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  • Long Nights Journey into DaySleep 2009 Update

    Jay A. Yeomans, M.D. CMC-Randolph Behavioral Health CenterGrand Rounds

    December 1, 2009

  • THE SECRET LIFE OF DREAMS

    Jay A. Yeomans, M.D.

    Carolina Behavioral Health

    February 3, 2005

  • What does sleep have to do with it?

    Update on Sleep Medicine

    Jay A. Yeomans, M.D.

    CMR-Randolph, Behavioral Health CenterGrand Rounds

    October 16, 2012

  • What does sleep have to do with it?

    Update on Sleep Medicine

    Jay A. Yeomans, M.D.

    CMC-Internal Medicine ResidencyNoon Conference

    February 1, 2013

  • Sleep is not a passive state

    we spend 1/3 of our lives sleeping

    1960 the average american slept 8 & 1/2 hours/nite 2000 the average american slept 7 hours/nite

    The incidence of childhood obesity and metabolic disorders has increased over the past 30 yrs - at the same time the prevalence of chronic sleep deprivation has increased precipitously

    "You'll feel better tomorrow"

  • Long Nights Journey into DaySleep 2009 Update

    Jay A. Yeomans, M.D.

    CMC-R, BHCGrand Rounds

    December 1, 2009

  • ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ

    Awake from Sleep

  • American Academy of Sleep Medicine

    Deja review sleep physiology

    The neural impact of Sleep on Memory

    The neural impact of Sleep on Emotion (MDD / PTSD)

    Chronobiology Psychiatric Disorders Treatments

  • 09 American Academy of Sleep Medicine

    Review sleep physiology Americas Sleep DebtThe neural impact of Sleep on Memory and EmotionSleep in PTSDAdolescence & SleepSleep-related Breathing Disorders Connecting the Zzzots Sleep & the Metabolic Syndrome Sleep & Circadian Rhythms in Bipolar Affective DisorderBlue Light Special

  • Sleep, the chief nourisher of lifes great feast

    William Shakespear (MacBeth; Act II, Scene II)

  • SLEEP ARCHITECTURENREM : 1-4orthodox, quiet,slow-wave or s-state Stage 1: (2-5% of total sleep time) transition phase from wakefulness & sleep

    EEG: activity between 3-7 Hz low V, mixed f EEG length: min. 7 min. mentation: thinking no longer reality- orientedshort dreams hypnic myoclonia Stage 2: (45-55%) first bona fide sleep stage

    EEG: sleep spindles (burst of 12-24 Hz act. lasting - 2 sec.) & K complexes (well delineated, slow, neg. EEG deflections followed by a + component ) length: approx. 20 30 min. mentation: short, mundane fragmented thoughts

  • SLEEP ARCHITECTURENREM : 1-4orthodox, quiet, slow-wave Stage 1: transition phase from wakefulness & sleep EEG: activity between 3-7 Hz (Theta waves) length: min. 7 min. mentation: thinking no longer reality-oriented short dreams hypnic myoclonia

    Stage 2: first bona fide sleep stage EEG: Sleep spindles - burst of 12-24 Hz act. ( -2 sec) K complexes (well delineated, slow, neg. EEG deflections followed by a + component ) length: approx. 20 30 min. mentation: short, mundane fragmented thoughts

  • SLEEP ARCHITECTURE

    NREM

    Stage 3 & 4: deepest / SWS / high voltage Delta waves core sleep hypothesis SWS serves to repair the effects of waking wear & tear on the cerebrum, i.e. lower metabolic rate & brain temperature allows repair from free-radical damagedecreases with age (40 y/o 50% / elderly nonexistent)

    SWS: GH, Prolactin, Cortisol; inhibition of TSH vagal tone increased; decrease in sympathetic NS activity, HR, BP and cerebral glucose utilization decreased

    Schizophrenia (Am J Psych 08)

  • 50%10% 85 0%

  • SLEEP ARCHITECTURE

    REM paradoxical sleep : active brain /adrenaline, pulse & oxygen consumption come closest to those in wakefulness with muscle atonia REM: occurs approx every 90 min with each REM period progressively more dense and longer in duration (1st REM 9 min; doubles each time)Episodic burst of rapid eye movementscontrolled by the pons (brain stem, i.e. primitive brain) which also controls breathing & heart rateplateaus around 20 yrs., then decreases with age

  • SLEEP ARCHITECTURE

    Body size is a major determinant in the total amt of sleep: opossum (18h); man (8h); elephant (3-4h)

    Smaller animals have higher metabolic rates & higher brain & body temperatures metabolism generates free radicals. NREM repairs / mops up free radicals

  • The majority of MT1/MT2 receptors are found in the SCN. This limited distribution of MT1 and MT2 receptors combined with an increased understanding of the role of melatonin in sleep-wake regulation suggests that selective MT1 and MT2 agonists may have significant therapeutic potential. [pp. 1099-1103]

    Dubocovich ML, Rivera-Bermudez MA, Gerdin MJ, Masana MI. Molecular pharmacology, regulation and function of mammalian melatonin receptors. Front Biosci. 2003;8:1093-1108.

