This document provides a summary of Dr. A V Srinivasan's presentation on the management of insomnia in the modern era. It begins with background on the Greek and Roman personifications of sleep. It then discusses normal sleep architecture and stages, factors that can affect sleep, and common sleep disorders like insomnia, hypersomnias, circadian rhythm disorders and parasomnias. It also summarizes the effects of neurological/psychiatric conditions and medications on sleep architecture and how diagnosis of sleep disorders is conducted. The overall document provides a comprehensive overview of sleep and sleep disorders.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, the stages of sleep, measuring brain waves and sleep stages, sleep disorders, dreams and dream interpretation, hypnosis, and the effects of various psychoactive drugs. It also examines trends in drug use, perceived risks of drugs like marijuana, and experiences reported after near-death situations.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, the stages of sleep, measuring brain waves and sleep stages, sleep disorders, dreams and their interpretation, hypnosis, and the effects of various psychoactive drugs. Near-death experiences are also examined.
This document discusses various topics related to consciousness, including biological rhythms and sleep, dreams, hypnosis, meditation, and drugs. It explores the sleep-wake cycle, stages of sleep, changes in brain activity during sleep, and differences in dreams between sleep stages. Factors like age, time of day, and traveling east vs west are examined. The effects of meditation on respiration and hypnosis on memory are also summarized.
The document discusses various topics related to sleep and dreams, including:
- Circadian rhythms regulate the sleep-wake cycle on a 24-hour basis through factors like body temperature and hormone levels.
- Stages of sleep include light, deep, and REM sleep, each with different brain wave patterns. Sleep cycles through these stages throughout the night.
- Theories for the functions of sleep include repair and restoration, neural resetting, memory consolidation, and energy conservation.
- Dream theories include activation-synthesis (dreams result from random brain activity interpreted by the cortex) and wish fulfillment (dreams represent unconscious desires).
S. Sherrill - General Psychology - Chapter 3 power pointsjbrabham
The document discusses sensation and perception. It defines sensation as uninterpreted messages from the senses and perception as an individual's unique interpretation based on experiences. It then provides details on the anatomy and physiology of vision, including the cornea, iris, lens, retina, optic nerve and photoreceptors. It also discusses types of color blindness and theories of color vision. Additional senses of smell, taste, touch, balance and depth perception are explained.
This document discusses the anatomy and physiology of neurons, glia, and muscles. It describes the different types of glia that support neurons in the central and peripheral nervous systems. It also outlines the different types of neurons and their functions. The document then discusses nerve impulses, membrane potentials, and how electrical signals are transmitted through neurons. It provides an overview of the organization of the central and peripheral nervous systems. Finally, it defines and compares voluntary and involuntary muscles, and includes data on response times.
This document discusses the anatomy and physiology of neurons, glia, and muscles. It describes the different types of glia that support neurons in the central and peripheral nervous systems. It also outlines the different types of neurons and their functions. The document then discusses nerve impulses, membrane potentials, and how the nervous system is organized into the central and peripheral divisions. Finally, it examines the differences between voluntary and involuntary muscles.
1. The document summarizes key aspects of the physiological basis of behavior, including the three mechanisms of behavior: receiving (sense organs), connecting (neurons), and integrating mechanisms (nervous system).
2. It describes the basic parts of a neuron and different types of neurons.
3. It outlines the two main divisions of the human nervous system: the autonomic nervous system and the central nervous system. The central nervous system includes the cerebrum, midbrain, and diencephalon.
4. Twelve pairs of cranial nerves are listed along with their functions. Spinal nerves are also briefly mentioned.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, the stages of sleep, measuring brain waves and sleep stages, sleep disorders, dreams and dream interpretation, hypnosis, and the effects of various psychoactive drugs. It also examines trends in drug use, perceived risks of drugs like marijuana, and experiences reported after near-death situations.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, the stages of sleep, measuring brain waves and sleep stages, sleep disorders, dreams and their interpretation, hypnosis, and the effects of various psychoactive drugs. Near-death experiences are also examined.
This document discusses various topics related to consciousness, including biological rhythms and sleep, dreams, hypnosis, meditation, and drugs. It explores the sleep-wake cycle, stages of sleep, changes in brain activity during sleep, and differences in dreams between sleep stages. Factors like age, time of day, and traveling east vs west are examined. The effects of meditation on respiration and hypnosis on memory are also summarized.
The document discusses various topics related to sleep and dreams, including:
- Circadian rhythms regulate the sleep-wake cycle on a 24-hour basis through factors like body temperature and hormone levels.
- Stages of sleep include light, deep, and REM sleep, each with different brain wave patterns. Sleep cycles through these stages throughout the night.
- Theories for the functions of sleep include repair and restoration, neural resetting, memory consolidation, and energy conservation.
- Dream theories include activation-synthesis (dreams result from random brain activity interpreted by the cortex) and wish fulfillment (dreams represent unconscious desires).
S. Sherrill - General Psychology - Chapter 3 power pointsjbrabham
The document discusses sensation and perception. It defines sensation as uninterpreted messages from the senses and perception as an individual's unique interpretation based on experiences. It then provides details on the anatomy and physiology of vision, including the cornea, iris, lens, retina, optic nerve and photoreceptors. It also discusses types of color blindness and theories of color vision. Additional senses of smell, taste, touch, balance and depth perception are explained.
This document discusses the anatomy and physiology of neurons, glia, and muscles. It describes the different types of glia that support neurons in the central and peripheral nervous systems. It also outlines the different types of neurons and their functions. The document then discusses nerve impulses, membrane potentials, and how electrical signals are transmitted through neurons. It provides an overview of the organization of the central and peripheral nervous systems. Finally, it defines and compares voluntary and involuntary muscles, and includes data on response times.
This document discusses the anatomy and physiology of neurons, glia, and muscles. It describes the different types of glia that support neurons in the central and peripheral nervous systems. It also outlines the different types of neurons and their functions. The document then discusses nerve impulses, membrane potentials, and how the nervous system is organized into the central and peripheral divisions. Finally, it examines the differences between voluntary and involuntary muscles.
1. The document summarizes key aspects of the physiological basis of behavior, including the three mechanisms of behavior: receiving (sense organs), connecting (neurons), and integrating mechanisms (nervous system).
2. It describes the basic parts of a neuron and different types of neurons.
3. It outlines the two main divisions of the human nervous system: the autonomic nervous system and the central nervous system. The central nervous system includes the cerebrum, midbrain, and diencephalon.
4. Twelve pairs of cranial nerves are listed along with their functions. Spinal nerves are also briefly mentioned.
The document discusses sleep and wakefulness from a neurological perspective. It describes how sleep is a brain process characterized by different stages, including non-REM sleep (NREM) and REM sleep. NREM and REM sleep can be measured using electroencephalography (EEG) brain wave patterns. Factors such as age, circadian rhythms, homeostasis, and the autonomic nervous system regulate sleep-wake cycles.
This document summarizes a report by the Royal College of Obstetricians and Gynaecologists on fetal awareness. The report was prompted by a review of the RCOG's 1997 report on fetal awareness by the UK House of Commons Science and Technology Committee. The new report completely rewrites the 1997 report to incorporate recent scientific literature and evidence presented to Parliament. It reviews neuroanatomical and physiological evidence in fetuses to determine at what points in development fetuses may experience pain and sensory perceptions.
