Stages Of Sleep

STAGES OF SLEEP

Q. 1 In narcolepsy, the polysomnographic recording typically shows which of the following patterns?
 A REM intrusion during inappropriate periods
 B An absence of REM sleep in midcycle
 C Spike-and-wave EEG recording
 D Extreme muscular relaxation
Q. 1 In narcolepsy, the polysomnographic recording typically shows which of the following patterns?
 A REM intrusion during inappropriate periods
 B An absence of REM sleep in midcycle
 C Spike-and-wave EEG recording
 D Extreme muscular relaxation
Ans. A

Explanation:

REM intrusion during inappropriate periods


Q. 2 Changes associated with normal aging include all of the following except:
 A Decreased intelligence
 B Decreased REM sleep
 C Diminished sense of taste and smell
 D Increased sleep latency
Q. 2 Changes associated with normal aging include all of the following except:
 A Decreased intelligence
 B Decreased REM sleep
 C Diminished sense of taste and smell
 D Increased sleep latency
Ans. A

Explanation:

Normal  aging  is  not  associated  with  decreased intelligence. Decreased rapid   eye   movement (REM) sleep, adiminished sense of taste and smell, increased sleep latency and thinning of the vaginal mucosa are associated with normal ageing.


Q. 3 A 27-year-old girl gets up at night and, still asleep, walks around the house for a few minutes before  retuning  to bed.  When  she  is  forced  to awaken during one of these episodes, she is confused and disoriented. Which of the following statements about this disorder is correct?
 A Violent outbursts are possible when the individual is suddenly awakened
 B This behavior usually takes place during early morning hours
 C This behavior coincides with periods of REM sleep 
 D This behavior is more common between ages 10 and 15 years.
Q. 3 A 27-year-old girl gets up at night and, still asleep, walks around the house for a few minutes before  retuning  to bed.  When  she  is  forced  to awaken during one of these episodes, she is confused and disoriented. Which of the following statements about this disorder is correct?
 A Violent outbursts are possible when the individual is suddenly awakened
 B This behavior usually takes place during early morning hours
 C This behavior coincides with periods of REM sleep 
 D This behavior is more common between ages 10 and 15 years.
Ans. A

Explanation:

Sleepwalking disorder is a parasomnia associated with slow wave sleep. The patient is usually difficult to awaken, amnesic for the episode. Common in children, sleepwalking peaks between ages 4 and 8 years and usually disappear by adolescence. The severity of the disorder range from less than one episode per month without any problem to several episodes complicated by physical injury to the patient and others.


Q. 4

Seen in REM sleep:

 A

Heart rate is increased and brain produces delta wave

 B

Brain is very active but muscles are virtually paralyzed

 C

Muscles are active but brain waves are slow

 D

Both brain and muscles are relaxed

Q. 4

Seen in REM sleep:

 A

Heart rate is increased and brain produces delta wave

 B

Brain is very active but muscles are virtually paralyzed

 C

Muscles are active but brain waves are slow

 D

Both brain and muscles are relaxed

Ans. B

Explanation:

Brain is very active but muscles are virtually paralyzed

REF: Check APPENDIX-11 for “Sleep physiology”

Repeat from June 2010


Q. 5 Not a feature of REM sleep:
 A Bruxism
 B

Irregular breathing

 C Muscle tone in the body is depressed
 D Is associated with active dreaming
Q. 5 Not a feature of REM sleep:
 A Bruxism
 B

Irregular breathing

 C Muscle tone in the body is depressed
 D Is associated with active dreaming
Ans. A

Explanation:

Bruxism REF: GUYTON & HALL, Ganong, various internet resources. See APPENDIX-11 for “SLEEP PHYSIOLOGY”


Q. 6

Which of the following statement is TRUE about REM sleep?

 A

Dreams

 B

Low muscle tone

 C

Slow waves on EEG

 D

Decrease in BP

Q. 6

Which of the following statement is TRUE about REM sleep?

 A

Dreams

 B

Low muscle tone

 C

Slow waves on EEG

 D

Decrease in BP

Ans. A

Explanation:

Normal sleep involves two states: REM sleep and non-REM sleep. REM sleep is often associated with dreaming.

Non-REM sleep is a period of decreased physiologic and psychological activity and is further divided into stages 1, 2, 3, and 4 on the basis of visually scored EEG patterns.

