NORMAL SLEEP NEUROBIOLOGY OF SLEEP NEUROPHYSIOLOGY OF SLEEP INTRODUCTION TO CLINICAL SLEEP

Questions/ Concerns?

Phone:

244-9841 Email: John.DeCerce@Jax.Ufl.edu

Occupies 1/3 of our Lives (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?

Sleepiness/Wakefulness Initiating & Maintaining Sleep

Lack of Sleep (Homeostatic Balance) Biological Clock (Circadian Rhythm)

Aminergic

Cholinergic

Fig. 2.1 aldrich

Wake Sleep REM

Reticular Formation

Basal Forebrain Thalamus Post. Hypothalamus

Cholinergic Serotonergic Monoaminergic Histaminergic

The ascending arousal system

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

The Sleep Switch

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

Process S
Sleep Load

ADENOSINE

Interleukins

DSIP

Wake

GHRH PgD2 Serotonin

Sleep
9AM 3PM 9PM 3AM 9AM

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

Process C
Biological Clocks

Mimosa pudica heliotrope

Process C
Subjective Alertness
0

18

27

36

45

54

63

72

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

Process C
Subjective Alertness
0

18

27

36

45

54

63

72

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

Process C
Schem p.47 aldrich
Retina Retina

Retino-hypothalamic Tract

Suprachiasmatic Nucleus Afferent: Light Efferent: Sleep, etc Melatonin

 Polysomnographic (PSG) Evaluation

EEG EOG Chin EMG Ant. Tibialis EMG ECG Pulse Oximeter Respiratory Belts Airflow

 Biological State Two 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 Active

resembles wakefulness (fast)

 Sleep Assessment

Sleep Efficiency Sleep Latency Test

10-15

minutes Average < 7 minutes Problem

Diagnosis
Polysomnography
Insomnia onset age 44

Diagnosis
Actigraphy

Control

Insomniac

Polysomnography

Diagnosis
Hypersomnia since age 11

Sleep Histogram
wake

REM

S1 S2

S3

S4

23

24

TIME

 Two Major Categories Dyssomnias

Difficulties

Getting Enough Sleep Quantity, Quality, Timing

Parasomnias
Abnormal

Behavior During Sleep

I have difficulty falling asleep Thoughts race through my mind and prevent 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 cant sleep

ADD ALL TRUES SCORE > 3, you have symptoms of INSOMNIA INSOMNIA is a persistent inability to fall asleep or stay asleep

 Primary Insomnia Most Common Sleep Disorder

Trouble

Initiating Sleep Trouble Maintaining Sleep Have Nonrestorative Sleep

Clinical Description

 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 an aching or crawling sensation in my legs I experience leg pain or cramps at night

Sometimes I cant keep my legs still at night, I just have to move them to feel comfortable 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

 Primary Insomnia

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

 Insomnia Hypersomnia

Narcolepsy The Sleep Attack

Excessive

Sleepiness & Cataplexy Triggered by Strong Emotion Go Right Into REM Sleep Paralysis Hypnagogic Hallucinations

 Insomnia Hypersomnia

Narcolepsy Facts and Statistics

Rare

Condition Affects Males and Females Equally Often Begins in Adolescence Seems to Improve Over Time Behavior Also Seen in Dogs

I have been told that I snore I have been told that I hold my breath when I sleep I have high blood pressure My friends and family say that Im often 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

 Insomnia Hypersomnia Narcolepsy

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

 Insomnia Hypersomnia 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

Insomnia Hypersomnia Narcolepsy Apnea

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

 Two Main Types During REM

Nightmares

During NREM
Sleep

Terrors Sleep Walking (somnambulism)