  • SummaryREM Sleep occurs approx. every 90 minutesREM periods increase in length & density as the sleep cycle progressesDreams / Nightmares occur primarily during REMDisorders of REM occurs in a) primary sleep disorders, b) mood disorders, c) anxiety disorders and d) substance use disordersMedications, EtOH & illicit drugs can effect REM

    Maybe a cigar is not a cigar (or is it?)REM Sleep consolidates memory: early SWS initiates the consolidation process late REM sleep enhances memory consolidation only when preceded by early SWS

  • Sleep Research

    Delta sleep (SWS) Sleep recovery / GH / soft peddle memory / decrease in SchizophreniaREMmemory consolidation (assoc. w/neg emotional memory depression: REM density / PTSD: dysregulation of REM) memory: semantic (Anterior Temporal Lobe) vs episodic (SWS) in the hippocampusREM dreams (Freud: road to the unconscious vs Dobson: road to consciousness)

  • The role of REM sleep

    Rapid Eye Movements Kleitman & Aserinsky reported in Science 53 Regularly occurring periods of eye motility and concomitant phenomena during sleepScience 66: Dreaming sleep important to the developing brainREM sleep: riddle wrapped in a mystery inside an enigma

    REM: brain stem (primitive brain)Fetus REM sleep w/o muscle atonia

    REM stimulates neural development REM deprivation in early development has long term negative consequences for synaptic plasticity in the hippocampus

    REM sleep required for hippocampal (memory processed & stored) development

  • The role of REM sleep

    Rapid Eye Movements Kleitman & Aserinsky reported in Science 53 Regularly occurring periods of eye motility and concomitant phenomena during sleepScience 66: Dreaming sleep important to the developing brainREM sleep: riddle wrapped in a mystery inside an enigmaREM: brain stem (primitive brain)Fetus REM sleep w/o muscle atonia

    REM stimulates neural development REM deprivation in early development has long term negative consequences for synaptic plasticity in the hippocampus

    REM sleep required for hippocampal (memory processed & stored) development

    Visual stimuli retina (thalamus) lateral geniculate body (LGN) primary visual cortex (PVC) LGN & PVC active in REM sleep (even though eyes are closed)REM brain activity: emotional centers are 30% active Prefrontal cortex (logical / rational / creative / critical thinking) are deactivated (> than deep sleep)

  • PVCLGNPFC

  • Electro-oculogram

  • The role of REM sleepKeynote address at the AASM Conference Howard P. Roffwarg, MD; University of Mississippi Infancy > 50%; Adults ~ 20 % REM sleep (90-120 min / 8 h cycle)

    Increased REM if altricial naked / defenseless when hatched, (platypus) vs. precocial born relatively mature / mobile from the moment of birth or hatching (dolphin)

    REM sleep: rat & cat 100% > Man > Monkey > Dolphins & Chickens = little to no REM

    REM sleep deprivation does not lead to insanityREM sleep deprivation can alleviate clinical depressionTotal amt of REM sleep not correlated with IQ Rats/maze deprived of REM learning not retainedHippocampus (stores LTM) exhibits theta wave activity during REM but not NREM nor waking state except when engaged in activity crucial to its survival (e.g. rat exploring or rabbit threatened)

  • The Elephant lies down during non-REM sleep but stands during REM sleep.

  • The role of REM sleep

    Total amt REM Sleep: platypus 8 h; humans 90 2 h REM sleep: rat & cat 100% > Man > Monkey > Dolphins & Chickens = little to no REMMonoamine neurotransmitter (5HT, NE, Histamine) release ceases during REM which allows receptors to rest & regain full sensitivity Depression: shortened REM latency & REM densityMemory: multistep process: Hippocampus: episodic (SWS) memory semantic (REM) memory REM: consolidation / pruning of memory (Poe, Nature; 83)

  • The role of REM sleepDreams Freud: Royal Road to the Unconscious Dreams ~80% occur during REM REM dreams: bizarre & detailed, storyline plot

    Jouvet, et al 62, RE