Sleep de Cerce's NEW PPT 06

8/2/2019 Sleep de Cerce's NEW PPT 06

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NORMAL SLEEP NEUROBIOLOGY OF SLEEP

NEUROPHYSIOLOGY OF SLEEP

INTRODUCTION TO CLINICAL SLEEP



Questions/ Concerns?

Phone: 244-9841

Email: [email protected]



Occupies 1/3 of ourLives (3,000 hrs /year)

Necessary for Physical

and Mental Health $50 Billion / Year in

Lost Productivity



Amount Varies

By Persons

By Age

Sensitive to Waking Behavior

Problems are Common





Neurobiology of Sleep

Neurophysiologic Basis of Sleepiness



What determines it?

Lack of Sleep (Homeostatic Balance)

Biological Clock (Circadian Rhythm)

Sleepiness/Wakefulness

Initiating & Maintaining Sleep



Basal Forebrain

Thalamus

Post. Hypothalamus

Cholinergic

Serotonergic

Monoaminergic

Histaminergic

Reticular Formation

Aminergic Cholinergic

Wake

Sleep

REM

Fig. 2.1 aldrich



The ascending arousal system

Saper, CB., et.al. Trends in Neuroscience. Vol 24. No 12. Dec 2001



Orexin neurons in the lateral hypothalamic area innervate all of the components of the

ascending arousal system, as well as the cerebral cortex (CTX) itself.Saper, CB., et.al. Trends in Neuroscience. Vol 24. No 12. Dec 2001

The Sleep “Switch”



Process S

9AM 3PM 9PM 3AM 9AM

“Sleep Load”

Sleep

Wake

Interleukins

DSIP

GHRH

PgD2

Serotonin

ADENOSINE

From Aldrich, M. S. Sleep Medicine. Oxford University Press 1999



Mimosa pudica

heliotrope

Biological

Clocks

Process C



Process C

0 9 18 27 36 45 54 63 72

Hours of wakefulness

S u b j e c t i v e A l e r t n e s s

Carskadon & Dement (from Aldrich, M. Sleep Medicine. Oxford Univ Press 1999. P.57



Process C

0 9 18 27 36 45 54 63 72

Hours of wakefulness

S u b j e c t i v e A l e r t n e s s

Carskadon & Dement (from Aldrich, M. Sleep Medicine. Oxford Univ Press 1999. P.57



Schem p.47 aldrich

Retina Retina

Retino-hypothalamicTract

SuprachiasmaticNucleus

•Afferent: Light

•Efferent: Sleep, etc…

•Melatonin

Process C



Polysomnographic (PSG)

Evaluation EEG

EOG

Chin EMG

Ant. Tibialis EMG ECG

Pulse Oximeter

Respiratory Belts

Airflow



Biological StateTwo Major Periods

NREM

Non-Rapid Eye Movement

REM

Rapid Eye Movement



STAGE 1 (NREM) Transitional

Theta Waves



STAGE 1 (NREM)

STAGE 2 (NREM)

First True Sleep State

Sleep Spindles

K-Complexes



STAGE 1 (NREM)

STAGE 2 (NREM)

STAGE 3 & 4 (NREM)

Deeper Sleep Delta Waves

Slow Wave



STAGE REM

Rapid Eye Movement

Body is Atonic

Brain Highly Activeresembles wakefulness (fast)



Sleep Assessment Sleep Efficiency

Sleep Latency Test

10-15 minutes Average < 7 minutes Problem



Diagnosis

Polysomnography

Insomnia onset age 44



P l h



Diagnosis

Polysomnography

Hypersomnia

since age 11



wake

S4

S3

S2

S1

REM

23 24 1 2 3 4 5 6 7 8

TIME

Sleep Histogram



Dyssomnias

Difficulties Getting Enough Sleep

Quantity, Quality, Timing Parasomnias

Abnormal Behavior During Sleep

Two Major Categories



I have difficulty falling asleep

Thoughts race through my mind andprevent me from getting to sleep

I anticipate a problem with sleep

several times a week

I often wake up and have trouble going

back to sleep



I worry about things and have trouble

relaxing I wake up earlier in the morning than I

would like to

I lie awake for a half an hour or more

before I fall asleep

I often feel sad or depressed because I

can’t sleep



ADD ALL TRUES

SCORE > 3, you have symptoms of INSOMNIA

INSOMNIA is a persistent inability to fall

asleep or stay asleep



Most Common Sleep Disorder

Trouble Initiating Sleep

Trouble Maintaining Sleep

Have Nonrestorative Sleep

Clinical Description

Primary Insomnia



Primary Insomnia

Facts and Statistics

Common (1/3 Population)

17% Have it in Severe Form

Females Report Problem > Males

Common in Older Populations



I have noticed (or others have commented)that parts of my body jerk during sleep

I have been told that I kick and jerk

during sleep

When trying to go to sleep, I experience anaching or crawling sensation in my legs

I experience leg pain or cramps at night



Sometimes I can’t keep my legs still at

night, I just have to move them to feelcomfortable

Even though I slept through the night, I

feel sleepy during the day



ADD ALL TRUES

SCORE > 3, you have symptoms of

PERIODIC LIMB MOVEMENT

DISORDER--uncontrollable leg or

arm jerks during sleep

or RESTLESS LEG SYNDROME--

uncomfortable feelings in the legs at

night



Idiopathic Hypersomnia

Problem of Sleeping Too Much

Severe Excessive Sleepiness

Appear to Have Enough Sleep

Little is Known About Causes

Appears to Run in Families

Primary

Insomnia



Narcolepsy

The “Sleep Attack”

Excessive Sleepiness & Cataplexy

– Triggered by Strong Emotion

– Go Right Into REM

Sleep Paralysis

Hypnagogic Hallucinations

Insomnia Hypersomnia





I have been told that I snore

I have been told that I hold my breathwhen I sleep

I have high blood pressure

My friends and family say that I’moften grumpy and irritable

I wish I had more energy



I get morning headaches

I often wake up gasping for breath I am overweight

I often feel sleepy and struggle to

remain alert during the day

I frequently wake with a dry mouth



ADD ALL TRUES

SCORE > 3, you have symptoms of SLEEP APNEA

SLEEP APNEA is a serious disorder that

causes you to stop breathing repeatedly,

often hundreds of times in the night

during sleep



Breathing-Related Sleep Disorders

Sleep Apnea

Breathing is Constrained or Ceases

Snoring and Night Sweats

Person Often Unaware of Problem

Several Types of Sleep Apnea


Narcolepsy



Breathing-Related Sleep Disorders

Types Sleep Apnea

Obstructive (OSA)

– Airflow Stops; Related to Obesity

Central (CSA)

– Cessation of Respiratory Activity

Mixed Sleep Apnea

– Combination of OSA and CSA


Narcolepsy



Circadian Rhythm Sleep Disorders

Problem With Circadian Clock

Disturbed Sleep

– Insomnia or Excessive Sleepiness

The Biological Clock

– Suprachiasmatic Nucleus

– Melatonin May Help Set the Clock

Jet Lag & Shift Work Types


Narcolepsy Apnea



During REM

Nightmares

During NREM

Sleep Terrors

Sleep Walking (somnambulism)

Two Main Types

Documents

Sleep de Cerce's NEW PPT 06