This document provides an agenda and notes for a lecture on neural and hormonal systems. The agenda includes discussing neurons, action potentials, and synaptic communication. The notes cover topics like the basic parts and functions of neurons, how neurons communicate via neurotransmitters and action potentials, examples of neurotransmitters and how drugs can affect them, divisions of the nervous system, and an introduction to the endocrine system and hormones. Interactive activities are included, such as having students put events of neural communication in chronological order and demonstrations of reflexes.
This document provides information on sensory receptors and the structures involved in the special senses of smell, taste, hearing, and balance. It discusses the main types of sensory receptors, including mechanoreceptors, photoreceptors, chemoreceptors, thermoreceptors, and nociceptors. It then describes the structures of sensory organs like muscle spindles, Meissner corpuscles, Pacinian corpuscles, Merkel disks, and Golgi tendon organs. The following sections focus on the special senses, outlining the neural pathways and mechanisms of smell, taste, hearing, and the roles of the inner ear in balance.
The document discusses the relationship between the mind and brain. It states that the mind is an emergent abstraction that arises from neuronal circuit activity in the cortex, utilizing sensory inputs, memory, and various cortical regions. It also notes that the mind manages sensory inputs and memories, associates them with emotions, forms frameworks of understanding through cognition, and makes decisions to initiate behaviors and speech.
Sleep promotes the consolidation of newly formed memories. During slow-wave sleep, slow oscillations coordinate the reactivation and redistribution of hippocampus-dependent memories to neocortical sites, supporting system consolidation. Rapid eye movement sleep supports synaptic consolidation through local increases in plasticity-related gene activity and theta oscillations in the cortex. Behavioral studies show sleep enhances retention of declarative and procedural memories, especially for explicitly encoded information. Sleep leads to quantitative strengthening and qualitative changes in memory representations.
Psychosis involves a failure of the dreaming function to cope with burdens that overtax it, triggering a psychotic break. In psychosis, the dream generator is perpetually switched on even during waking hours yet unable to complete its psychic house-cleaning. The experience of psychosis feels like dreaming while awake. Something has gone awry with the sleep-wake cycle at its root, and for those with a genetically susceptible dream generator, the dream generator takes over waking consciousness without medication. Sleep deprivation is often an early sign of psychosis and suppresses important brain processes, denying the brain relief and worsening the condition.
The document discusses the neurophysiological basis for the effects of equine assisted therapy based on brain research studies. It covers topics such as perception, sensory processing, body schemas, neuronal selection theory, central pattern generators, multisensory processing, postural balance, and mirror neurons. The document provides background on these topics and their relevance to understanding how equine assisted therapy can impact patients.
Self Organisation: Inspiring Neural Network & IT DesignOlivia Moran
In an attempt to build more sophisticated neural networks and other Information Technology (I.T.) products, the industry constantly turns to the world of Biology for inspiration. The most advanced
computers in the World today, are of course humans.
This paper looks at Self Organisation in the Human Nervous System and aims to highlight the means by which the understanding gained, from the study of this issue, can influence and inspire the design of Neural Networks and I.T. products and services.
The document discusses various aspects of consciousness, sleep, and dreams. It begins by defining consciousness and describing different levels of consciousness such as waking, subconscious, and unconscious states. It then discusses sleep stages and brain wave patterns associated with each stage. REM sleep is specifically called out as the stage where most vivid dreams occur. The document also covers sleep disorders, the effects of sleep deprivation, and theories about the purpose and meaning of dreams.
This document discusses the physiology of sleep and EEG waves. It begins by defining sleep and coma, then outlines the objectives and functions of sleep. The mechanisms of sleep are explored, including theories about what causes sleep onset. The four main EEG wave types - alpha, beta, theta, and delta - are defined. The two types of sleep, NREM and REM, are described along with the sleep cycle and stages. Common sleep disorders and basic sleep hygiene recommendations are also summarized.
This document provides an overview of states of consciousness and related topics. It discusses waking consciousness and explores daydreaming and altered states of consciousness. It also covers the necessity of sleep, explaining circadian rhythms and the stages and cycles of sleep. The document analyzes brain wave patterns during sleep and various sleep disorders. It examines dreams and theories about dreaming. Finally, it looks at hypnosis and different theories of hypnosis, as well as psychoactive drugs and categories of drugs like stimulants, depressants, hallucinogens, and opiates.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, sleep stages, sleep disorders, dreaming, hypnosis, and effects of psychoactive drugs. Near-death experiences are also examined in relation to dualism versus monism perspectives.
This document discusses the history and science of human sleep patterns. It notes that historically, humans slept in two distinct periods throughout the night rather than one continuous period, waking up briefly in between. A study found that depriving volunteers of artificial light led them to revert to this bi-modal sleep pattern. The circadian rhythm and biological clocks that regulate sleep are also discussed, along with the neurobiology of sleep and wakefulness. Key brain regions and neurotransmitters involved in promoting sleep and wakefulness are identified.
Sleep is important for memory consolidation and emotional regulation. Lack of sleep can impair memory formation and exaggerate emotional reactions by overactivating the amygdala. The brain's master clock is located in the hypothalamus and regulates circadian rhythms, with light being the main synchronizing cue. Disruptions to circadian rhythms and sleep disturbances are associated with mood disorders like depression. Chronotherapy approaches like light therapy and sleep scheduling can help treat mood disorders by realigning circadian rhythms.
The document discusses biological rhythms and sleep stages, explaining that circadian rhythms operate on a 24-hour cycle and influence sleep and wakefulness, and describing the five distinct sleep stages that occur in a repeating cycle approximately every 90 minutes. It also reviews theories about why we sleep and dream, such as for physiological functions like neural development and information processing, and examines some common sleep disorders like insomnia, narcolepsy, and sleep apnea.
This document summarizes key information about sleep and sleep disorders. It discusses how sleep is measured using EEG, EOG and EMG recordings. It describes the different types of brain waves seen on EEGs during sleep stages. The stages of sleep including non-REM sleep stages I-IV and REM sleep are outlined. Factors influencing sleep such as biological rhythms and neuroendocrine regulation are also summarized.
The document discusses the neurology of sleep. It describes the two main types of sleep - NREM and REM sleep. NREM sleep involves synchronous cortical EEG, low muscle tone, and minimal dreaming. REM sleep is characterized by rapid eye movements, muscle atonia, and vivid dreaming. The document also discusses circadian rhythms and how the suprachiasmatic nucleus regulates sleep-wake cycles. Disruptions to circadian rhythms can lead to sleep disorders like jet lag.
The document discusses sleep disorders and the measurement and stages of sleep. It provides details on:
1) How sleep is measured using EEG, EOG, and EMG electrodes to record brain waves, eye movements, and muscle activity.
2) The stages of sleep including NREM stages 1-4 and REM sleep, characterized by different brain wave patterns.
3) Common sleep disorders like insomnia, hypersomnia, sleep apnea, circadian rhythm disorders and parasomnias. Treatment options are also outlined.