REM sleep is characterized by high-frequency; low-amplitude EEG and loss of muscle tone in the major antigravity muscles.
REM sleep is a distinct state of sleep characterized by wake-pattern EEG, skeletal muscle paralysis, and rapid, conjugate eye movements.
Ref: Clark C.P., Moore P.J., Gillin J.C. (2008). Chapter 27. Sleep Disorders. In M.H. Ebert, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

Q. 7

The Non-REM (NREM) sleep is commonly associated with which of the following?

 A

Night terrors

 B

Frequent dreaming

 C

Frequent penile erections

 D

Increased blood pressure

Q. 7

The Non-REM (NREM) sleep is commonly associated with which of the following?

 A

Night terrors

 B

Frequent dreaming

 C

Frequent penile erections

 D

Increased blood pressure

Ans. A

Explanation:

Night terror (pavor nocturnes), occurs primarily in young children during the first several hours after sleep onset, in slow-wave sleep (NREM stage 3, 4 sleep).

In this, the child suddenly screams exhibiting autonomic arousal with sweating, tachycardia, and hyperventilation.

It is difficult to arouse children and they rarely recalls the episode on awakening in the morning. 

Ref: Porth Pathophysiology: Concepts of Altered Health States By Ruth A. Hannon, Pages 585-6 ; Lexicon of Psychiatry, Neurology, and The Neurosciences By Frank J. Ayd, Page 931


Q. 8

Disturbances in sleep due to depression are associated with which of the following?

 A

Decreased REM sleep

 B

Increased total sleep time

 C

More vivid dreams

 D

Decreased REM (rapid eye movement) latency

Q. 8

Disturbances in sleep due to depression are associated with which of the following?

 A

Decreased REM sleep

 B

Increased total sleep time

 C

More vivid dreams

 D

Decreased REM (rapid eye movement) latency

Ans. D

Explanation:

Disturbed sleeps as a result of depression is associated with increased REM sleep and decreased REM latency.
Although hypersomnia can occur in depressive illness, insomnia is more common.
Therefore it is hard to identify whether disturbances in sleep due to depression increase or decrease total sleep time.
More vivid dreams is not identified as an association.
 
Ref: Singer C.M., Applebee G.A. (2008). Chapter 28. Sleep Disorders. In M.D. Feldman, J.F. Christensen (Eds), Behavioral Medicine: A Guide for Clinical Practice, 3e.

Q. 9

EEG taken during which of the following sleep stages shows sleep spindles?

 A

Stage 1

 B

Stage 2

 C

Stage 3

 D

Stage 4

Q. 9

EEG taken during which of the following sleep stages shows sleep spindles?

 A

Stage 1

 B

Stage 2

 C

Stage 3

 D

Stage 4

Ans. B

Explanation:

Stage 2 sleep, a component of Non REM sleep is characterised by the presence of sleep spindles and K complexes. Sleep spindles appears as sinusoidal waves occurring at a frequency of 12–14 Hz. K complexes are occasional high voltage biphasic waves.
  • Stage 1 sleep is characterised by the presence of theta waves 4-Hz).
  • In stage 3 of NREM sleep, a high-amplitude delta rhythm (0.5–4 Hz) are seen.
  • Stage 4 of NREM sleep is characterised by the presence of slow waves.
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 14. Electrical Activity of the Brain, Sleep—Wake States, & Circadian Rhythms. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong’s Review of Medical Physiology, 24e.

Q. 10

A 72-year-old woman with insomnia participates in a sleep study . As part of the study protocol, she has EEG leads attached, then goes to sleep. At one point during the evening, 12-16 Hz sleep spindles and K-complexes are observed. Which of the following stages of sleep is associated with this pattern?

 A

REM

 B

Stage 1

 C

Stage 2

 D

Stage 3

Q. 10

A 72-year-old woman with insomnia participates in a sleep study . As part of the study protocol, she has EEG leads attached, then goes to sleep. At one point during the evening, 12-16 Hz sleep spindles and K-complexes are observed. Which of the following stages of sleep is associated with this pattern?

 A

REM

 B

Stage 1

 C

Stage 2

 D

Stage 3

Ans. C

Explanation:

Stage 2 has more theta waves than stage 1 and is associated with sleep spindles (short bursts of 12-16 Hz activity) and K-complexes (high amplitude slow waves with superposed sleep spindles) on the electroencephalogram.

