the science of sleep
DESCRIPTION
The Science of Sleep. 2 Phases: REM and Non-REM Sleep. Physiology of Normal Sleep. Non-REM Sleep. 4 stages of progressively deeper sleep Normal muscle tone Associated with increased 5HT (serotonin) Decreased autonomic activity: Lower BP, Pulse, respirations slow. Stage One. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/1.jpg)
![Page 2: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/2.jpg)
2 Phases: REM and Non-REM Sleep
![Page 3: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/3.jpg)
Non-REM Sleep
4 stages of progressively deeper sleep
Normal muscle tone Associated with increased 5HT
(serotonin) Decreased autonomic activity:
Lower BP, Pulse, respirations slow
![Page 4: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/4.jpg)
Stage One
Brief transition between wakefulness and sleep (accounts for only 5% of sleep time)
![Page 5: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/5.jpg)
Stage Two
Light sleep Accounts for 50% of total sleep time ElectroEncephaloGram (EEG) shows
some characteristic findings…
![Page 6: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/6.jpg)
EEG in Stage 2
![Page 7: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/7.jpg)
Stages 3,4
Most restful, restorative stages of sleep
Aka: Delta wave sleep/ slow wave sleep
Greatest proportion is in the first 1/3 to 1/2 of night
![Page 8: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/8.jpg)
NREM Sleep: Theories of its purpose… The decrease in metabolic demand
on the brain during NREM allows glycogen stores to replenish
Allows for consolidation of memories and learning
![Page 9: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/9.jpg)
REM (dreamland)
10-20 min. cycles consisting of: Rapid Eye Movements ElectroEncepahaloGram shows fast
activity very similar to wakeful EEG pattern
Suppression of peripheral muscle tone Often increased autonomic tone- ie,
increased blood pressure, resp, heart rate
![Page 10: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/10.jpg)
REM (dreamland)
Where dreaming occurs REM is marked by increased
brainwave activity Thus REM-supression seen with anti-
cholinergic drugs (ex. some antidepressants)
![Page 11: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/11.jpg)
Normal Sleep Pattern
Sleep cycles between NREM and REM approx. 4-5 times/night
Cycles last approx. 90min REM duration and frequency
increase thru night Proportion of slow wave sleep
(stages 3,4) decreases thru night
![Page 12: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/12.jpg)
Normal Sleep Parameters
Sleep Onset Latency- the time it takes one to fall asleep, averages 10-20min
REM Latency- time between sleep onset and the first REM period, averages 90-120min
![Page 13: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/13.jpg)
Normal Sleep Distribution REM sleep accounts for
approximately 25% of total sleep time
Non-REM sleep accounts for 75% of sleep time, with 25% of that spent in Stages 3,4 (most restful portion)
![Page 14: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/14.jpg)
Age-Related Changes
Decreases in dreaming, total sleep time, REM, and slow-wave (deep sleep)
Increases in early morning awakening, fragmentation, daytime napping, and phase advancement- Ie, earlier to bed, and awaken earlier
![Page 15: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/15.jpg)
![Page 16: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/16.jpg)
Sleep Disorders- 2 Divisions Dyssomnias- disorders of quality,
timing, or amount of sleep (quantity) Parasomnias- abnormal behaviors
associated with sleep or sleep-wake transition, that often produce arousals
![Page 17: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/17.jpg)
Dyssomnias
Primary Insomnia Narcolepsy Sleep Apnea Circadian Rhythm Sleep Disorder (jet
lag, et al.) Restless Legs Syndrome (RLS) Medical/Substance related insomnia
![Page 18: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/18.jpg)
Primary Insomnia
“Primary”, meaning no underlying medical cause
Onset often with stressor or disruption to sleep schedule or environment
Results from poor sleep hygiene, along with classical conditioning- Faulty learning/association of sleep
environment with state of arousal
![Page 19: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/19.jpg)
INSOMNIA- an epidemic?
Definition: “Subjective” experience of poor sleep quality or quantity that adversely affects daily functioning
Extremely common complaint in general practice
30-40% adults have occasional poor sleep
15-20% adults have chronic insomnia
![Page 20: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/20.jpg)
Consequences of Insomnia
Depression Irritability Decreased cognitive functioning Decreased productivity Injuries and accidents
![Page 21: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/21.jpg)
Narcolepsy
A dyssomnia characterized by poor sleep quality (restless, fragmented) and dysfunction in the transitions between sleep and wakefulness
Presents with Excessive Daytime Sedation (EDS)
![Page 22: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/22.jpg)
Narcolepsy Tetrad
Classic tetrad of associated findings: 1. Sleep attacks 3. Sleep paralysis 4. Sleep hallucinations
![Page 23: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/23.jpg)
Cataplexy
Sudden loss of muscle tone (rarely full body paralysis) caused by intrusion of REM activity into daytime wakefulness
Triggered by heightened emotion Average duration: 30 seconds No loss of consciousness
![Page 24: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/24.jpg)
Sleep Paralysis
Brief paralysis upon waking Remain alert with full eye
movements Can occur in the absence of Narcolepsy (ie, normal variant)
![Page 25: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/25.jpg)
Sleep Hallucinations
Hypnogogic hallucinations- occur during transition into sleep
Hynopompic hallucinations- occur upon awakening from sleep
Can occur in the absence of Narcolepsy (ie, normal variant)
![Page 26: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/26.jpg)
Sleep Apnea
Dyssomnia characterized by poor sleep quality due to frequent awakenings (apneas)
Apneas last sec-minutes Presents with excessive daytime
sedation- EDS
![Page 27: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/27.jpg)
Sleep Apnea: Two Types
Obstructive Sleep Apnea: most common
Central Sleep Apnea
![Page 28: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/28.jpg)
Obstructive Sleep Apnea
Classic- obese, middle-aged male with thick neck or enlarged tonsils
Apneas- brief gasps…silence, followed by loud “resuscitative” snores, and sometimes body movements (restless)
Usually unaware of snoring, arousals…but sleep partner is aware
![Page 29: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/29.jpg)
Central Sleep Apnea
Apneas- episodic cessation of central ventilation drive Thus snoring is less common
More in elderly, with underlying CNS lesions- ex. tumor, stroke
![Page 30: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/30.jpg)
Sleep Apnea: Consequences Depression Anxiety Morning headaches Cognitive dysfunction Hypertension
![Page 31: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/31.jpg)
Restless Legs Syndrome
Paresthesias and/or dysesthesias in the legs, relieved by movements
Usually occur in transition from wakefulness to sleep
![Page 32: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/32.jpg)
RLS Causes
Peripheral neuropathies Peripheral vascular disease Medication side effects Anemia Pregnancy Renal failure
![Page 33: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/33.jpg)
Circadian Rhythm Disorders
Delayed Sleep Phase Syndrome
Jet Lag Accelerated Sleep
Phase Syndrome Shift Work Sleep
Disorder
![Page 34: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/34.jpg)
Psychiatric Causes of Insomnia Depression Anxiety Psychosis Substance intoxication/withdrawal
![Page 35: The Science of Sleep](https://reader031.vdocuments.mx/reader031/viewer/2022032612/56813152550346895d97cba7/html5/thumbnails/35.jpg)