Now days due to various lifestyle people cannot able to sleep and having good sleep
There is difficulty in initiation, maintaining, & awakening during sleep.
I will try to help for understanding normal sleep, neurophysiology, sleep disorder & its Pharmacotherapy by this seminar session.
The outcome of this course is for the learner to describe the normal stages of sleep, common sleep measurement tools sleep characteristic, common sleep disorders, the changes that affect the quality and quantity of sleep as an individual ages, and methods the healthcare provider can use to assess and assist clients with sleep disorders.
It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
Sleep and rest, BSC NURSING FIRST YEAR NURSING FOUNDATION , UNIT X , MEETING NEEDS OF PATIENT , PHYSIOLOGY OF SLEEP, SLEEP DISORDERS, FACTORS AFFECTING SLEEP, PROMOTING SLEEP AND STAGES OF SLEEP.
The outcome of this course is for the learner to describe the normal stages of sleep, common sleep measurement tools sleep characteristic, common sleep disorders, the changes that affect the quality and quantity of sleep as an individual ages, and methods the healthcare provider can use to assess and assist clients with sleep disorders.
It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
Sleep and rest, BSC NURSING FIRST YEAR NURSING FOUNDATION , UNIT X , MEETING NEEDS OF PATIENT , PHYSIOLOGY OF SLEEP, SLEEP DISORDERS, FACTORS AFFECTING SLEEP, PROMOTING SLEEP AND STAGES OF SLEEP.
it explain about definition of sleep, normal sleep, sleep disturbance, causes of sleep disturbance, management therapy, nursing therapy and its effect om normal life.
Physiology of Sleep and its correlation with EEG wavesABHILASHA MISHRA
Content includes Physiology of sleep and and its correlation with EEG waves along with specific characteristics of different phases of sleep as well as an account of sleep disorders.
This is very simple and very useful for the students of medical and nursing students .it will help you in enhancing your knowledge.i will be happy if you like and share my ppt
this topic is about sleep, stages of sleep, types of sleep, factors influencing sleep, sleep disorders and their management and various interventions to promote sleep
Similar to Sleep Disorders & Management - By Dr. Jeenal Mistry (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Newer Drug Delivery System_31-01-2024_Dr. Jeenal Mistry.pdfDr Jeenal Mistry
Advances in molecular pharmacology and an improved understanding of the mechanism of most diseases have created the need to specifically target the cells involved in the initiation and progression of diseases. This is especially true for most life-threatening diseases requiring therapeutic agents which have numerous side effects, thus requiring accurate tissue targeting to minimize systemic exposure. Recent drug delivery systems (DDS) are formulated using advanced technology to accelerate systemic drug delivery to the specific target site, maximizing therapeutic efficacy and minimizing off-target accumulation in the body. As a result, they play an important role in disease management and treatment. Recent DDS offer greater advantages when compared to conventional drug delivery systems due to their enhanced performance, automation, precision, and efficacy. They are made of nanomaterials or miniaturized devices with multifunctional components that are biocompatible, biodegradable, and have high viscoelasticity with an extended circulating half-life. This review, therefore, provides a comprehensive insight into the history and technological advancement of drug delivery systems. It updates the most recent drug delivery systems, their therapeutic applications, challenges associated with their use, and future directions for improved performance and use.
Drug Drug Interactions_27-01-2024_Dr. Jeenal Mistry.pdfDr Jeenal Mistry
In pharmaceutical sciences, drug interactions occur when a drug's mechanism of action is affected by the concomitant administration of substances such as foods, beverages, or other drugs. A popular example of drug-food interaction is the effect of grapefruit in the metabolism of drugs.
Interactions may occur by simultaneous targeting of receptors, directly or indirectly. For example, both Zolpidem and alcohol affect GABAA receptors, and their simultaneous consumption results in the overstimulation of the receptor, which can lead to loss of consciousness. When two drugs affect each other, it receives the name of a drug-drug interaction. The risk of a drug-drug interaction (DDI) increases with the number of drugs used.
A large share of elderly people regularly use five or more medications or supplements, with a significant risk of side-effects from drug-drug interactions.
Drug interactions can be of three kinds:
additive (the result is what you expect when you add together the effect of each drug taken independently),
synergistic (combining the drugs leads to a larger effect than expected), or
antagonistic (combining the drugs leads to a smaller effect than expected).
