-1.0 mg) or thioridazine (25 mg)
-n selected patients, use bright light therapy in the evening
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