Transient large amplitude potentials in the occipital areas (ponto-geniculo-occipital [PGO] spikes) are associated with REM sleep.
 
Stage 1 or drowsiness, is characterized by the attenuation of alpha rhythm (8-13 Hz) and the appearance of 4-7-Hz theta waves.
 
Stages 3 and 4, or slow wave sleep, are characterized by high amplitude slow waves, especially in the delta (< 4 Hz) frequency range.

Q. 11

Not a feature of REM sleep:

 A

Bruxism

 B

Irregular breathing

 C

Muscle tone in the body is depressed

 D

Is associated with active dreaming

Q. 11

Not a feature of REM sleep:

 A

Bruxism

 B

Irregular breathing

 C

Muscle tone in the body is depressed

 D

Is associated with active dreaming

Ans. A

Explanation:

Based on EEG, EMG, EOG characteristics, REM sleep can be divided into two stages, tonic and phasic. Characteristics of the tonic stage include a desynchronized EEG, atonia of skeletal muscle groups, and suppression of monosynaptic and polysynaptic reflexes. Phasic REM sleep is characterized by rapid eye movements in all directions as well as transient swings in blood pressure, heart rate changes, irregular respiration, tongue movements, and myoclonic twitching of chin and limb muscles.

 
EEG tracing during REM sleep are characterized by a low-voltage, mixed-frequency activity with slow alpha (defined as 1-2Hz slower than wake alpha) and theta waves.
 
Bruxism typically occurs during stages 1 and 2 non-REM sleepand infrequently in REM sleep.

 


Q. 12

Which of the following neurotransmitter is MOST important for the induction of REM sleep?

 A

Acetylcholine

 B

Dopamine

 C

Epinephrine

 D

Norepinephrine

Q. 12

Which of the following neurotransmitter is MOST important for the induction of REM sleep?

 A

Acetylcholine

 B

Dopamine

 C

Epinephrine

 D

Norepinephrine

Ans. A

Explanation:

Acetylcholine is the neurotransmitter of primary importance for the induction of REM sleep. Some of the other neurotransmitters do function in sleep, but REM sleep can occur in their absence.

Dopamine is a neurotransmitter with a role in voluntary movement, mood, cognition, and regulation of prolactin release. Epinephrine is important in sympathetic nervous system responses. It is also a CNS neurotransmitter. Norepinephrine is important in sympathetic nervous system responses. It is also a CNS neurotransmitter involved in attention, arousal, and mood.

 


Q. 13

Which of the following changes are noted in a person during REM sleep?

 A

Heart rate is increased and brain produces delta wave

 B

Brain is very active but muscles are virtually paralyzed

 C

Muscles are active but brain waves are slow

 D

Both brain and muscles are relaxed

Q. 13

Which of the following changes are noted in a person during REM sleep?

 A

Heart rate is increased and brain produces delta wave

 B

Brain is very active but muscles are virtually paralyzed

 C

Muscles are active but brain waves are slow

 D

Both brain and muscles are relaxed

Ans. B

Explanation:

During REM sleep, the brain is highly active and responsive, but the body is virtually paralyzed because of active inhibition of skeletal muscles by dedicated population of neurons in the brainstem. During REM sleep, the high amplitude slow waves seen in the EEG during sleep are periodically replaced by rapid, low voltage, EEG activity, which resembles that seen in the awake aroused state and in stage 1 sleep.  Another characteristic feature of REM sleep is the occurrence of pontogeniculo-occipital spikes.

NREM sleep is divided into 4 stages: stage 1,2, 3 and 4. Throughout NREM sleep there is some activity of skeletal muscle but absent eye movements.
 
In stage 1: EEG shows a low voltage mixed frequency pattern. A theta rythm(4-7Hz) is seen at this stage.
In stage 2: there are sinusoidal waves called sleep spindles (12-14Hz) and occasional high voltage biphasic waves called K complexes.
In stage 3: a high amplitude delta rythm (0.5 – 4Hz)dominates the EEG waves.
In stage 4: Maximum slowing with large waves are seen.
 