It may be difficult to distinguish between synergistic or additive interactions, as individual effects of drugs may vary.
Direct interactions between drugs are also possible and may occur when two drugs are mixed before intravenous injection. For example, mixing thiopentone and suxamethonium can lead to the precipitation of thiopentone.
Rational Use of Medicine_Evidence Based Medicine_Therapeutic Drug Monitoring_...Dr Jeenal Mistry
Rational use of Medicine: Irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include: use of too many medicines per patient ("poly-pharmacy"); inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections; over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing regimes.
Evidence based medicine: Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.
Therapeutic drug monitoring: Therapeutic drug monitoring (TDM) is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication levels in blood. Its main focus is on drugs with a narrow therapeutic range, i.e. drugs that can easily be under- or overdosed.
Topical Dosage Form practical session mainly for undergraduate students, those are learning competency based medicine with PH 2.1: Demonstrate an understanding of use of various dosage forms(Oral/Local/Parenteral ;Solid/Liquid)
Specific Learning Objectives:
The student should be able to:
•Enlist the common dosage forms used for oral route of administration
•Instruct the patient about the correct method of using an oral dosage form
•Describe the advantages and disadvantages of various dosage forms
ORAL ROUTE OF DRUG ADMINISTRATION_Dr. Jeenal Mistry.pdfDr Jeenal Mistry
Oral Dosage Form practical session mainly for undergraduate students, those are learning competency based with PH 2.1: Demonstrate an understanding of use of various dosage forms(Oral/Local/Parenteral ;Solid/Liquid)
Specific Learning Objectives:
The student should be able to:
•Enlist the common dosage forms used for oral route of administration
•Instruct the patient about the correct method of using an oral dosage form
•Describe the advantages and disadvantages of various dosage forms
A Monoclonal Anti–Calcitonin Gene-Related
Peptide Antibody Decreases Stress-Induced
Colonic Hypersensitivity
This is my Journal club presentation for critical appraisal of the article...The Purpose is only learning, presentation skill, teaching...not judge the respective persons.
Dr Jeenal Mistry_Recent Advances in DM_8th Sept 2022.pptxDr Jeenal Mistry
The pharmacotherapy of DM has evolved tremendously in the last
100 years since the successful extraction of insulin in 1921. The efficacy of multiple drugs has been established for microvascular and
macrovascular outcomes. Despite manufacturing successful insulinanalogues, newer analogues such as icodec and newer automated
insulin delivery pumps are in the pipeline to further improve glycaemic
control. CVOTs were initiated to establish the safety of antidiabetics;
however, apart from establishing efficacy as well, some drugs have
grown to the extent of establishing efficacy and safety in nondiabetic
patients as well. Current research must be directed towards new therapeutic options for TIDM and evaluating efficacy of antidiabetics for
diseases concomitantly associated with DM, such as cerebrovascular
diseases, neuropathies, retinopathies and cancers. Diabetes with
COVID-19 provides a therapeutic dilemma for establishing adequate
glycaemic control as well as managing complications. Numerous
hypotheses exist for the management of COVID-19 with diabetics,
which need to be evaluated. Various new drug delivery systems and
drugs with novel mechanisms of action, are in the pipeline for the
management of TIDM and TIIDM, with some of them demonstrating
adequate promise in clinical trials or other diseases.
Dr Jeenal Mistry_ Journal Club 3_6th August 2022.pptxDr Jeenal Mistry
CVN424 is a novel small molecule and first-in-class candidate therapeutic to selectively modulate GPR6, an orphan G-protein coupled receptor. Expression of GPR6 is largely confined to the subset of striatal projection neurons that give rise to the indirect(striatopallidal) pathway, important in the control of movement.