The document discusses sleep and wakefulness from a neurological perspective. It describes how sleep is a brain process characterized by different stages, including non-REM sleep (NREM) and REM sleep. NREM and REM sleep can be measured using electroencephalography (EEG) brain wave patterns. Factors such as age, circadian rhythms, homeostasis, and the autonomic nervous system regulate sleep-wake cycles.
This document summarizes a report by the Royal College of Obstetricians and Gynaecologists on fetal awareness. The report was prompted by a review of the RCOG's 1997 report on fetal awareness by the UK House of Commons Science and Technology Committee. The new report completely rewrites the 1997 report to incorporate recent scientific literature and evidence presented to Parliament. It reviews neuroanatomical and physiological evidence in fetuses to determine at what points in development fetuses may experience pain and sensory perceptions.
This document provides an agenda and notes for a lecture on neural and hormonal systems. The agenda includes discussing neurons, action potentials, and synaptic communication. The notes cover topics like the basic parts and functions of neurons, how neurons communicate via neurotransmitters and action potentials, examples of neurotransmitters and how drugs can affect them, divisions of the nervous system, and an introduction to the endocrine system and hormones. Interactive activities are included, such as having students put events of neural communication in chronological order and demonstrations of reflexes.
This document provides information on sensory receptors and the structures involved in the special senses of smell, taste, hearing, and balance. It discusses the main types of sensory receptors, including mechanoreceptors, photoreceptors, chemoreceptors, thermoreceptors, and nociceptors. It then describes the structures of sensory organs like muscle spindles, Meissner corpuscles, Pacinian corpuscles, Merkel disks, and Golgi tendon organs. The following sections focus on the special senses, outlining the neural pathways and mechanisms of smell, taste, hearing, and the roles of the inner ear in balance.
The document discusses the relationship between the mind and brain. It states that the mind is an emergent abstraction that arises from neuronal circuit activity in the cortex, utilizing sensory inputs, memory, and various cortical regions. It also notes that the mind manages sensory inputs and memories, associates them with emotions, forms frameworks of understanding through cognition, and makes decisions to initiate behaviors and speech.
Sleep promotes the consolidation of newly formed memories. During slow-wave sleep, slow oscillations coordinate the reactivation and redistribution of hippocampus-dependent memories to neocortical sites, supporting system consolidation. Rapid eye movement sleep supports synaptic consolidation through local increases in plasticity-related gene activity and theta oscillations in the cortex. Behavioral studies show sleep enhances retention of declarative and procedural memories, especially for explicitly encoded information. Sleep leads to quantitative strengthening and qualitative changes in memory representations.
Psychosis involves a failure of the dreaming function to cope with burdens that overtax it, triggering a psychotic break. In psychosis, the dream generator is perpetually switched on even during waking hours yet unable to complete its psychic house-cleaning. The experience of psychosis feels like dreaming while awake. Something has gone awry with the sleep-wake cycle at its root, and for those with a genetically susceptible dream generator, the dream generator takes over waking consciousness without medication. Sleep deprivation is often an early sign of psychosis and suppresses important brain processes, denying the brain relief and worsening the condition.
The document discusses the neurophysiological basis for the effects of equine assisted therapy based on brain research studies. It covers topics such as perception, sensory processing, body schemas, neuronal selection theory, central pattern generators, multisensory processing, postural balance, and mirror neurons. The document provides background on these topics and their relevance to understanding how equine assisted therapy can impact patients.
Self Organisation: Inspiring Neural Network & IT DesignOlivia Moran
In an attempt to build more sophisticated neural networks and other Information Technology (I.T.) products, the industry constantly turns to the world of Biology for inspiration. The most advanced
computers in the World today, are of course humans.
This paper looks at Self Organisation in the Human Nervous System and aims to highlight the means by which the understanding gained, from the study of this issue, can influence and inspire the design of Neural Networks and I.T. products and services.
The document discusses various aspects of consciousness, sleep, and dreams. It begins by defining consciousness and describing different levels of consciousness such as waking, subconscious, and unconscious states. It then discusses sleep stages and brain wave patterns associated with each stage. REM sleep is specifically called out as the stage where most vivid dreams occur. The document also covers sleep disorders, the effects of sleep deprivation, and theories about the purpose and meaning of dreams.
This document discusses the physiology of sleep and EEG waves. It begins by defining sleep and coma, then outlines the objectives and functions of sleep. The mechanisms of sleep are explored, including theories about what causes sleep onset. The four main EEG wave types - alpha, beta, theta, and delta - are defined. The two types of sleep, NREM and REM, are described along with the sleep cycle and stages. Common sleep disorders and basic sleep hygiene recommendations are also summarized.
This document provides an overview of states of consciousness and related topics. It discusses waking consciousness and explores daydreaming and altered states of consciousness. It also covers the necessity of sleep, explaining circadian rhythms and the stages and cycles of sleep. The document analyzes brain wave patterns during sleep and various sleep disorders. It examines dreams and theories about dreaming. Finally, it looks at hypnosis and different theories of hypnosis, as well as psychoactive drugs and categories of drugs like stimulants, depressants, hallucinogens, and opiates.
This chapter discusses various states of consciousness including waking consciousness, sleep and dreams, premenstrual syndrome, and drug-induced states. It covers topics like circadian rhythms, sleep stages, sleep disorders, dreaming, hypnosis, and effects of psychoactive drugs. Near-death experiences are also examined in relation to dualism versus monism perspectives.
This document discusses the history and science of human sleep patterns. It notes that historically, humans slept in two distinct periods throughout the night rather than one continuous period, waking up briefly in between. A study found that depriving volunteers of artificial light led them to revert to this bi-modal sleep pattern. The circadian rhythm and biological clocks that regulate sleep are also discussed, along with the neurobiology of sleep and wakefulness. Key brain regions and neurotransmitters involved in promoting sleep and wakefulness are identified.
Sleep is important for memory consolidation and emotional regulation. Lack of sleep can impair memory formation and exaggerate emotional reactions by overactivating the amygdala. The brain's master clock is located in the hypothalamus and regulates circadian rhythms, with light being the main synchronizing cue. Disruptions to circadian rhythms and sleep disturbances are associated with mood disorders like depression. Chronotherapy approaches like light therapy and sleep scheduling can help treat mood disorders by realigning circadian rhythms.
The document discusses biological rhythms and sleep stages, explaining that circadian rhythms operate on a 24-hour cycle and influence sleep and wakefulness, and describing the five distinct sleep stages that occur in a repeating cycle approximately every 90 minutes. It also reviews theories about why we sleep and dream, such as for physiological functions like neural development and information processing, and examines some common sleep disorders like insomnia, narcolepsy, and sleep apnea.
This document summarizes key information about sleep and sleep disorders. It discusses how sleep is measured using EEG, EOG and EMG recordings. It describes the different types of brain waves seen on EEGs during sleep stages. The stages of sleep including non-REM sleep stages I-IV and REM sleep are outlined. Factors influencing sleep such as biological rhythms and neuroendocrine regulation are also summarized.
