Think Science: Sleep, by Dr. James Andry
•Download as PPTX, PDF•
1 like•486 views
Slide presentation to accompany TPR's "Think Science" event on November 17, 2017.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Think Science: Sleep, by Dr. James Andry
Similar to Think Science: Sleep, by Dr. James Andry (20)
More from Nathan Cone
More from Nathan Cone (20)
Recently uploaded
Recently uploaded (20)
Think Science: Sleep, by Dr. James Andry
- 1. Sleep James M. Andry, MD Nagwa N. Lamaie, MD Co-Medical Directors Sleep Therapy & Research Center SleepTRC.com
- 2. What is Sleep? What is its purpose?
- 3. Creation of Eve - Michaelangelo.org
- 5. So what is Sleep? 1. Behavioral criteria consist of • Immobility or slight mobility, • Closed eyes, • Characteristic species-specific sleeping posture, • Decreased response to external stimulation, • Quiescence, • Increased reaction time, • Elevated arousal threshold, and • Reduced cognitive function • Reversible unconscious state. 2. Physiological criteria are based on • EEG, • electrooculography (EOG), and • electromyography (EMG) findings, • as well as unique physiological changes such as unique ventilation and circulation.
- 6. Sleep Architecture HypnogramW R N1 N2 N3 ALPHA 8-13 Hz THETA 3 – 7 Hz DELTA 0.5 – 4 Hz SAW-TOOTHED REMVERTEX WAVE +/- SEM = N1 SPINDLES +/- K- COMPLEX = N2 SEM
- 8. Stages of Sleep • Non-REM (N) – 75% – 85% – Stage 1 (N1) – 0% - 5% of Total Sleep – Stage 2 (N2) - 45% – 65% – Stage 3 (N3) – 0% – 20% • Stage REM (R) – 15% - 25% • Time to Fall Asleep – 5 – 10 minutes
- 10. Optimal Sleep Quantity • General Health • Cardiovascular Health • Metabolic Health • Mental Health • Immunologic Health • Human Performance • Cancer • Pain • Mortality
- 11. Optimal Sleep Quality • Wake after Sleep – less than 30 minutes • Disturbances (arousals without awakening) during sleep – less than 5 per hour
- 12. What is Sleep’s purpose?
- 13. Physiologic effects of Sleep Deprivation • Associated with systemic inflammation • Increased levels of key inflammatory mediators – Tumor Necrosis Factor-alpha (TNFα), – C-reactive protein CRP) – Chemokines • Intermittent and chronic hypoxia & sympathetic discharge – Associated with glucose intolerance and insulin resistance • sleep disruption very debilitating – Daytime sleepiness – Cognitive impairment – Depression – Relationship difficulties – Dementia – Appetite changes/obesity – Reduced immunity
- 14. Sleep Deprivation Inflammation, Infection, Malignancy • Reduction in natural killer cells and their activity, • Decrease in lymphocytes and granulocytes in response to antigens. • Antibody production reduced • Sleep , 4 hours - 50% reduction was found 10 days after immunization with influenza • C-reactive protein (CRP) is increased in both – Sleep-deprived normal humans and – Obstructive sleep apnea patients - Elevation is associated risk for CV disease. • Increased risk of mortality with sleep deprivation (<6.5 hours)
- 15. Sleep Deprivation Endocrine & Metabolic • Disruption of hormone secretion / balance – Reproductive issues – Menstrual irregularities – Impotence • Changes in metabolism – Appetite control – Weight changes – Leptin / Ghrelin changes
- 16. MELATONIN ANTI-DIURETIC HORMONE RENIN-ANGIOTENSIN- ALDOSTERONE THYROID STIMULATING HORMONE TESTOSTERONE PROLACTIN GONADOTROPIN CORTISOL GROWTH HORMONE CIRCADIAN LINKED SLEEP-LINKED
- 17. Other Sleep Function • Memory & Learning – REM sleep helps facilitate consolidation of perceptual and emotional memories. – Sleep has been shown to enhance prior learning of various skills and emotions. • Consolidation of different skills requires involvement of different portions of sleep – Late-night REM and early-night slow wave sleep correlated with improvements in visual texture discrimination – Paired word associate learning enhanced by early night sleep – Recall of a paired associate list), and emotional declarative memory improved by late-night sleep
- 18. Proposed Biological Functions of Sleep 1. Body and brain tissue restoration 2. Facilitation of waste clearance of the central nervous system via the glymphatic system 3. Energy conservation 4. Adaptation 5. Memory reinforcement and consolidation 6. Synaptic neuronal network integrity 7. Gene expression in sleep/wakefulness 8. Thermoregulation Avidan, A., Review of Sleep Medicine, 4th Ed. © 2018
- 19. Neurochem Res. 2015 Dec; 40(12): 2583–2599.