Ref: Fundamentals of Sleep Technology: Endorsed by the American Association of …
edited by Nic Butkov, page 257 ; Ganong’s Review of Medical Physiology, 24e, chapter 14

Q. 14

Slow wave sleep is known as:

 A

REM sleep

 B

NREM sleep

 C

Both of the above

 D

None of the above

Q. 14

Slow wave sleep is known as:

 A

REM sleep

 B

NREM sleep

 C

Both of the above

 D

None of the above

Ans. B

Explanation:

This is a straight forward memory question. There are two kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow-wave sleep.

Ref: Ganong’s Review of Medical Physiology 23rd edition, Chapter 15.


Q. 15

Hallucinations which occur at the ‘start’ of sleep is :

 A

Hypnagogic hallucinations

 B

Hypnopompic hallucinations

 C

Jactatio nocturna capitis

 D

Non – specific hallucination

Q. 15

Hallucinations which occur at the ‘start’ of sleep is :

 A

Hypnagogic hallucinations

 B

Hypnopompic hallucinations

 C

Jactatio nocturna capitis

 D

Non – specific hallucination

Ans. A

Explanation:

A. i.e. Hypnagogic hallucinations


Q. 16

Not a feature of paradoxical sleep is :

 A

Decreased muscle tone

 B

Rapid eye movements

 C

Brain shows increased metabolism

 D

EEG shows decreased activity

Q. 16

Not a feature of paradoxical sleep is :

 A

Decreased muscle tone

 B

Rapid eye movements

 C

Brain shows increased metabolism

 D

EEG shows decreased activity

Ans. D

Explanation:

D i.e. EEG shows decreased activity

Features

NREM

REM

Other names

Synchronised or S-sleep/ Orthodox-Sleep/

Quiet-Sleep

Desynchronized D-Sleep, A-wave/ Active-SleepQ,

Paradoxical sleepQ

EEG

– Synchronized

Theta wave’ (I)

Sleep spindles & K-ComplexQ (II)

Delta waveQ (III & IV)

–   Low voltage Fast activity Saw tooth wavesQ

–    Ponto- geniculo occipita spikes

–   Reappearance of alpha wavesQ

EMG

Partial relaxation

AtoniaQ of antigravity & intercostal muscles

Cerebral metabolism

Brain temperature

-I,

t Q

EOG

Slow or Quiescent eye movement

Rapid eye movementsQ

Genital Tumescence

Infrequent

CommonQ

Dreaming

Infrequent

Frequent

Pathology

Night terrorQ.

Nocturnal eneurasisQ

BruxismQ

SomnambulismQ

Somniloquy

Night maresQ

NarcolepsyQ


Q. 17

Which one of the following phenomenon is closely associated with slow wave sleep

 A

Dreaming

 B

Sleep walking

 C

Atonia

 D

Irregular heart,rate

Q. 17

Which one of the following phenomenon is closely associated with slow wave sleep

 A

Dreaming

 B

Sleep walking

 C

Atonia

 D

Irregular heart,rate

Ans. B

Explanation:

B i.e. Stage II

Type of wave

Found in

Alpha (a) Wave

(8-12 Hz)

–    Adult humans, who are awake but at rest with

the mind wondering & eyes closedQ.

Alpha block

(a wave is replaced by fast, irregular,

low voltage activity)

–    Arousal or Alerting responseQ

–     Senosry stimulation

–    Mental concentration as solving problem

–    Attention is focused on something

Disappearance of a – activity

Onset of sleep

Reappearance of a – waves

Saw tooth waves

Ponto – geniculo-occipital (PCO) Spikes

REMQ

Theta waves

Stage I – NREMQ

Stage – II – NREMQ

Sleep spindles & K- Complexes

Appearance of Delta (8) waves

Stage – III – NREMQ

Predominant Delt (8) waves

Stage – IV – NREMQ


Q. 18

Not true about nocturnal penile tumerscence is

 A

Totals about 100 min / night

 B

Normal phenomenon

 C

Occurs in NREM sleep

 D

Can be used to distinguish between psychological or organic impotence.

Q. 18

Not true about nocturnal penile tumerscence is

 A

Totals about 100 min / night

 B

Normal phenomenon

 C

Occurs in NREM sleep

 D

Can be used to distinguish between psychological or organic impotence.