The document discusses the neurology of sleep. It describes the two main types of sleep - NREM and REM sleep. NREM sleep involves synchronous cortical EEG, low muscle tone, and minimal dreaming. REM sleep is characterized by rapid eye movements, muscle atonia, and vivid dreaming. The document also discusses circadian rhythms and how the suprachiasmatic nucleus regulates sleep-wake cycles. Disruptions to circadian rhythms can lead to sleep disorders like jet lag.
The document discusses sleep disorders and the measurement and stages of sleep. It provides details on:
1) How sleep is measured using EEG, EOG, and EMG electrodes to record brain waves, eye movements, and muscle activity.
2) The stages of sleep including NREM stages 1-4 and REM sleep, characterized by different brain wave patterns.
3) Common sleep disorders like insomnia, hypersomnia, sleep apnea, circadian rhythm disorders and parasomnias. Treatment options are also outlined.
The document discusses sleep disorders and how sleep is measured. It describes the stages of sleep including non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). NREM sleep is divided into 4 stages characterized by different brain wave patterns. The cycles between NREM and REM sleep are important for rest. Common sleep disorders include primary insomnia, hypersomnia, narcolepsy, and sleep apnea. Insomnia involves difficulty initiating or maintaining sleep while hypersomnia involves excessive daytime sleepiness. Breathing-related disorders disrupt sleep through interrupted breathing.
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.
The document discusses the reticular activating system and its role in consciousness and sleep. It notes that the reticular activating system is a collection of neurons in the brain stem that secretes different transmitters and connects specific portions of the thalamus to areas of the cerebral cortex. This system plays an important role in regulating states of consciousness and sleep through synchronization and desynchronization of brain waves.
This document discusses various states of consciousness and levels of awareness. It covers topics like dual processing theory, inattentional and change blindness, levels of consciousness (conscious, preconscious, subconscious, unconscious), sleep stages, circadian rhythms, sleep disorders, dreams, hypnosis, and psychoactive drugs. The key points are that consciousness exists on a continuum, we process information both consciously and unconsciously, sleep is important for restoration and involves cycles between REM and non-REM sleep, and drugs can alter states of consciousness by interacting with neurotransmitters in the brain.
- Animals generate circadian and circannual rhythms that regulate sleep/wake cycles, eating/drinking patterns, temperature, hormone secretion and other functions on 24-hour and yearly cycles respectively.
- Humans have a circadian rhythm slightly longer than 24 hours that is reset by light/dark cues. Disruption of circadian rhythms can cause jet lag. The suprachiasmatic nucleus regulates circadian rhythms.
- Sleep stages include NREM (stages 1-4) and REM sleep. REM is characterized by dreaming and paralysis while NREM deepens across stages 1-4. Sleep aids restoration, energy conservation, memory consolidation and more.
Dreams occur during both non-REM and REM sleep. REM sleep is characterized by rapid eye movements. Lucid dreams occur during REM sleep and allow people to be aware they are dreaming and control dream events. Studies show lucid dreams have high brain activity in frontal and temporal regions in the gamma frequency range. REM sleep behavior disorder is a condition where people physically act out their dreams, which can be associated with neurological diseases. It can be treated with drugs like clonazepam or melatonin.
Isabella thoburn college neural mechanism of sleepMadeeha Zaidi
Sleep is regulated by two main mechanisms - sleep homeostasis and circadian rhythms. Sleep homeostasis refers to the increasing need for sleep driven by a buildup of adenosine in the brain throughout periods of wakefulness. Circadian rhythms refer to the approximately 24 hour cycles in physiology and behavior driven by the brain's biological clock in the hypothalamus, which is synchronized to light/dark cycles. Disruptions to these mechanisms can cause sleep disorders like jet lag. Neural control of sleep involves both sleep-promoting and wake-promoting areas. Key sleep-promoting areas include the basal forebrain, raphe nucleus, and ventrolateral preoptic area. Key wake-promoting areas include the brainstem
Sleep involves different stages including non-REM sleep and REM sleep. The stages can be measured through polysomnography which tracks brain activity, eye movements, and muscle activity. Non-REM sleep involves reduced brain and muscle activity and is when most physical restoration occurs. REM sleep involves an active brain and paralyzed muscles except for eye movements; it is when most vivid dreaming occurs. Sleep serves functions like restoration and energy conservation, and is regulated by biological processes in the brain.
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Vertigo is a type of dizziness characterized by sensations of movement, typically spinning or rotation. It can be caused by issues in the inner ear, vestibular nerve, or brainstem. Episodes are often unpredictable and accompanied by nausea, vomiting, imbalance, and anxiety. Between episodes, vertigo sufferers may experience headaches, instability, and depression. Long-term, vertigo negatively impacts quality of life.
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1) Dizziness and vertigo are common, with vertigo defined as a perception of movement and dizziness having various meanings.
2) Vertigo can be peripheral or central in origin, with peripheral vertigo arising from problems in the inner ear and central vertigo from problems in the brain or brainstem.
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Practical algorithm for surgical management of facial painwebzforu
The document presents a practical algorithm for surgically managing facial pain. It classifies different types of facial pain and lists various treatment modalities. It then describes the authors' current algorithm, which treats around 100 new facial pain patients per year using procedures like microvascular decompression, radiofrequency gangliolysis, and radiosurgery. Based on their experience, the algorithm provides 96% pain relief and high patient satisfaction for a variety of facial pain conditions.
Migraine is an inherited central nervous system disorder characterized by a hyperexcitable brain. Imaging studies show changes in brain structures like the periaqueductal gray over time with repeated migraine attacks. Understanding the pathophysiology has led to improved treatments that target mechanisms like central sensitization and abnormal neuronal activity in the trigeminal nucleus caudalis.
Quality of life in post stroke patients-role of nootorpilwebzforu
Nootropil is approved for the management and early recovery of symptoms of post-stroke sequelae of thrombotic origin by binding to neuronal cell membranes and improving membrane fluidity, glucose and oxygen uptake, and neurotransmitter functioning to limit neuronal damage and aid in early restoration of neuronal function. Guidelines recommend initiating Nootropil therapy with IV bolus to attain desired levels through collaterals to prevent further damage, followed by IV infusion and at least 12 weeks of oral administration for optimal results in recovering neurological functions after stroke. Certain clinical factors like paralysis lasting over 96 hours or permanent sensory loss indicate a poorer prognosis for recovery from stroke.
Practice pearls diagnosis and prophylaxis of migrainewebzforu
This document provides guidelines and recommendations for the diagnosis and prophylaxis of migraine. It begins with the International Headache Society criteria for diagnosing migraine which involves assessing head-related symptoms and associated non-headache symptoms. It emphasizes taking a detailed patient history including triggers and risk factors. The physical exam should include a neurological exam. It discusses differentiating migraine from other headache types like tension headaches and discusses migraine triggers. It provides recommendations for when prophylactic treatment should be considered and guidelines for successful prevention. It discusses common preventive medications and their mechanisms of action and side effects.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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.