CVN424 improves motor function in preclinical animal models
of Parkinson’s disease. Here, we report results of a phase 1,
first-in-human study investigating the safety, tolerability, and
pharmacokinetics of CVN424 in healthy volunteers. The study
(NCT03657030) was randomized, double-blind, and placebo controlled. CVN424 was orally administered in ascending doses to successive cohorts as inpatients in a clinical research unit. Single
doses ranged from 1 mg to 225 mg, and repeated (7 day) daily
doses were 25, 75, or 150 mg. CVN424 peak plasma concentrations were reached within 2 h post-dose in the fasted state and increased with increasing dose. Dosing after a standardized high fat meal reduced and delayed the peak plasma concentration, but total plasma exposure was similar. Mean terminal half-life
ranged from 30 to 41 h. CVN424 was generally well tolerated:
no serious or severe adverse effects were observed, and there
were no clinically significant changes in vital signs or laboratory parameters. We conclude that CVN424, a nondopaminergic compound that modulates a novel therapeutic target, was
safe and well tolerated. A phase 2 study in patients with Parkinson’s disease is underway.
This is the first-in-human clinical study of a first-in-class candidate therapeutic. CVN424 modulates a novel drug target,
GPR6, which is selectively expressed in a pathway in the brain
that has been implicated in the motor dysfunction of patients
with Parkinson’s disease. This study paves the way for investigating this novel mechanism of action in patients with Parkinson’s disease.
The goal of reverse pharmacology is to utilize disease pathology in order to identify specific and targetable elements that novel compounds can be modeled from.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. ▰ Introduction
▰ Stages of sleep
▰ Neurophysiology of sleep and wakefulness
▰ Classification of sleep disorder
▰ Common sleep disorder and management
▰ Conclusion
▰ References
OVERVIEW
4. ➢ Sleep is state of unconsciousness in which the brain is relatively
more responsive to internal than external stimuli.
➢ A good night’s sleep is when you fall asleep quite easily, do not fully
wake up during the night, do not wake up too early, and feel
refreshed in the morning.
➢ The origin of sleep and the meaning of dreams have fascinated people
for centuries-
Edgar allen poe described sleep as “ little slices of death”
William Shakespeare regarded it to be “chief nourisher in life’s
feast”
5. Infants 4 months to 12 months: 12 to 16 hours per 24 hours, including naps
1 to 2 years: 11 to 14 hours per 24 hours, including naps
3 to 5 years: 10 to 13 hours per 24 hours, including naps
6 to 12 years: 9 to 12 hours per 24 hours
13 to 18 years: 8 to 10 hours per 24 hours
Adults need at least 7 hour of sleep per night
Older: 6 to 7 hour of sleep per night
13. Flip-Flop Switch
LC,RN,
TMN
• Monoaminergic nuclei inhibit sleep-promoting neurons in the VLPO, which in turn relieves inhibition of the
monoaminergic cells and Orexin neurons
• The Monoaminergic cells: Raphe nuclei(RN), locus coeruleus(LC), & Tubero-mamillary nucleus(TMN)
directly stimulate wakefulness
Orexin
• Orexin neurons act to promote the activity of monoaminergic nuclei
VLPO
• VLPO neurons promotes sleep
• The VLPO neurons inhibit the monoaminergic neurons & in turn, relieve their own inhibition
• The disinhibition of the VLPO neurons inhibits Orexin neurons which in turn prevents activation of
monoaminergic nuclei
14. An overview of the flip-flop switch model
Orexin
Awake
ON
15. An overview of the flip-flop switch model
Orexin
Sleep
OFF
21. Insomnia is dissatisfaction with sleep, characterised by difficulty falling a
sleep (sleep latency >30 min), difficulty maintaining sleep (Total sleep
time <5.5 to 6 hr), or difficulty returning to sleep after awakenings during
the night.
