Circadian rhythms are 24-hour biological cycles that influence various body functions like sleep-wake cycles, temperature regulation, and hormone secretion. They are controlled by the brain's central pacemaker and can be disrupted by conditions like shift work or jet lag. Common circadian rhythm disorders include delayed sleep phase syndrome, where one has difficulty falling asleep before late night, and advanced sleep phase syndrome, where people fall asleep early in the evening. Non-24-hour sleep-wake syndrome causes people to maintain 25-27 hour cycles instead of 24 hours.
Tem gente que vive em permanente incomodo. Dorme mal, se sente mal porque dorme mal e nunca procurou descobrir os motivos de ter um sono ruim. Dormir bem é muito importante para que a gente tenha uma boa saúde e seja mais feliz
Understanding the sleep cycle is often the first step to better sleep quality. When you know, what affects your sleep cycle, you can take measures to cut out distractions and get ample restful sleep every night.
Also, to help you understand the various sleep stages and sleep cycles easily, we have also created an infographic for this.
Read more details on the source site: https://sleepsherpa.com/stages-of-sleep-and-sleep-cycles-explained/
Tem gente que vive em permanente incomodo. Dorme mal, se sente mal porque dorme mal e nunca procurou descobrir os motivos de ter um sono ruim. Dormir bem é muito importante para que a gente tenha uma boa saúde e seja mais feliz
Understanding the sleep cycle is often the first step to better sleep quality. When you know, what affects your sleep cycle, you can take measures to cut out distractions and get ample restful sleep every night.
Also, to help you understand the various sleep stages and sleep cycles easily, we have also created an infographic for this.
Read more details on the source site: https://sleepsherpa.com/stages-of-sleep-and-sleep-cycles-explained/
Sleep is defined as unconsciousness from which the person can be aroused by sensory or other
stimuli.
distinguished from coma, which is unconsciousness from which the person cannot be
aroused. There are multiple stages of sleep, from very light sleep to very deep sleep; sleep
researchers also divide sleep into two entirely different types of sleep that have different qualities,
Sleep-wake cycle refers to our 24 hour daily sleep pattern which consists of
approximately 16 hours of daytime wakefulness and 8 hours of night-time sleep.
The complex process of the sleep-wake cycle is controlled by the body’s circadian rhythm and sleep homeostasis (the amount of accumulated sleep need that builds during time spent awake).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. ⚫The term circadian comes from two Latin
words namely
“circa” means around
“diem/dies” means day
Circadian means “approximately one day’’
4. ⚫4th century BC - Androsthenes
⚫13th century - The observation of a
circadian or diurnal process in humans is
mentioned in Chinese medical texts .
⚫1729 - The first recorded observation of
an endogenous circadian oscillation by the
French scientist Jean-Jacques d'Ortous de
Mairan
5. ⚫1896 - Patrick and Gilbert observed that
during a prolonged period of sleep
deprivation, sleepiness increases and
decreases with a period of approximately 24
hours.
⚫1918 - J.S. Szymanski showed that animals
are capable of maintaining 24-hour activity
patterns in the absence of external cues.
⚫1994 - Joseph Takahashi discovered the
first mammalian 'clock gene' (clock) using
6. CIRCADIAN RHYTHM
A 24-hour biological rhythm
controlled by a “pacemaker” in the brain
that sends messages to other systems
in the body. Circadian rhythm
influences various regulatory
functions, including the sleep–wake
cycle, body temperature
regulation, patterns of activity such as
eating and drinking, and hormonal and
neurotransmitter secretion.
7. 1. Circadian rhythm are 24-hour cycles that are part of the
body’s internal clock, running in the background to carry
out essential functions and processes. One of the most
important and well-known circadian rhythms is the sleep-
wake cycle.
2. Different body systems follow circadian rhythms
synchronized with a master clock in the brain. This
master clock is directly influenced by environmental
cues, especially light, which is why circadian rhythms are
tied to the day and night cycle.
3. When properly aligned, a circadian rhythm can promote
consistent and restorative sleep. But when this circadian
rhythm is thrown off, it can create significant sleeping
problems, including insomnia. Research is also revealing
that circadian rhythms play an integral role in diverse
aspects of physical and mental health.
8. ⚫Zeitgebers induce changes in the
concentrations of the molecular
components of the clock to levels
consistent with the appropriate stage
in the 24-hour cycle, a process
termed entrainment.
9.
10. BIOLOGICALMARKERS
The classic phase markers for measuring
the timing of a mammal's circadian
rhythm are:
⚫melatonin secretion by the pineal gland
⚫core body temperature
⚫plasma level of cortisol
11. Effects of age on Circadian rhythm
Newborn baby -16 to 20 h
Child - 10 to 12 h
Age 10 - 9 to 10 h
Adolescence - 7 to 7.5 h
A gradual decline to about 6.5 h develops
in late adult life.