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Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
1. MANAGEMENT OF INSOMNIA IN THIS
MILLENNIUM
Dr A V Srinivasan M.D, D.M., PhD (Neuro),FAAN,FIAN
Emeritus Professor
The TamilNadu Dr M.G.R Medical University
Former Head- Institute of Neurology
Madras Medical College, Chennai
In Greek mythology,
Hypnos was the
personification of sleep; the
Roman equivalent was
known as Somnus. His twin
was Thanatos ("death");
their mother was the
goddess Nyx ("night"). His
palace was a dark cave
where the sun never shines.
At the entrance were a
number of poppies and
other hypnogogic plants.
2. Sleep architecture revisited
What is it & How is it relevant in
Psychiatry and Neurology?
Science is below the mind; Spirituality is beyond the
mind
3. What is sleep?
Sleep is a physiological state of reduced sensory
awareness and an absence of voluntary movements.
Sleep is necessary for life.
Sleep is also an essential component of good health
(body development and restitution as well as mental
health and well-being). It is also important for optimal
cognitive functioning.
A woman’s desire for revenge outlasts all her
other emotions
4. Total Sleep Requirement
Percentage of
All People
50
40
30
20
10
0
0 2 4 5 6 7 8 9 10
Length of Sleep in Hours
In order to be at your peak performance you need at
least 8 hours of sleep.
5. Function of Sleep
1. Restoration and recovery
– Sleep serves to reverse and/or restore biochemical
and / or physiological processes degraded during
prior wakefulness
2. Energy conservation
– 10% reduction of metabolic rate below basal level
3. Memory consolidation
4. Thermoregulation
The world shall perish not
5. Homeostasis for lack of wonders but lack
of wonder
6. Memory Consolidation at Sleep Onset
Impairment of Memory Consolidation
during Sleep
80
60
40
20
0
10 9 8 7 6 5 4 3 2 1
Subjects awakened 30 seconds after sleep onset
Subjects awakened 10 minutes after sleep onset
Word Presentation Minutes BeforeMinnesota, Sleep Onset
Assessment of Sleepiness / Sleep Deprivation, M. Mahowald, University of
Sleep Academic Award
7. Sleep and Hormones
Hormones Tightly Coupled with
Sleep
Determinants of Sleepiness / Circadian Rhythms, M. Mahowald, University of Minnesota, Sleep Academic Award
8. Illustration of Normal vs. Insomnia
Sleep Pattern
Normal Sleep Pattern
Onset
Insomnia Sleep Pattern
Onset
Awakenings
10. Normal Sleep Architecture
Stages of sleep
__________________________
1. NREM Sleep
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
2. REM Sleep
Truth comes out of error
sooner than that of confusion
10
11. Thought is the labour of
Sleep Stages the intellect
Reverie is its pleasure
___________________________
Wake
2/3 of life
NREM Sleep REM Sleep
~80% of night ~20% of night
11
12. Normal Sleep Histogram
Sequences of States and Stages
of Sleep on a Typical Night
Identification and Staging of Adult Human Sleep, L. Shigley, Sleep Academic Award
13. Normal Sleep Stages
Stage 1 Stage 2 Stage 3&4 REM
Body starts to relax Brain slows Body and tissue restored Learning and memory
‘Falling asleep’ ‘Stable, light sleep’ ‘Deep, consolidation
restorative sleep’ ‘Dreaming sleep’
3-8% 45-55% 15-20% 20%
NREM 75-80% REM 20-25%
1 cycle = 80-100 minutes
Adapted from Damien R.Stevens MD.Sleep medicine secrets.2004
14.
15. Wakefulness, NREM, and REM
Wake NREM REM
Arousability High Lowest Low
EEG amplitude Low High Low
EEG frequency Fast Slow Mixed fast
Muscle tone Variable Low Absent
Eye movements Voluntary Infrequent Rapid
Heart Rate, Blood Variable Slow/ low, Variable
Pressure, regular
Respiratory Rate
O2, CO2 response Full Lower Lowest
Thermoregulation Behavioral/ Physiological Reduced
Physiological physiological
Mental activity Full None/ limited Story-like
dreams
16. Importance of sleep architecture
• Sleep architecture provides a useful means for
quantitatively analyzing sleep.
• It includes both macroarchitectural features
(those derived from sleep staging) and
microarchitectural features (those derived from
waveform analysis). Architectural features can
characterize:
– sleep integrity and continuity
– global sleep-stage structure
– presumed underlying physiologic mechanisms
17. Neurochemical control of sleep-
wake states
Neurotransmitter Location Action
Acetylcholine LDT, PPT (pons) REM, wake
Histamine TMN (posterior Wake
hypothalamus)
GABA, galanin VLPO NREM sleep
Serotonin Raphe nuclei Wake, NREM
Norepinephrine Locus coeruleus Wake
Hypocretin Later hypothal Wake
18. Neurochemical control of sleep-
wake states
• Dopamine
• Adenosine
• Nitrous oxide
• Cytokines (IL-1, IL-6, TNF-α)
• Prostaglandins
• Hormones: melatonin, growth hormone,
VIP NPY
• Delta sleep-inducing peptide
19. Aminergic Cholinergic
Wake
Fig. 2.1 aldrich
Sleep
REM
Basal Forebrain Cholinergic
Reticular Formation Thalamus Serotonergic
Post. Hypothalamus Monoaminergic
Histaminergic
20. Social Isolation
Factors that affect sleep is in itself a
pathogenic
Factor for
disease
production
• Age
– Increased wakefulness during sleep period
– Decreased Stage 3/4 NREM
– Earlier timing
– Greater daytime sleepiness
• Sex (women have longer sleep, more
Stage 3/4 NREM)
• Timing: Sleep is best at night!
• Illnesses, medications
21. Sleep in healthy young and
older adults
20 year old woman 71 year old woman
Motivation is the Spark that lights
the Fire of Knowledge and
fuels the engine of Accomplishment
22. Sleep stages across the life
span
Ohayon et al., SLEEP 2004; 27: 1255-73
Minutes
Age (years)
23. Is there any difference
between sleep and sedation?
Mind is the great level of all things;
human thought is the process by
which human ends are ultimately
answered - Daniel Webster
24. Traits to define sleep and sedation
NREM/REM sleep SEDATION
• Hypotonia/atonia • Analgesia
• Slow/fast eye • Amnesia
movements • Obtundation of
• Regular/irregular waking
breathing, heart • Anxiolysis
rate, BP
Social Isolation is in itself a
pathogenic
Factor for disease production
25. Knowledge without
action is useless;
Sleep v/s sedation Action without
knowledge is
foolish
• Sleep is reversible with sensory stimulation;
sedation depresses sensory processing
in the face of noxious physical &/or aversive
psychological stimulation
• Sleep disrupts mammalian temperature
regulation during REM phase; Sedation can alter
the relationship between body temp and energy
expenditure
• Nausea and vomiting are not associated with
sleep; but can be positively correlated with
sedation level.
26. Sleep architecture in
neurological and psychiatric
conditions
A bad teacher
complains;
A good teacher
explains;
The best teacher
inspires;
27. Effect of Sleep Stage in
Epileptic patients on Interictal
and Ictal Discharges
Pure love ever gives. Never
seeks
28. Seizure effect on sleep architecture
• Seizures acutely alter the sleep-wake state.
• The most prominent clinical features of this
seizure effect are postictal somnolence and
insomnia.
