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8/2/2019 Sleep de Cerce's NEW PPT 06
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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
8/2/2019 Sleep de Cerce's NEW PPT 06
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Questions/ Concerns?
Phone: 244-9841
Email: John.DeCerce@Jax.Ufl.edu
8/2/2019 Sleep de Cerce's NEW PPT 06
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Occupies 1/3 of ourLives (3,000 hrs /year)
Necessary for Physical
and Mental Health $50 Billion / Year in
Lost Productivity
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Amount Varies
By Persons
By Age
Sensitive to Waking Behavior
Problems are Common
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Neurobiology of Sleep
Neurophysiologic Basis of Sleepiness
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What determines it?
Lack of Sleep (Homeostatic Balance)
Biological Clock (Circadian Rhythm)
Sleepiness/Wakefulness
Initiating & Maintaining Sleep
8/2/2019 Sleep de Cerce's NEW PPT 06
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Basal Forebrain
Thalamus
Post. Hypothalamus
Cholinergic
Serotonergic
Monoaminergic
Histaminergic
Reticular Formation
Aminergic Cholinergic
Wake
Sleep
REM
Fig. 2.1 aldrich
8/2/2019 Sleep de Cerce's NEW PPT 06
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The ascending arousal system
Saper, CB., et.al. Trends in Neuroscience. Vol 24. No 12. Dec 2001
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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”
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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
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Mimosa pudica
heliotrope
Biological
Clocks
Process C
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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
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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
8/2/2019 Sleep de Cerce's NEW PPT 06
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Schem p.47 aldrich
Retina Retina
Retino-hypothalamicTract
SuprachiasmaticNucleus
•Afferent: Light
•Efferent: Sleep, etc…
•Melatonin
Process C
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Polysomnographic (PSG)
Evaluation EEG
EOG
Chin EMG
Ant. Tibialis EMG ECG
Pulse Oximeter
Respiratory Belts
Airflow
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Biological StateTwo Major Periods
NREM
Non-Rapid Eye Movement
REM
Rapid Eye Movement
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STAGE 1 (NREM) Transitional
Theta Waves
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STAGE 1 (NREM)
STAGE 2 (NREM)
First True Sleep State
Sleep Spindles
K-Complexes
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STAGE 1 (NREM)
STAGE 2 (NREM)
STAGE 3 & 4 (NREM)
Deeper Sleep Delta Waves
Slow Wave
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STAGE REM
Rapid Eye Movement
Body is Atonic
Brain Highly Activeresembles wakefulness (fast)
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Sleep Assessment Sleep Efficiency
Sleep Latency Test
10-15 minutes Average < 7 minutes Problem
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Diagnosis
Polysomnography
Insomnia onset age 44
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P l h
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Diagnosis
Polysomnography
Hypersomnia
since age 11
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wake
S4
S3
S2
S1
REM
23 24 1 2 3 4 5 6 7 8
TIME
Sleep Histogram
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Dyssomnias
Difficulties Getting Enough Sleep
Quantity, Quality, Timing Parasomnias
Abnormal Behavior During Sleep
Two Major Categories
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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
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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
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ADD ALL TRUES
SCORE > 3, you have symptoms of INSOMNIA
INSOMNIA is a persistent inability to fall
asleep or stay asleep
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Most Common Sleep Disorder
Trouble Initiating Sleep
Trouble Maintaining Sleep
Have Nonrestorative Sleep
Clinical Description
Primary Insomnia
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Primary Insomnia
Facts and Statistics
Common (1/3 Population)
17% Have it in Severe Form
Females Report Problem > Males
Common in Older Populations
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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
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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
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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
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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
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Narcolepsy
The “Sleep Attack”
Excessive Sleepiness & Cataplexy
– Triggered by Strong Emotion
– Go Right Into REM
Sleep Paralysis
Hypnagogic Hallucinations
Insomnia Hypersomnia
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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
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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
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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
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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
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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
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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
Insomnia Hypersomnia
Narcolepsy Apnea