35 years of age onward, women tend to
sleep slightly more than men
12. Phases of the sleep cycle
The human body cycles through two phases of sleep, (1) rapid eye
movement (REM) and (2) non-rapid eye movement (NREM) sleep, which
is further divided into three stages, N1-N3. Each phase and stage of sleep
includes variations in muscle tone, brain wave patterns, and eye
movements. The body cycles through all of these stages approximately 4 to
6 times each night, averaging 90 minutes for each cycle.
Sleep quality and time spent in each sleep stage may become altered by
depression, aging, traumatic brain injuries, medications, and circadian
rhythm disorders. The pathophysiology associated with each will be
discussed later in detail.
13. Stages of the sleep cycle
Sleep occurs in five stages: wake, N1, N2, N3, and REM. Stages N1 to N3 are
considered non-rapid eye movement (NREM) sleep, with each stage a
progressively deeper sleep.
Approximately 75% of sleep is spent in the NREM stages, with the majority
spent in the N2 stage. A typical night's sleep consists of 4 to 5 sleep cycles, with
the progression of sleep stages in the following order: N1, N2, N3, N2, and
REM.
A complete sleep cycle takes roughly 90 to 110 minutes. The first REM period
is short, and, as the night progresses, longer periods of REM and decreased
time in deep sleep (NREM) occur.
14. Wake/Alert
EEG recording: beta waves - highest frequency, lowest amplitude (alpha waves are seen during
quiet/relaxed wakefulness)
The first stage is the wake stage or stage W, which further depends on whether the eyes are
open or closed. During eye-open wakefulness, beta waves predominate. As individuals become
drowsy and close their eyes, alpha waves become the predominant pattern.
N1 (Stage 1) - Light Sleep (5%)
EEG recording: theta waves - low voltage
This is the lightest stage of sleep and begins when more than 50% of the alpha waves are
replaced with low-amplitude mixed-frequency (LAMF) activity. Muscle tone is present in the
skeletal muscle, and breathing tends to occur at a regular rate. This stage lasts around 1 to 5
minutes, consisting of 5% of total sleep time.
15. N2 (Stage 2) - Deeper Sleep (45%)
EEG recording: sleep spindles and K complexes
This stage represents deeper sleep as your heart rate and body temperate drop. It is
characterized by the presence of sleep spindles, K-complexes, or both. Sleep spindles are
brief, powerful bursts of neuronal firing in the superior temporal gyri, anterior cingulate,
insular cortices, and thalamus, inducing calcium influx into cortical pyramidal cells.
This mechanism is believed to be integral to synaptic plasticity. Numerous studies suggest
that sleep spindles play an important role in memory consolidation, specifically
procedural and declarative memory.
K-complexes are long delta waves that last for approximately one second and are known
to be the longest and most distinct of all brain waves. K-complexes have been shown to
function in maintaining sleep and memory consolidation.
Stage 2 sleep lasts around 25 minutes in the first cycle and lengthens with each successive
cycle, eventually consisting of about 45% of total sleep. This stage of sleep is when
bruxism (teeth grinding) occurs.
16. N3 (Stage 3) - Deepest Non-REM Sleep (25%)
EEG recording: delta waves - lowest frequency, highest amplitude
N3 is also known as slow-wave sleep (SWS). This is considered the deepest stage of sleep and
is characterized by signals with much lower frequencies and higher amplitudes, known as delta
waves.
This stage is the most difficult to awaken from, and, for some people, even loud noises (> 100
decibels) will not awaken them. As people age, they tend to spend less time in this slow, delta-
wave sleep and more time in stage N2 sleep. Although this stage has the greatest arousal
threshold, if someone is awoken during this stage, they will have a transient phase of mental
fogginess, known as sleep inertia.
Cognitive testing shows that individuals awakened during this stage tend to have moderately
impaired mental performance for 30 minutes to an hour. This is the stage when the body repairs
and regrows tissues, builds bone and muscle, and strengthens the immune system. This is also
the stage when sleepwalking, night terrors, and bedwetting occurs.
17. REM (25%)
EEG recording: beta waves - similar to brain waves during wakefulness
REM is associated with dreaming and is not considered a restful sleep
stage. While the EEG is similar to an awake individual, the skeletal
muscles are atonic and without movement, except for the eyes and
diaphragmatic breathing muscles, which remain active. However, the
breathing rate becomes more erratic and irregular.