• Patients with nocturnal seizures are subjectively
and objectively sleepy on the day following a
seizure.
• Seizures or the postictal state produce
pathophysiological changes in the CNS that
result in sleep fragmentation and suppression of
REM sleep. Individuals with partial or
generalized seizures have less REM sleep on
nights with seizures.
“Anger Begins In Folly And Ends In
Repentance”
29. Sleep in Patients With Depression
• Primary sleep complaints1,3
– Difficulty falling asleep
– Frequent nocturnal awakenings
– Waking too early in the morning
– Daytime fatigue
• Effects on sleep architecture in depression1-3
– Prolonged sleep latency
– Increased wake time after sleep onset (WASO)
– Decreased slow wave sleep (stages 3 and 4)
– Reduced REM sleep latency; prolonged first REM
period
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev (DSM-IV-TR®). 2000:645-650.
2. Perlis M, et al. Biol Psychiatry 1997;42:904-913.
3. Benca RM. In: Principles and Practice of Sleep Medicine. 4th ed. 2005:1311-1326.
30. Sleep pattern in Alzheimer’s Disease
• Sleep pattern in early stage :
– Disruption in sleep-wake patterns, rhythmicity,
– Increased amounts and frequency of nighttime
wakefulness,
– Reduction of slow-wave sleep - worsen with disease
progression.
• Sleep pattern in late stage:
– Reduction of REM sleep,
– Increased REM latency,
– Alteration of the circadian rhythm resulting in daytime
sleepiness.
– Daytime napping and somnolence increase with
disease progression.
31. Effect of drugs on sleep
architecture
“The Wise Man Before He Speaks ,
Will Consider Well What He Speaks
32. Effect of antidepressants on sleep
architecture
• Tricyclic antidepressants
– Mostly produce sedation
– Variation in the reported effects on sleep from
TCAs.
– Amitriptyline, trimipramine, nortriptyline,
dothiepin and doxepin have all been
associated with sedation,
– Imipramine and desipramine are less likely to
be linked with sedation, but have been
associated with insomnia;
– The evidenceMayersless al. Hum Psychopharmacol Clin Exp 2005; 20: 533-559.
is AG et clear with clomipramine.
33. Effect of antidepressants on sleep
architecture
• SSRIs
– SSRIs immediately suppress REM sleep,
and continue to do so throughout treatment.
– REM parameters return to normal once the
SSRI is discontinued.
– SSRIs block serotonin reuptake, but some
also block noradrenaline reuptake. Both
actions have been associated with REM
suppression and sleep disruption.
Mayers AG et al. Hum Psychopharmacol Clin Exp 2005; 20: 533-559.
34. Effect of antidepressants on sleep Discipline
Weighs
architecture ounces:
Regret
• Fluoxetine weighs Tons
– Sleep was significantly less efficient, and
nocturnal awakenings were significantly greater,
with fluoxetine (20-40 mg) - Rush et al. (1998)
– Fluoxetine significantly suppressed REM sleep
– Fluoxetine (20 mg) was associated with less
efficient, shorter and more disrupted sleep -
Wolf et al. (2001)
– Improvements in sleep latency and total sleep
time were not marked for fluoxetine
Mayers AG et al. Hum Psychopharmacol Clin Exp 2005; 20: 533-559.
35. Effect of hypnotics drugs on sleep
architecture
• Benzodiazepines
– Being anticonvulsants, they tend to suppress
synchronized EEG activity (such as slow waves) and
confer some risk of seizure if abruptly withdrawn.
• Barbiturates
– Decrease REM and slow-wave sleep.
• Non-BZD hypnotics.
– Do not alter sleep architecture when taken at
therapeutically recommended doses.
Some people feel the rain;
Others just get wet
36. Stilnoct®
Preservation of Sleep Stages
Placebo Stilnoct
Stage 0 Stage 0
REM REM 6.64% Stage 1
10.50% Stage 1 7.27%
19.02% 16.39%
6.26%
Stage 4 11.22% Stage 4 15.81%
44.48%
8.51% 46.23%
7.65%
Stage 3
Stage 2 Stage 3
Stage 2
Opinion is ultimately determined by the
N=36 feelings
Data on file. Sanofi-aventis. and not by the intellect
37. Sleep Disorders
• International Classification of Sleep Disorders (ICSD-2)
(1) insomnias
(2) sleep-related breathing disorders
(3) hypersomnias not due to a breathing disorder
(4) circadian rhythm sleep disorders
(5) parasomnias
(6) sleep-related movement disorders
(7) other sleep disorders, and
(8) isolated symptoms, apparently normal variants, and
unresolved issues.
It is the province of the knowledge to speak
and it is the privilege of the wisdom to listen -
38. Insomnia
• Difficulty in initiating sleep and staying
asleep
• Waking up earlier
• Poor quality sleep, non restorative.
• Subjective
• Day time impairment (RDC-AASN)
The meek shall inherit the earth
- but not its mineral rights
39. Etiology
• Primary
• Secondary
Medications
Psychiatric
Medical
Sleep Disorders
A Man Of Words And Not Of Deeds Is
Like
A Garden Full Of Weeds
40. Drugs
• SSRI’s & SNRI’s
• Alpha and beta blockers
• Diuretics
• Decongestants
• Stimulants
• Steroids, thyroid harmones
What is mind no matter
What is matter never mind
41. Psychiatric and Sleep disorders
• Mood & anxiety disorders
• Circadian rhythm disorders
• Parasomnias
• Apneas
• Movement disorders
''When Beauty Fires The Blood; Love Exalts
The Mind"
42. Hypersomnias
• Excessive day time sleepiness
• Interfering with day time activities,
productivity, enjoyment
• Reflects insufficient sleep, disrupted
sleep, primar sleep disorder
Experience : “Yesterday’s Answer To Today’s Problems”
43. Diagnosis
• Detailed medical and sleep history
• Snoring or apnoea
• Restlessness, jerking
• Hypnogogic or hypnopompic
hallucinations
• Sleep paralysis, cataplexy
• Automatic behavior which, through the process of
Teachers are reservoirs from
education,
the students draw the water of life
44. Narcolepsy
• Excessive day time sleepiness (EDS)
Sedentary and active pursuit's
Short and refreshing
Followed by recurrent somnolence
Ranging from mild to disabling
Name and form are destroyed in the
sands of time
45. Cataplexy
• Unique
• Paroxysmal episodes of weakness
• Triggered by emotions
• Secs to Min
• Can be localized
• Consciousness and respiration not
affected.
Time and tide wait for no man;
And sins and sorrows are also swallowed in
time
46. • Develops years after EDS
• Frequency varies
• Adolescence, young adulthood
• Narcolepsy with and without
cataplexy
• Loss of hypocretin – 1 secreting
cells Every man is a volume if you know how
to read him
47. Being ignorant
• Narcolepsy – non obligate is not so much
a shame as
manifestations being unwilling
to learn
Sleep paralysis – muscle atonia at
interface between sleep and
wakefulness; for few minutes.
Hypnogogic hallucinations
brief, Sec to Mins, dream-like vivid and
distressing
Automatic behavior
Purposeful/inappropriate with impaired
recollection of the activities.