- 20. Pathway to Clear Cellular Waste from the Brain Using the Glymphatic System. Avidan, A., Review of Sleep Medicine, 4th Ed. © 2018
- 22. Light Pollution
- 23. Sleep Disorders Insomnia • Chronic Insomnia Disorder • Short-Term Insomnia Disorder Sleep Related Breathing Disorders • Obstructive Sleep Apnea Disorders • Central Sleep Apnea Syndromes • Sleep Related Hypoventilation Disorders • Sleep Related Hypoxemia Disorder Sleep Related Movement Disorders • Restless Legs Syndrome • Periodic Limb Movement Disorder • Sleep Related Leg Cramps • Sleep Related Bruxism • Sleep Related Rhythmic Movement Disorder • Benign Sleep Myoclonus of Infancy • Propriospinal Myoclonus at Sleep Onset • Sleep Related Movement Disorder Due to a Medical Disorder • Sleep Related Movement Disorder Due to a Medication or Substance Central Disorders of Hypersomnolence • Narcolepsy Type 1 • Narcolepsy Type 2 • Idiopathic Hypersomnia • Kleine-Levin Syndrome • Hypersomnia Due to a Medical Disorder • Hypersomnia Due to a Medication or Substance • Hypersomnia Associated with a Psychiatric Disorder • Insufficient Sleep Syndrome Circadian Rhythm Sleep-Wake Disorders • Delayed Sleep-Wake Phase Disorder • Advanced Sleep-Wake Phase Disorder • Irregular Sleep-Wake Rhythm Disorder • Non-24-Hour Sleep-Wake Rhythm Disorder • Shift Work Disorder • Jet Lag Disorder
- 24. Sleep Disorders NREM-Related Parasomnias • Disorders of Arousal (From NREM Sleep) • Confusional Arousals • Sleepwalking • Sleep Terrors • Sleep Related Eating Disorder Other Parasomnias • Exploding Head Syndrome • Sleep Related Hallucinations • Sleep Enuresis • Parasomnia Due to a Medical Disorder • Parasomnia Due to a Medication or Substance • Parasomnia, Unspecified REM-Related Parasomnias • REM Sleep Behavior Disorder • Recurrent Isolated Sleep Paralysis • Nightmare Disorder
- 25. Florence Nighting 1859 “Notes on Nursing” “Of one thing you may be certain, that anything which wakes a patient suddenly out of his sleep will invariably put him into a state of greater excitement, do him more serious, aye, and lasting mischief, than any continuous noise, however loud. Never to allow a patient to be waked, intentionally or accidentally, is a sine qua non of all good nursing.”
- 26. Thank you!
Editor's Notes
- The Pearl
- These questions have perplexed us since the beginning of creation. Adam was put into a deep sleep in order to achieve a greater good..Eve. Some may argue however, that the Lord introduced not only the Field of Sleep, but also its Disorders.
- It is well recognized that there are 3 Pillars of Health. Sleep, Eating, and Exercise In many respects, Sleep is the Pillar of the Pillars of Health.
- ”It is a privilege, to watch someone sleep. It is a privilege to be able to witness someone both here and not here. To be included in someone’s absence, it is an honour, and it asks quiet. It asks respect.”
- Two conceptualizations of sleep duration.Adapted with permission from Marshall et al. Sleep Med Rev 2008;12:289–298. The green line represents an optimal dose of sleep where the odds of incident disease are lowest. The orange line represents a sleep saturation model, where longer sleep is not necessarily associated with poor health, and may be beneficial in some circumstances (e.g., recovery from sleep deprivation or illness).
- You don’t know what you have until it is gone!