This stage usually starts 90 minutes after you fall asleep, with each of
your REM cycles getting longer throughout the night. The first period
typically lasts 10 minutes, with the final one lasting up to an hour. REM
is when dreaming, nightmares, and penile/clitoral tumescence occur.
18. Important characteristics of REM:
• Associated with dreaming and irregular muscle movements as well as rapid
movements of the eyes
• A person is more difficult to arouse by sensory stimuli than during SWS
• People tend to awaken spontaneously in the morning during an episode of
REM sleep
• Loss of motor tone, increased brain O2 use, increased and variable pulse
and blood pressure
• Increased levels of ACh
• The brain is highly active throughout REM sleep, increasing brain
metabolism by up to 20%
19. Related Testing
The clinical evaluation of sleep is performed using a polysomnogram, a
procedure that utilizes an electroencephalogram (EEG), electrooculogram,
electromyogram, electrocardiogram, pulse oximetry, airflow, and respiratory
effort. These tests are performed overnight and usually require a minimum of 6
hours of monitoring.
Specifically, an EEG records brain wave patterns via small electrodes placed
on the scalp. A polysomnogram is the gold standard test for diagnosing sleep-
related breathing disorders such as obstructive sleep apnea, central sleep apnea,
and sleep-related hypoventilation/hypoxia.
A polysomnogram may also be used to evaluate nocturnal seizures, periodic
limb movement disorder, narcolepsy, and REM sleep behavior disorder
20. CRITERIAOFA CIRCADIAN RHYTHM
To be called circadian, a biological rhythm must
meet these four general criteria:
⚫ The rhythms repeat once a day (they have a 24- hour
period).
⚫ The rhythms persist in the absence of external cues
(endogenous).
⚫ The rhythms can be adjusted to match the local time
(entrainable).
⚫ The rhythms maintain circadian periodicity over a range
of physiological temperatures; they exhibit temperature
compensation.
22. CIRCADIAN RHYTHM DISORDERS
The common types of circadian rhythm sleep disorders
include:
Delayed Sleep Phase Disorder: If you have this sleep disorder,
you go to sleep and wake up more than two hours later than
what is typically considered a normal sleep-wake cycle. For
example, you're a “night owl” who may not be able to fall
asleep until 2 a.m. or later, but then sleep in until as late as 3
p.m.
Other common features of delayed sleep phase disorder are:
•You're often most alert, productive, and creative
late at night.
•If forced to get up early, you are sleepy during the
day.
•You're often perceived as lazy, unmotivated, or a
poor performer who is always late for morning
23. Delayed sleep phase syndrome
⚫ First identified by Weitzman et al. (1981) as a ‘‘chrono
biological disorder with
sleep-onset insomnia.’’
⚫ Sleep-wake circadian rhythm is delayed compared to
the time the individual attempts to sleep
⚫ Individuals report difficulty falling asleep at a desired
bedtime but have normal sleep if they attempt to sleep a
few hours later.
24. Intrinsic Circadian Rhythm
Disorders.
Intrinsic circadian rhythm disorders refer to
desynchronizes between attempts to sleep and
the sleep-wake circadian rhythm that are due
presumably to internal rather than external
causes. These disorders might result from a
weak circadian rhythm or from an inability to
entrain the rhythm to the environment.
25. Delayed sleep phase
syndrome
⚫Individuals with DSPS show late sleep
onset, few awakenings, early wake-up
times when work or social demands are
present, and late (mid afternoon) wake-up
times when there are no such demands
on their time.
⚫Delayed sleep phase individuals
commonly identify themselves as „„night
people‟‟ and report being most alert
during the late evening and night hours.
26. advanced sleep phase
syndrome
⚫Inability to stay awake until the desired
bedtime and inability to remain asleep until
the desired wake-up time.
⚫Typical sleep onset times are between 6
P.M. and 8 P.M., and no later than 9
P.M., and wake times are between 1 A.M.
and 3 A.M., and no later than 5 A.M.
27. Advanced sleep phase
syndrome
⚫ ASPS is much more common in older
individuals than in the young and the complaint of
waking up too early in the morning may be
confused with depression. The current approach to
treating ASPS is bright light exposure in the
evening and avoidance of light exposure (e.g.
wearing dark, wrap-around sunglasses) in the
morning. Bright light exposure in the evening and
the avoidance of bright light in the morning, it is
thought, help to re-entrain the sleep-wake cycle
into the circadian rhythm
28. Irregular Sleep-Wake Pattern
⚫ This rare disorder is characterized by a variable and
disorganized sleep-wake pattern that suggests the absence of
circadian rhythmicity.
⚫ Sleep is broken into several short sleep episodes, but the
cumulative sleep for a 24-hour period is at normal levels.