48. Other Hypersomnias
• Recurrent hypersomnias
Recurrent hypersomnias
Kleine – Levin syndrome
Menstrual associated
• Idiopathic hypersomnias
With long sleep time
Without long sleep time
Beauty lies in the eyes of the
beholder
49. The secret of walking on water is knowing
where the stones are
Parasomnias
• Include abnormal movements,
behaviors, emotions and
automatic activities.
• Intrusion of sleep and wakeful
state into one another with CNS
activation.
• Not a unitary phenomenon.
50. Parasomniasis
• Disorders of arousal –
NREM sleep – confusional arousal
sleep walking
sleep terrors
REM sleep – RBD
Isolated sleep paralysis
Nightmares
Others – enuresis
eating disorders
Future Medicine – Scientific
etc determinism or humanism
51. RBD – REM Sleep Behavior
Disorders
• Prevalence of 0.5%; 90% Men
• Above 50 years
• 25% with PD, OPCA, DCBD
• Complex motor activity during REM
• Augmentation of EMG tone during REM
sleep
• Toxic/metabolic disorders
52. RBD
• During second half
• Abnormal brain stem control of medullary
inhibitory regions
• Cat models- locus ceruleous adjacent lesions
• SPECT – decrease striatal dopa innervations
decrease dopa transportation
• Withdrawal of alcohol, sedatives
• Hypnotics
• TCA, SSRI, MAOI, cholinergics
The sign wasn’t placed there
By the Big Printer in the sky
53. Sleep-Related Movement
Disorders- Restless Legs
Syndrome
• 5-15% - healthy people
• 15-20% - uremia
• 30% - R.A
• High prevalence in West
• Low in South & S.E Asia
A open foe may prove a curse ; but
a pretended friend is worse
54. Diagnostic criteria – NIH –IRLSSG
(2003)
1. Disagreeable leg sensations before
sleep onset
2. Irresistible urge to move the limbs
3. Partial or complete relief on leg
movement
4. Return of symptoms on cessation of
movement
When they tell you to grow up, they mean
stop growing
55. Restless Leg Syndrome
• Bilateral, though asymmetrical
• Ankle & knees. Can involve thigh or
feet & arm
• Minutes to hours
• Dopamine dysfunction, Iron storage
deficiency
• Anti emetics, antihistamines, TCA,
SSRI, neuroleptics
56. Rest less Leg
Syndr ome wit h
Per iodic Limb
Movement s
Speak obligingly even
if you cannot oblige
57. Periodic Limb Movement
Disorder
• Common as age advances
• Nocturnal myoclonus captured on
Polysomnography
• Extension of the big toe with flexion of
ankle, knee & hip
• Sleep may or may not be affected
• Centrally mediated event
“The True Art of Memory is The Art of Attention” -
S.Johnson
58. • Can accompany OSA & Narcolepsy
• Uremia, metabolic disorders
• TCA, MAOI
• Withdrawal of AED, benzodiazepines,
hypnotics
• Hypnic jerks & nocturnal seizures to
be differentiated
Through Action You Create your Own Education - D.B.
ELLIS
59. PLMS –Secondary (previous
Myelopathy)
“ We Sometimes think we have forgotten something when
in fact we never really learned it in the first place”
Imp.Your Memory Skills
60. Sleep Related Leg Cramps
• Not uncommon with increasing age
• “Charley horse” muscular tightness
involving the calf & foot during sleep
• Results in arousal and can lead to
insomnia or EDS
• Pregnancy, DM, fluid & electrolytes,
arthritis, vigorous exercise
61. Sleep related Bruxism
• Children and adults, MR
• Stereotyped grinding or clenching
• Diurnal & nocturnal
• Situational or psychological stress
• SSRI, dopa, alcohol exacerbate
Thought is the labour of the intellect
Reverie is its pleasure
62. Sleep-Related Rhythmic Movement
Disorder
• Head Banging – back & forth down
into the pillow
• Head Rolling – side to side
• Body Rocking – forward & backward
• Humming or chanting
• Persistence with autism, MR
Whatever the Mind can conceive and Believe,
the mind can Achieve
Napoleon Hill
63. Nocturnal Paroxysmal Dystonia
(NPD)
• Repeated, stereotyped, dystonia or
dyskinetic episodes in NREM sleep
• Sleep related epilepsy
• Short episodes < 1 min. every night and
many times
• Long episodes – up to 60 min
• Can have sleep disruption
Imagination is more Important than Knowledge
65. Obstructive Sleep Apnea-
Hypopnea Syndrome
• Asphyxia with decreased O2 & increased
CO2
• Associated with snoring and obstruction of
the pharynx
• Day time – sleepiness, decreased
concentration, fatigue
• Nocturnal – chocking, dyspnoea,
diaphoresis, nocturia
A open foe may prove a curse ; but a pretended
friend is worse
66. • Apnoea – 70% reduction in airflow
• Hypopnea – 30% reduction in airflow
for minimum 10 sec
• Apnea-hypopnea index (AHI) of at
least five apneas plus hypopneas per
hour of sleep together with complaints
of persistent daytime sleepiness.
It is a great misfortune not to possess sufficient wit to speak
well
nor sufficient judgment to keep silent
La Broyers character
67. Risk Factors
• Obesity ( BMI > 30 kg/m2)
• Male gender
• Family history of obstructive sleep apnea-hypopnea
syndrome
• Consumption of alcohol before bedtime
• Smoking
• Drugs (growth hormone, β-blockers, testosterone,
flurazepam)
• Use of sedatives
• Sleeping in a supine position
• Anatomic upper airway obstruction
• Comorbid medical conditions
68. Central Sleep Apnea
• 10 sec of no airflow
• Reduced ventilatory drive
• Ventilatory responses to hypoxia,
hypercapnia are reduced
• Day time sleepiness, mild snoring
• PSG – no airflow or ventilatory effort
You are what you think and not what you think you are
69. Circadian rhythm Sleep
Disorders (CRSD)
• Master Clock – SCN in anterior hypothalamus
Sleep wake cycle/temperature control and
melatonin levels.
• Zeitgebers (time given) are light and
melatonin
• Input into SCN from ganglion cells-
melanopsin
• Melatonin > pineal > SCN, shifts circadian
rhythm Discipline Weighs ounces; Regret
weighs Tons
70. • DD for insomnia & hypersomnia
Delayed sleep phase
Advanced sleep phase
Free running
Irregular sleep-wake
Shift work sleep disorder
Jet lag
A great many people think they are thinking when they are merely re
arranging their prejudices
W. James
71. When they tell you to
Criteria for CRSD grow up, they mean
stop growing -Piccaso
• Persistent or recurrent pattern of sleep
disturbance due to
- Alteration in circadian timing or misalignment
of endogenous & external factors
- Leading to insomnia, EDS or both
- Associated with impairment of function
• CRSDs are important in practice but
parameters for treatment have not been
established.