Ans. B

Explanation:

B i.e. Sleep walking


Q. 19

Slow waves In EEG activity seen in :

 A

Depression

 B

Delirium

 C

Schizophrenia

 D

Mania

Q. 19

Slow waves In EEG activity seen in :

 A

Depression

 B

Delirium

 C

Schizophrenia

 D

Mania

Ans. B

Explanation:

B i.e. Delirium


Q. 20

EEG rhythm recorded from the surface of the scalp during REM sleep –

 A

Alpha

 B

Beta

 C

Delta

 D

Theta

Q. 20

EEG rhythm recorded from the surface of the scalp during REM sleep –

 A

Alpha

 B

Beta

 C

Delta

 D

Theta

Ans. B

Explanation:

B i.e. Beta


Q. 21

Delta waves in EEG are ‘seen in :

 A

Deep sleep

 B

REM sleep

 C

Awake with eyes open

 D

Awake with eyes closed

Q. 21

Delta waves in EEG are ‘seen in :

 A

Deep sleep

 B

REM sleep

 C

Awake with eyes open

 D

Awake with eyes closed

Ans. A

Explanation:

A i.e. Deep sleep


Q. 22

The condition known as REM sleep is –

 A

That point at which the

 B

Indivudual becomes aware and alert.

 C

Referred to as paradoxical sleep.

 D

Characterized by total lack of all muscular activity

Q. 22

The condition known as REM sleep is –

 A

That point at which the

 B

Indivudual becomes aware and alert.

 C

Referred to as paradoxical sleep.

 D

Characterized by total lack of all muscular activity

Ans. C

Explanation:

C i.e. Referred to as paradoxical sleep


Q. 23

About paradoxical sleep. True is:

 A

Prominent beta waves

 B

Prominent alpha waves

 C

Also known as NREM sleep

 D

Low amplitude, mixed frequency waves.

Q. 23

About paradoxical sleep. True is:

 A

Prominent beta waves

 B

Prominent alpha waves

 C

Also known as NREM sleep

 D

Low amplitude, mixed frequency waves.

Ans. D

Explanation:

D i.e. Low amplitude, mixed frequency wave


Q. 24

Nightmare is seen in :

 A

REM sleep

 B

Stage II NREM sleep

 C

Stage IV NREM sleep

 D

Stage I NREM sleep

Q. 24

Nightmare is seen in :

 A

REM sleep

 B

Stage II NREM sleep

 C

Stage IV NREM sleep

 D

Stage I NREM sleep

Ans. A

Explanation:

A i.e. REM sleep


Q. 25

Slow wave sleep associated with:

 A

Dreams

 B

Cardiac arrhythmia

 C

Penile intumescence

 D

Delta activity

Q. 25

Slow wave sleep associated with:

 A

Dreams

 B

Cardiac arrhythmia

 C

Penile intumescence

 D

Delta activity

Ans. D

Explanation:

D i.e. Delta activity


Q. 26

Lugol’s Iodine contains-

 A

5% iodine & 10% KI

 B

10% Iodine & 20% KI

 C

10% iodine & 15% KI

 D

5% iodine & 15% KI

Q. 26

Lugol’s Iodine contains-

 A

5% iodine & 10% KI

 B

10% Iodine & 20% KI

 C

10% iodine & 15% KI

 D

5% iodine & 15% KI

Ans. A

Explanation:

Ans. is `a’ i.e., 5% iodine & 10% KI


Q. 27

Dreaming is common in which stage of sleep:

September 2008

 A

REM

 B

NREM 1

 C

NREM 2

 D

NREM 3

Q. 27

Dreaming is common in which stage of sleep:

September 2008

 A

REM

 B

NREM 1

 C

NREM 2

 D

NREM 3

Ans. A

Explanation:

Ans. A: REM

Humans aroused at a time when they show the EEG characteristics of REM sleep generally report that they were dreaming, whereas individuals awakened from slow-wave sleep/ NREM do not. This observation and other evidence indicate that REM sleep and dreaming are closely associated. The tooth-grinding (bruxism) that occurs in some individuals is also associated with dreaming.