Insomnia
Transient
3 days
Short-Term
3 days- 3 weeks
Chronic
3 weeks
30. Triazolam
• Potent BZD
• Good for sleep induction but poor for
maintaining
• Short duration of action
• Withdrawal phenomenon- patient may
wake up early morning & feel anxious
Alprazolam
• Potent & intermediate duration of
action
• Night time hypnotic due to rapid
oral absorption
• Withdrawal phenomenon
Temazepam
• Intermediate duration of BZD
• Good for sleep onset difficulty
• Free of residual effect
31. ▰ Act on α1 subunit
▰ Addiction property
▰ Antidote: Flumazenil (Blocks α/γ {α1-α2}
subunit)
Atypical Benzodiazepines/ Z Compounds
34. ▰ Selective antagonist of the orexin receptor OX1R & OX2R
▰ Selectively increase REM sleep in the first 4 hour after dosing, increase
NREM N2 stage, decrease latency to sleep onset
▰ Strong effect on increasing total sleep time
▰ t1/2= 12 hours
▰ S/E: somnolence, headache, cough, dry mouth
Orexin receptor antagonist
Suvorexant (Belsomra)
35. ▰ Tricyclic anti-depressant with anti histaminic effects
▰ Doxepin inhibits the reuptake of serotonin and norepinephrine and
antagonizes cholinergic, histaminergic, and α-adrenergic activity
▰ Increase REM sleep, increase NREM N2 stage, decrease latency to
sleep onset
▰ S/E: sedation, fatigue, constipation, lethargy
Doxepin
37. ➢ Narcolepsy is characterised by difficulty in sustaining wakefulness,
poor regulation of REM sleep, and disturbed nocturnal sleep.
➢ Narcolepsy is caused by loss of the hypothalamic neurons that produce
the orexin neuropeptides.
Cataplexy
• Sudden bilateral loss
of muscle tone with
preserved
consciousness and
often precipitated by
strong emotion and
as laughter
Sleep paralysis
• The person
temporarily loses the
ability to talk or
move when he or she
wakes up or first
become drowsy
Hypnagogic
hallucination
• vivid dream like
experience that take
place when person is
sleeping, falling
asleep, or awakening
Automatic
behaviour
• A person continues to
function, such as
talking & putting
objects in different
places during sleep
but he or she does
not recall doing such
activity after
awakening.
43. Sodium oxybate (Xyrem)
• CNS Depressant
• Taken immediately before sleep & again 2 to 4 hr later
• Increase in slow wave sleep, decrease number of nocturnal
awakening, enhanced sleep continuity
• GABA-B activation
• FDA approved in 2002 for treatment of excessive daytime
sleepiness & cataplexy in narcoleptic patients.
• S/E: headache, pharyngitis, enuresis, vomiting
45. ➢ Excessive sleepiness despite a normal sleep duration at night.
➢ Repeated episode of sleep during daytime hours, prolonged night
time sleep, typically 9 hours or longer, and/or difficulty
transitioning from sleep to wakefulness
➢ Must be present at least 3 days per week for at least 3 months.
Types of hypersomnia
49. Characterised by sleep disruption leading to excessive sleepiness
or insomnia caused by sleep related breathing disturbances such
as apnea , hypopnea, & oxygen desaturation.
➢ Types :
1. Obstructive Sleep Apnea Hypopnea (OSAH)-obstruction of airway
2. Central Sleep Apnea (CSA)- absence of respiratory effort
3. Sleep Related Hypoventilation (SRH)
❖ All are associated with impaired ventilation during sleep
❖ With intermittent or sustained hypoxemia
❖ Sleep disruption
❖ Result in awakening--daytime sleepiness--fatigue
50. Obstructive sleep apnea hypopnea
Diagnosis
• Polysomnography at
least an AHI: 15,
absence of symptoms
• AHI>15 with
predominantly
obstructive respiratory
events
Symptoms
51. Pharmacological
Treatment
Management of OSAH
Non-Pharmacological
Treatment
Devices such as positive airway pressure(PAP),
continuous positive airway pressure(CPAP), Bilevel
positive airway pressure(BiPAP), Nasal continuous
positive airway pressure(nCPAP).
Oral appliances such as Mandibular
advanced splints(MAS).
Surgeries such as Tracheostomy,
Uvulopalatopharyngeoplasty, Maxillo-
mandibular advancement, Tonsillectomy,
Adenoidectomy, Bariatric Surgery
Life style modification
Weight loss,
Positional Therapy,
Educational &
Behaviour Therapy
52. ▰ Characterised by variability in respiratory effort that
lead to episodes of apnea & hypopnea during sleep
Central Sleep Apnea(CSA)
1) Cheyne-strokes breathing –Heart
failure, stroke, renal failure
2) Central sleep apnea comorbid
with opioid use- such as
methadone
3) Idiopathic central sleep apnea
Subtype
• CPAP
• Adaptive servo-ventilation(ASV)
• Low flow oxygen Therapy
• CSA comorbid with opioid use
may improve with reduction in
opioid dosage
Treatment
53. ▰ Characterised by inadequate ventilation during sleep
Sleep related Hypoventilation(SRH)
Symptoms
• Fatigue
• Sleepiness
• Awakening during
sleep
• Morning headache
• Insomnia
Diagnosis
• PSG- Abnormal
elevation of Co2 level
• Obesity
hypoventilation
syndrome (BMI >30
kg/m2 Pco2>45 mmhg
Treatment
• Bi-level positive
airway pressure
55. ➢ Persistent or recurrent pattern of sleep-wake disturbance characterised
by abnormal timing of sleep or sleep propensity relative to the physical
environment
➢ Disorder of sleep timing can be either organic (i.e., due to an
abnormality of circadian pacemaker or environmental/behaviour (i.e.,
due to a disruption of environmental synchronizer).
