Sleep disorders are an important part of neurology examinations as they require a strong knowledge of complex diagnostic studies such as EEG, and also of a multitude of medications. In this chapter, you will learn sleep waveforms using real EEG tracings, and review high-yield treatments for sleep disorders. Test your knowledge at the end with practice questions and flashcards!

Authors: Jody Manners MD, Brian Hanrahan MD

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Phases of Sleep

Wakefulness

  • Characterized by alpha frequency activities, sporadic eye movements, and a posteriorly dominant alpha rhythm that attenuates with eye-opening.

NREM sleep

  • Stage N1 (5%): Attenuation of the alpha rhythm, the emergence of theta activity, and slow rolling eye movements.
    • Frontocentral beta activity can increase.

    • Young adults spend the least amount of time in NREM stage 1 sleep.
  • Stage N2 (45-55%):
    • The stage at which adults spend the most time during normal sleep.
    • Characterized by the presence of either sleep spindles and/or K-complexes with theta range background activity.

  • Stage N3 (15-20%):
    • a.k.a “deep sleep” or “slow-wave sleep” (no longer called “stage 4 sleep”)
    • EEG will show slow-waves and high amplitude delta waves.
    • Parasomnias tend to occur during this stage.

REM sleep

  • 20-25% of sleep.
  • Normally occurs ~90 minutes into sleep.
  • Characterized by a desynchronized low voltage, high-frequency background.
  • There will be decreased EMG activity (REM atonia).
  • Sharply peaked irregular eye movements with lateral rectus spikes (see below) can be seen ON eeg. Note the lack of muscle artifact.


 

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Table of Contents

Table of Contents