⚫ Polysomnographic studies show no abnormalities in sleep
parameters except for the short duration of each episode.
⚫ Common in elderly people with dementia.
⚫ Treatment consists of a gradual decrease in the number
and duration of daily naps. An increase in activity levels
and social interaction is recommended to facilitate the
29. Non-24-Hour Sleep-Wake Syndrome
⚫This is a disorder in which individuals
are unable to entrain to a 24-hour day
and instead maintain 25- to 27- hour
sleep-wake cycles. Some individuals
with this syndrome tend to
progressively phase delay. The
disorder is rare in the general
population and is assumed to have
higher prevalence among blind
people.
31. Non-24-Hour Sleep-Wake Syndrome
⚫ It is a chronic circadian rhythm sleep
disorder, classified within Chapter VI, Diseases of
the Nervous System, in the ICD 10.
⚫ It can be defined as "a chronic steady pattern
comprising one- to two-hour daily delays in sleep
onset and wake times in an individual living in
society".
⚫ The pattern of delay persists literally "around the
clock", typically taking a few weeks to complete
one cycle.
⚫ This disruption of the body clock causes cyclical
bouts of nighttime sleeplessness and excessive
daytime fatigue and napping.
32. Non-24-Hour Sleep-Wake Syndrome
⚫Treatment focuses on entraining the
circadian rhythm to a 24-hour day
through social interaction, exposure to
light, and melatonin.
⚫Melatonin has been successful in
treating this disorder in blind
individuals.
34. Shift Work Disorder
A disrupted sleep-wake schedule often
results in
disturbed and shortened sleep
sleepiness on the job
reduced performance levels
psychological distress due to disruptions
in family and social life.
36. Time-Zone Change Disorders
⚫ Dyssomnia associated with rapid time-zone
change sdue todesynchrony between the
endogenous sleep-wake rhythm and the
light/dark cycle.
⚫ Symptoms include an inability to sustain sleep
and excessive sleepiness.
⚫ For most people, these symptoms subside after a
few days, depending on the number of time
zones crossed.
37. Time-Zone Change Disorders
⚫Frequent travelers, such as transatlantic airline
crews, may experience more persistent difficulties.
⚫Westward travel is associated with disturbed sleep
at the end of the sleep period, which coincides
with habitual wakeup time, and eastward travel is
associated with sleep onset insomnia.
39. Risk Groups
⚫DSP is more common in teens and young
adults, occurring at a rate of 16 percent
⚫ASP is more common as people
age, occurring in about one percent of
middle aged and older adults.
⚫Irregular sleep-wake rhythm may occur in
nursing home residents and other people
who have little exposure to time cues such
as light, activity and social schedules.
40. Risk Groups
⚫Free-running (nonentrained) type occurs
in more than half of all people who are
totally blind.
⚫Jet lag can affect anyone who travels by
air, but symptoms may be more severe
and may last longer in older people and
when anyone travels in an eastward
direction.
⚫Shift work disorder is most common in
people who work night shifts and early
morning shifts
42. TREATMENT OF CIRCADIAN
RHYTHM DISORDERS
⚫Behavior therapy or advice about sleep
hygiene.
⚫Avoid naps, caffeine, and other stimulants.
⚫Bright light therapy
⚫Blue blocking glasses therapy
⚫Medications such
as melatonin and modafinil (Provigil)
⚫Tasimelteon has been proven effective in
Phase III trials.
⚫Sleep phase chronotherapy
43. TREATMENT OF CIRCADIAN
RHYTHM DISORDERS
⚫People who suffer from delayed sleep
phase syndrome are generally unable to
reset their circadian rhythm by moving
their bedtime and rising time earlier.
⚫In sleep phase chronotherapy, an
attempt is made to move bedtime and
rising time later and later each
day, around the clock, until the person is
sleeping on a normal schedule.
44. ⚫ Here's an example of how chronotherapy could
work over a week's course of treatment, with the
patient going to sleep 3 hours later every day until
the desired sleep and waketime is reached.
(Shifting the sleep phase by 3 hours per day may
not always be possible; shorter increments of 1–2
hours are needed in such cases.)
⚫ Day 1: sleep 04:00 to 12:00
⚫ Day 2: sleep 07:00 to 15:00
⚫ Day 3: sleep 10:00 to 18:00
⚫ Day 4: sleep 13:00 to 21:00
⚫ Day 5: sleep 16:00 to 00:00
⚫ Day 6: sleep 19:00 to 03:00
⚫ Day 7 to 13: sleep 22:00 to 06:00
⚫ Day 14 and thereafter: sleep 23:00 to 07:00