Delayed sleep-wake
phase disorder
• Reported sleep onset and
wake times persistently
later than desired
• Actual sleep times at nearly
the same clock hours daily
• If conducted at the habitual
delayed sleep time,
essentially normal sleep on
polysomnography
Advanced Sleep-
wake phase disorder
• Individual exhibit a stable
sleep-wake cycle that is
advanced in relation to
conventional times.
• History of falling a sleep
between 6 pm to 9 pm, and
waking up between 2 to 5
pm
56. Non-24-hour sleep-wake
rhythm disorder
• N24SWRD most commonly occurs
when the primary synchronizing
input(i.e., the light-dark cycle) from the
environment to the circadian
pacemaker is lost (as occur in many
blind people with no light perception),
and the maximal phase advancing
capacity of the circadian pacemaker in
response to non-photic cues can’t
accommodate difference between the
24-h geophysical day & intrinsic period
of the patient’s circadian pacemaker,
resulting in loss of entrainment to the
24-h day.
Shift Work Disorder
•Characterised by sleep &
wake disturbances for at
least 3 months in the
context of chronic shift
work
•Excessive daytime
sleepiness
•Difficulty falling asleep
while allowed for rest
JET LAG Disorder
•With the advent of highspeed
air level, an induced
desynchrony between circadian
and environmental clocks
become possible.
•When individual rapidly travels
across many time zones, either
circadian phase advance or a
phase delay is induced,
depending on the direction of
travel.
57. Diagnosis & Treatment
• Sleep logs and/or
actigraphy measurements
for 7-14 days
• Dim-light melatonin test
• Core body temperature
• Both light & melatonin,
given at specific time can act
to reset the circadian clock
• Behavioural intervention
• Modafinil or armodafinil 30-
60 min before the start of an
8-h overnight shift for use in
shift workers with excessive
day time sleepiness
59. These disorder is recurrent episode of partial arousals from sleep,
usually during the first third of night.
Patients affected by this disorder carry out automatic motor activities that range from simple to complex
Individuals may walk, urinate inappropriately, eat, exit the house or drive a car with minimal awareness.
Sleepwalking arise from NREM stage N3 sleep
EEG: slow cortical activity of deep NREM sleep
Treatment: Relaxation technique, Antidepressant (Benzodiazepine), Tricyclic Anti-depressant (Imipramine)
Commonly in young child
During first few hours of sleep in NREM stage N3
Child often sits up during sleep & screams, exhibiting autonomic arousal with sweating, tachycardia, large pupils, hyperventilation
Treatment: Reassuring the parents that the condition is self limited
Sleep walking(Somnambulism)
Sleep Terror
60. Bed wetting occurs during the sleep in young
Treatment: Bladder training exercise, behavioural therapy
Pharmacotherapy: Desmopressin, oxybutynin chloride or imipramine
It is an involuntary, forceful grinding of teeth during sleep
At age onset of 17-20 years and remission at age of 40 years
Treatment: Mouth guard, Stress management, Benzodiazepines
Sleep enuresis
Sleep bruxism
61. Desmopressin :
• Selective V2 agonist
• Longer acting
• Decreasing urine volume at night &
decreasing intravesicular pressure
• t1/2= 1-2 hr
Oxybutynin Chloride
• Vasico-selective anticholinergics
• High affinity for receptor in
urinary bladder & salivary glands
• Selective M3 & M1 subtype
• Used fir detrusor instability
resulting in urinary frequency &
urge incontinence
63. • Bad dreams & nightmare are normal
• What differentiates Nightmare disorder from bad dreams & nightmare is
the frequency of events, degree of dysphoria, and the extent of
distress or impairment in social, occupational, or other important
areas of functioning.