72. Thank you
Many Ideas grow better when transplanted into another mind
than in the one where they sprang UP
O.W. Holmos
Editor's Notes
Dr V N
How much sleep do people need? The real question is ….how much sleep do person need to: Get through the day? Go from the bed to the couch? Perform physical tasks that require concentration and focus such as microscopic surgery or wielding metal beams on a 60- story sky-scraper? The truth is…..the amount of sleep needed will be vary with every individual and perhaps with specific activities. However, when provided the opportunity/environment to sleep, most Americans sleep between 7-8 hours each night Short sleepers are the exception. They only require 3-4 hours of sleep each night; however, it is rare that someone is fully functional and feels rested after short sleep periods. Conversely, there are long sleepers! These folks often require 9-10 hours of sleep to be fully functional and rested. Unfortunately, they are out of sync with a 8-4/ 9-5 society and have difficulty adjusting to demanding daytime work schedules. Animals such as cats and dogs tend to sleep at least half of the day. Larger animals such as horses, elephants and giraffes usually sleep no more than 4 hours a day.
Talking Points What does a normal night of sleep look like diagrammatically, and how does that compare to the insomnia experience? A normal sleep pattern is illustrated by the top diagram. The good sleeper would typically report a latency to sleep onset of approximately 6 to 14 minutes and might awaken briefly (<5 mins) 1 to 2 times during the night but is able to return to sleep quickly after the brief arousals. Sleep pattern is consolidated without significant interruptions. Patients with insomnia may have difficulty falling asleep (“sleep onset”), difficulty staying asleep (“sleep maintenance”), or have early morning awakenings, and some patients have difficulty with all three. After initially falling asleep, interruptions in the sleep process (defective sleep maintenance) are said to cause “sleep fragmentation” because they impair normal “sleep consolidation.” Sleep maintenance insomnia may consist of one or multiple awakenings of variable duration.
Stilnox CR: Preservation of Sleep Stages Within NREM sleep, there are four stages of varying ‘depths’ of sleep. Stage 1 sleep is very shallow sleep; drowsiness with closed eyes. People aroused from stage 1 sleep may feel as if they have not slept at all. Stage 2 sleep is light sleep, during which the heart rate slows and the body temperature decreases in preparation for deep sleep. Stage 2 sleep is characterised by spontaneous periods of muscle tone increase mixed with periods of muscle relaxation. Stage 3 and stage 4 are deep sleep, also known as slow-wave sleep, because the EEG records a low frequency of cycles per second (the ‘delta’ rhythm’). During these stages heart rate, blood pressure and respiratory rates are lowered. Stage 3 and 4 account for approximately 20% of total sleep time and are the dominant NREM stages of sleep at the beginning of the night. Damien R.Stevens MD.Sleep medicine secrets.2004
Sleep integrity and continuity measures focus on how well sleep is preserved and how well it progresses. They best reflect a patient's difficulty initiating and maintaining sleep. Global sleep-stage structure measures provide a look into the composition of sleep, including sleep-stage percentages as well as REM (rapid eye movement)-sleep latency
Sleep in Patients With Depression Sleep difficulties are a frequent symptom in patients with depression, reported to occur in 40% to 65% of outpatients 1,2 and in up to 90% of inpatients 1 with major depressive episode. Specific sleep complaints can include difficulty falling asleep, sleep continuity difficulties such as frequent nocturnal awakenings, and early morning awakenings. 1-3 Objective polysomnographic assessments of sleep in depressed patients have revealed several distinct abnormalities, including prolonged sleep latency, increased wake time after sleep onset (WASO), and decreased duration of time spent in slow wave sleep (stages 3 and 4). Additionally, reduced latency to the onset of rapid eye movement (REM), increased duration of the first REM period, and greater density of eye movements during REM have been observed. 1-3 Many of the neurological systems responsible for the regulation of mood (eg, hypothalamic-pituitary-adrenal axis) are also involved in the regulation of sleep and wakefulness, which offers the possibility that abnormal function of certain regions of the brain may lead to both sleep and mood disturbances. 3 References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 4th ed, text rev (DSM-IV-TR®). Washington, DC: American Psychiatric Association; 2000:645-650. 2. Perlis ML, Giles DE, Buysse DJ, Thase ME, Tu X, Kupfer DJ. Which depressive symptoms are related to which sleep electroencephalographic variables? Biol Psychiatry . 1997;42:904-913. 3. Benca RM. Mood disorders. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia, PA: Elsevier Science Ltd.; 2005:1311-1326.
Rush et al. (1998) found that sleep was significantly less efficient, and nocturnal awakenings were significantly greater, with fluoxetine (20-40 mg) Fhoxetine significantly suppressed REM sleep, Wolf et al. (2001) demonstrated that fluoxetine (20 mg) was associated with less efficient, shorter and more disrupted sleep fluoxetine suppressed REM sleep, Satterlee and Faries (1995) showed that HAMD sleep scores tended to show better improvement for fluoxetine (20mg) than placebo, but this was not significant. Winokur et al. (2003) found no differences between fluoxetine (20-40 mg) and mirtazapine (15-45 mg) in respect of HAMD sleep scores; both showing significant improvements. However, improvements in sleep latency and total sleep time were not as marked for fluoxetine as they were for mirtazapine, which resulted in more efficient sleep and less nocturnal disturbances than fluoxetine.
Rush et al. (1998) found that sleep was significantly less efficient, and nocturnal awakenings were significantly greater, with fluoxetine (20-40 mg) Fhoxetine significantly suppressed REM sleep, Wolf et al. (2001) demonstrated that fluoxetine (20 mg) was associated with less efficient, shorter and more disrupted sleep fluoxetine suppressed REM sleep, Satterlee and Faries (1995) showed that HAMD sleep scores tended to show better improvement for fluoxetine (20mg) than placebo, but this was not significant. Winokur et al. (2003) found no differences between fluoxetine (20-40 mg) and mirtazapine (15-45 mg) in respect of HAMD sleep scores; both showing significant improvements. However, improvements in sleep latency and total sleep time were not as marked for fluoxetine as they were for mirtazapine, which resulted in more efficient sleep and less nocturnal disturbances than fluoxetine.
Rush et al. (1998) found that sleep was significantly less efficient, and nocturnal awakenings were significantly greater, with fluoxetine (20-40 mg) Fhoxetine significantly suppressed REM sleep, Wolf et al. (2001) demonstrated that fluoxetine (20 mg) was associated with less efficient, shorter and more disrupted sleep fluoxetine suppressed REM sleep, Satterlee and Faries (1995) showed that HAMD sleep scores tended to show better improvement for fluoxetine (20mg) than placebo, but this was not significant. Winokur et al. (2003) found no differences between fluoxetine (20-40 mg) and mirtazapine (15-45 mg) in respect of HAMD sleep scores; both showing significant improvements. However, improvements in sleep latency and total sleep time were not as marked for fluoxetine as they were for mirtazapine, which resulted in more efficient sleep and less nocturnal disturbances than fluoxetine.
Stilnoct ™ : Preservation of Sleep Stages Following administration of Stilnoct (12.5 mg), very few modifications in sleep architecture were observed in healthy adults (18-40 years old, N=36) as monitored by PSG for 8 hours postdose. In this slide, the proportion of time spent in each stage of sleep is represented graphically. Reference Data on file. Sanofi-aventis.