Q. 28

Properties of alpha waves are all of the following except: 

September 2009

 A

It is most marked in the parieto-occipital area

 B

It has a frequency of 8-12 Hz

 C

Frequency is decreased by low glucose level

 D

Seen in REM sleep

Q. 28

Properties of alpha waves are all of the following except: 

September 2009

 A

It is most marked in the parieto-occipital area

 B

It has a frequency of 8-12 Hz

 C

Frequency is decreased by low glucose level

 D

Seen in REM sleep

Ans. D

Explanation:

Ans. D: Seen in REM sleep


Q. 29

The Non-REM (NREM) sleep is commonly associated with:         

March 2013 (d)

 A

Frequent dreaming

 B

Frequent penile erections

 C

Increased blood pressure

 D

Night terrors

Q. 29

The Non-REM (NREM) sleep is commonly associated with:         

March 2013 (d)

 A

Frequent dreaming

 B

Frequent penile erections

 C

Increased blood pressure

 D

Night terrors

Ans. D

Explanation:

Ans. D i.e. Night terrors

Sleep

  • Alpha waves: Eyes closed and mind wandering
  • Night terrors are seen in: NREM sleep
  • Sleep walking/ somnabulism is seen in: NREM sleep (stage 3/4)
  • Sleep terror/pavor nocturnus:

— Seen in NREM sleep (stage 3/4)

— Treated by diazepam


Q. 30

Classic tetrad of narcolepsy includes all, except:

CMC (Vellore) 07; NIMHANS 08; Kerala 11; NEET 13; PGI 14

 A

Hypnagogic hallucination

 B

Sleep attacks

 C

Sleep paralysis

 D

Catalepsy

Q. 30

Classic tetrad of narcolepsy includes all, except:

CMC (Vellore) 07; NIMHANS 08; Kerala 11; NEET 13; PGI 14

 A

Hypnagogic hallucination

 B

Sleep attacks

 C

Sleep paralysis

 D

Catalepsy

Ans. D

Explanation:

Ans. Catalepsy


Q. 31

Bruxism is:       

NEET 13

 A

Walking during sleep

 B

Nocturnal enuresis

 C

Grinding of teeth during sleep

 D

Sleep apnea

Q. 31

Bruxism is:       

NEET 13

 A

Walking during sleep

 B

Nocturnal enuresis

 C

Grinding of teeth during sleep

 D

Sleep apnea

Ans. C

Explanation:

Ans. Grinding of teeth during sleep


Q. 32

Growth hormone secretion is decreased by ‑

 A

Hypoglycemia

 B

Exercise

 C

REM sleep

 D

Stress

Q. 32

Growth hormone secretion is decreased by ‑

 A

Hypoglycemia

 B

Exercise

 C

REM sleep

 D

Stress

Ans. C

Explanation:

Ans. is ‘c’ i.e., REM sleep

REM sleep decreases the secretion of GH. Other three stimuli increase GH secretion.


Q. 33

Study the graphs carefully.In the image,wave ‘C’ indicates?

 A

REM Sleep

 B

NREM Sleep

 C

Awake

 D

Quiet Wakefulness

Q. 33

Study the graphs carefully.In the image,wave ‘C’ indicates?

 A

REM Sleep

 B

NREM Sleep

 C

Awake

 D

Quiet Wakefulness

Ans. A

Explanation:

Ans:B.)NREM sleep.

In the image,Wave A -represents awake stage,Wave B-represents REM sleep,Wave C-represents NREM sleep.

Sleep Cycle.

  • Sleep is generally divided into 2 broad types: nonrapid eye movement (NREM) sleep and REM sleep.
  • NREM and REM occur in alternating cycles, each lasting approximately 90-100 minutes, with a total of 4-6 cycles. In general, in the healthy young adult NREM sleep accounts for 75-90% of sleep time (3-5% stage I, 50-60% stage II, and 10-20% stages III and IV). REM sleep accounts for 10-25% of sleep time.
  • Based on EEG changes, NREM is divided further into 4 stages (stage I, stage II, stage III, stage IV).
    • Stage I sleep is also referred to as drowsiness or presleep and is the first or earliest stage of sleep.