• Common in physical/sexual abuse and Post Traumatic Stress Disorder
(PTSD)
• Treatment: Prazosin
Cyproheptadine, Guanfacine also helpful
Dream rehearsal therapy
66. • Defined by repeated episode of awakening from sleep
accompanied by agitated or violent behaviours, such as shouting,
screaming, kicking, and punching.
• Commonly occurs second half of sleep period
• Patient may have injuries including- ecchymosis, laceration, fractures
• Many patient adopted self protection measures such as- tethering
themselves to bed, using sleeping bags, pillow barricades
• It is frequent harbinger of neurodegenerative disorder (Parkinson’s)
• Treatment: Clonazepam, Melatonin
68. • RLS patients report an irresistible urge to move the legs
• A creepy-crawly or unpleasant deep ache within the thighs or calves
• Much worse in evening & first half of night
• Aggravated by inactivity, sitting prolonged time caffeine, alcohol
• Relieved by movement, stretching, massage
• Causes: Iron deficiency anaemia, Vit B12 deficiency
Treatment: treat underlying cause
Pharmacotherapy:
A) Agonist of dopamine D2/3 receptors : 1) Pramipexole or
2) Ropinirole
B) Alpha-2-delta calcium channel : 1) Gabapentin
2) Pregabalin
C) Benzodiazepines
D) Opioid
69. Pramipexole or
Ropinirole
Selective Agonist of dopamine D2/3
receptors
• t1/2= 8.5 hr
• S/E: Somnolence, insomnia, dizziness
Gabapentin
• Anti-convulsant
• Binds to α2δ subunit of voltage sensitive
calcium channel
• Increase slow wave sleep without affecting
other polygraphic variables & without
causing increased drowsiness during day
time
• t1/2= 5-7 hr
• S/E: Ataxia, fatigue, somnolence
Pregabalin
• Anti-convulsant
• Binds to α2δ subunit of voltage sensitive
calcium channel
• Increase duration of NREM & REM sleep
episode & reducing their number
• S/E: Dizziness, somnolence
71. • PLMD also called as nocturnal myoclonus, characterised by
periodic episode of spontaneous, repetitive, highly stereotyped
involuntary limb movement that occur during sleep.
• The movement resemble a triple flexion reflex with extensions of the
great toe & dorsiflexion of the foot for 0.5-5.0 sec
• Which recur every 20-40 s during NREM sleep
• Diagnosis: Polysomnogram- recording of anterior tibialis & other
muscle, EEG
• Treatment: Benzodiazepine, Levodopa (Dopamine precursor-
important neurotransmitter regulating muscle movement)
73. • This is a prominent sleep disturbance associated with
use, intoxication, or withdrawal from medication or
substance.
• Associated with depression, anxiety
• Medications and Substances associated with Insomnia
Alcohol, Caffeine
Nicotine, Cannabis
Anti depressant, Corticosteroids
β blocker
ACE inhibitor
74. ▰ This seminar will help to Learn-
▰ The term Sleep & Sleep disorder
▰ Sleep stages, their electrophysiologic correlates
▰ Basic neurophysiologic mechanism that promote brain arousal and
wakefulness, sleep onset & maintenance
▰ Basic circadian process and their interaction with sleep-wake cycle & drug
useful on it
▰ Recognize several sleep disorder & their Pharmacotherapy
▰ The rationale of certain classes of drug to treat specific sleep-related disorder
Conclusion
75. ▰ Goodman & Gillman The Pharmacological Basis therapeutics 13th
edition
▰ Harrison’s Principles of Internal Medicine 20th edition Volume1
▰ Essential of Medical Pharmacology 8th edition KD Tripathi
▰ Sleep and Sleep Pharmacology Ahmed S. BaHammam, David N.
Neubauer, Seithikurippu R. Pandi-Perumal article
▰ https://doi.org/10.1124/pr.117.014381 PHARMACOLOGICAL
REVIEWS Pharmacol Rev 70:197–245, April 2018
References