- The meaning of sleep stages and the many changes that occur in the brain during sleep have not ceased to puzzle researchers. No integrative explanation of brain changes during sleep has been uniformly accepted yet by the scientific community, but more and more pieces of information are emerging from the numerous studies in the field. Sleep has been shown to enhance prior learning of various skills and emotions. It has been found that consolidation of different skills requires involvement of different portions of sleep. Gais and co-workers (Neurosci 3[12]:1335–1359, 2000) have shown that in laboratory rats, late-night REM and early-night slow wave sleep correlated with improvements in visual texture discrimination (Stickgold, J Cogn Neurosci 12[2]:246, 2000. Humans were trained to recognize differences in orientation of certain arrays) and that this improvement was superior when compared with the same amount of time spent in the awake state. Other studies showed improvement in motor skills in correlation with late-night NREM sleep. 11 (Walker, Neuron 35:205–211, 2002. Humans trained to perform finger tapping patterns), paired word associate learning enhanced by early night sleep (Philal, Psychoneuroendocrinology 24:313–331, 1999. Recall of a paired associate list), and emotional declarative memory improved by late-night sleep (Wagner, Learn Mem 8:112–119, 2001. Memory retention of emotional versus neutral text material).
- Schematic representation of the brain's fluid compartments and barriersThe fluid compartments in the brain consist of intracellular fluid (ICF) (60-68%), interstitial fluid (ISF) (or extracellular fluid) (12-20%), blood (10%) and the cerebrospinal fluid (CSF) (10%) [5, 10]. The blood is separated from the CSF and interstitial fluid by the blood brain barrier (BBB) and blood-CSF barrier, respectively. Tight junctions between the blood endothelial cells constitute the BBB, restricting macromolecules to move freely from the blood to the brain parenchyma. Fluid and solutes in the perivascular space located between endothelial cells and astrocytic endfeet, expressing the water channel aquaporin-4 (AQP4) diffuses into the brain parenchyma. The blood-CSF barrier is formed by tight junctions between the choroid plexus epithelial cells. Macromolecules from the blood can move freely between the fenestrated endothelial cells to the interstitial fluid but is restricted by tight junctions in the choroid plexus epithelial cells, which therefore are believed to be the main players in determining CSF composition. Images in this article
- A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β.Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, Benveniste H, Vates GE, Deane R, Goldman SA, Nagelhus EA, Nedergaard M Sci Transl Med. 2012 Aug 15; 4(147):147ra111.
- Chronic Insomnia Disorder Short-Term Insomnia Disorder Other Insomnia Disorder Related Breathing Disorders Obstructive Sleep Apnea Disorders Central Sleep Apnea Syndromes Sleep Related Hypoventilation Disorders Sleep Related Hypoxemia Disorder Isolated Symptoms and Normal Variants Central Disorders of Hypersomnolence Narcolepsy Type 1 Narcolepsy Type 2 Idiopathic Hypersomnia Kleine-Levin Syndrome Hypersomnia Due to a Medical Disorder Hypersomnia Due to a Medication or Substance Hypersomnia Associated with a Psychiatric Disorder Insufficient Sleep Syndrome Circadian Rhythm Sleep-Wake Disorders Delayed Sleep-Wake Phase Disorder Advanced Sleep-Wake Phase Disorder Irregular Sleep-Wake Rhythm Disorder Non-24-Hour Sleep-Wake Rhythm Disorder Shift Work Disorder Jet Lag Disorder Circadian Sleep-Wake Disorder Not Otherwise Specified (NOS) Sleep Related Movement Disorders Restless Legs Syndrome Periodic Limb Movement Disorder Sleep Related Leg Cramps Sleep Related Bruxism Sleep Related Rhythmic Movement Disorder Benign Sleep Myoclonus of Infancy Propriospinal Myoclonus at Sleep Onset Sleep Related Movement Disorder Due to a Medical Disorder Sleep Related Movement Disorder Due to a Medication or Substance Sleep Related Movement Disorder, Unspecified
- Parasomnias NREM-Related Parasomnias Disorders of Arousal (From NREM Sleep) Confusional Arousals Sleepwalking Sleep Terrors Sleep Related Eating Disorder REM-Related Parasomnias REM Sleep Behavior Disorder Recurrent Isolated Sleep Paralysis Nightmare Disorder Other Parasomnias Exploding Head Syndrome Sleep Related Hallucinations Sleep Enuresis Parasomnia Due to a Medical Disorder Parasomnia Due to a Medication or Substance Parasomnia, Unspecified