      • The earliest indication of transition from wakefulness to stage I sleep (drowsiness) usually consists of a combination of drop out of alpha activity and slow rolling eye movements.
    • Stage II is the predominant sleep stage during a normal night’s sleep. The distinct and principal EEG criterion to establish stage II sleep is the appearance of sleep spindles or K complexes.
    • Stages III and IV sleep are usually grouped together as “slow wave sleep” or “delta sleep.
  • The different types and stages of sleep can be best identified using polysomnography, which simultaneously measures several body functions such as brain wave activity (electroencephalogram or EEG), eye movement (electrooculogram or EOG), muscle activity (electromyogram or EMG), respiration, heart rhythm, etc.
  • Electroencephalogram :
    • Non-REM sleep is characterized by very slow but relatively high amplitude or high voltage oscillations (with the frequency gradually slowing and the amplitude increasing as sleep deepens), while REM sleep shows a much faster and lower amplitude trace, much more similar to normal waking activity
    • Brain waves during non-REM sleep tend to be highly synchronized, and those during REM sleep much more unsynchronized.
  • Electrooculogram (EOG) :
    • Rapid eye movements during REM sleep, and little or no eye movement during non-REM sleep.
  • Electromyogram (EMG) :
    • The body is effectively completely paralyzed during REM sleep, the body does make some limited movements during non-REM sleep, including a major change in body position about once every twenty or thirty minutes on average.

Q. 34

X\ IINC patterns tit ELF, EOG and EMG are depicted below. The B pattern belongs to (Figure was not provided in the exam)

 A

NREM sleep

 B

REM sleep

 C

Wakefulness

 D

Quiet wakefulness

Q. 34

X\ IINC patterns tit ELF, EOG and EMG are depicted below. The B pattern belongs to (Figure was not provided in the exam)

 A

NREM sleep

 B

REM sleep

 C

Wakefulness

 D

Quiet wakefulness

Ans. D

Explanation:

Ans. d. Quiet wakefulness


Q. 35

REM sleep is associated with all except ‑

 A

Dreams

 B

Delta waves

 C

Loss of muscle tone

 D

Increased BP

Q. 35

REM sleep is associated with all except ‑

 A

Dreams

 B

Delta waves

 C

Loss of muscle tone

 D

Increased BP

Ans. B

Explanation:

Ans. is ‘b’ i.e., Delta wave

Stages of Sleep

  • Sleep is basically divided into two phases : ‑
  • Non-REM (NREM) or slow-wave sleep : – It is called Non-REM sleep because no rapid eye movement (REM) is there on eletrooculogram, rather there is slow or quiscent eye movement. It is also referred as S-sleep (synchronized sleep) or quiet sleep or orthodox sleep because there diminished physiological functions and a low level of overall activity. It is further divided into : ‑
  1. Stage 1 : – It is a transition from wakefulness to sleep and is characterized by disappearance of alpha activity and appearance of theta activity. There is slow eye movements.
  2. Stage 2 : – It is characterized by typical EEG activity i.e., Sleep spindles and IC-complex’. No eye movement occurs.
  3. Stage 3 & 4 : – Stage 3 & 4 are stages of deep sleep. These are also called slow wave sleep as these stages are characterized by slow delta waves. Delta wave appearance starts in stage 3 and dominated in stage 4.
  • REM sleep : – The REM sleep is so named as there is rapid roving movements of eye, i.e., rapid eye movement (REM)on electro-oculogram. It is also called paradoxical sleep because there is a paradoxical elevation of brain activity & metabolism and physiological activity. The high-amplitude slow waves seen in stage 3,4 of REM sleep is replaced by rapid low voltage activity (beta wave). Features of REM sleep are : –
  1. EEG Beta wave, Reappearance of alpha wave, Saw-tooth wave (low voltage fast activity), Ponto­genital-occipital spikes.
  2. Dreaming
  3. Other features : – Generalized muscular atony, Penile erection, autonomic hyperactivity (Increased pulse rate & BP) and intermittent movement of small muscle groups.

Q. 36

Bruxism is seen in ‑

 A

NREM stage 1,2

 B

NREM stage 3,4

 C

REM

 D

Any of the above

Q. 36

Bruxism is seen in ‑

 A

NREM stage 1,2

 B

NREM stage 3,4

 C

REM

 D

Any of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., NREM stage 3, 4

  • Slow wave sleep (stage 3 & 4 of NREM sleep) disorders :- Sleep walking (somnambulism), night terror (sleep terror or pavornocturnus), Nocturnal enuresis, Bruxism (teeth grinding), and sleep talking (somniloquy).
  • REM sleep events/disorder :- Nightmares, nocturnal penile tumescence, Narcolepsy.


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