Lecture given to the West of Scotland Pain Group on Wednesday 24th November 2010 in the Ebenezer Duncan Centre, Victoria Infirmary, Glasgow by Dr Paul Reading, Consultant Neurologist.
In this talk, Dr Reading describes the importance of good quality sleep and how pain and sleep interact.
www.wspg.org.uk
The ABCs of Your ZZZs - Alison S. Kole, MD, MPH, FCCP, Pulmonologist Kerry K...Summit Health
Learn from our Sleep Disorder Center experts about the basics of good sleep and the physical impact of poor sleep. We will also discuss tips for improving sleep and the treatment options for common sleep disorders, such as sleep apnea, restless legs syndrome, and insomnia, among others.
Today more and more people face sleep deprivation, caused mostly by stress, lots of work and other factors. Here you find more about this subject and few strategies to overcome sleep deprivation.
The ABCs of Your ZZZs - Alison S. Kole, MD, MPH, FCCP, Pulmonologist Kerry K...Summit Health
Learn from our Sleep Disorder Center experts about the basics of good sleep and the physical impact of poor sleep. We will also discuss tips for improving sleep and the treatment options for common sleep disorders, such as sleep apnea, restless legs syndrome, and insomnia, among others.
Today more and more people face sleep deprivation, caused mostly by stress, lots of work and other factors. Here you find more about this subject and few strategies to overcome sleep deprivation.
sleep problems, which plague up to 40% of the elderly, include light sleep, frequent waking, and daytime fatigue. Among older people, there is also a decrease in the deep-sleep stage and an increase in periods of wakefulness during the night.
Many people suffer from short term to long term insomnia but they do not know what to do about it. This short presentation slide can give you an insight into some of the underlying causes of insomnia.
Take this quiz and overcome insomnia- http://903014jdmkq2z6cn0-ndvnq-sd.hop.clickbank.net/
Explores impact of disturbed sleep on symptom management in patients with concurrent serious illness and at the end of life. Presented during Hospice and Palliative Medicine Fellowship at the University of Kansas 2014
sleep problems, which plague up to 40% of the elderly, include light sleep, frequent waking, and daytime fatigue. Among older people, there is also a decrease in the deep-sleep stage and an increase in periods of wakefulness during the night.
Many people suffer from short term to long term insomnia but they do not know what to do about it. This short presentation slide can give you an insight into some of the underlying causes of insomnia.
Take this quiz and overcome insomnia- http://903014jdmkq2z6cn0-ndvnq-sd.hop.clickbank.net/
Explores impact of disturbed sleep on symptom management in patients with concurrent serious illness and at the end of life. Presented during Hospice and Palliative Medicine Fellowship at the University of Kansas 2014
Presented by The Royal's Dr. Elliott Lee at our annual Women in Mind Conference.
Dr. Elliott Lee is an Assistant Professor and Sleep
Specialist at The Royal, where he works in both the
Sleep Disorders Clinic and the Anxiety Disorders Clinic.
Pulmonologist, Jenny Kim, MD, FCCP of our Sleep Disorders Center partnered with the Livingston Health Department to present, Can’t Sleep? The ABCs of Your ZZZs to the community. During the session, Dr. Kim discussed tips for improving sleep and treatment options for common sleep disorders.
Messy, not smelling of roses and a tilted view requiredepicyclops
Presidential Address given to the Glasgow Southern Medical Society on 24th October 2013. In her lecture, Dr Andrea Williamson discusses health inequalities and homelessness from the viewpoint of a general practitioner in Glasgow.
Two videos are discussed during the meeting:
The first is Isha and the Poverty Truth Commission:
http://www.youtube.com/watch?v=CKGMok5s2Rs&noredirect=1
The second is Brian and the Housing First pilot in Glasgow:
http://www.youtube.com/watch?v=iKyNhAaCsE0
Lecture given to the West of Scotland Pain Group on 27th February 2013 by Consultant Neurologist Dr Colin O'Leary on the clinical features of multiple sclerosis and management of MS pain and spasticity.
The Dismal Scientist: the price of everything, the value of nothingepicyclops
How do we evaluate the cost-effectiveness of new medicines? What value do we place on effective drugs? Prof. Ken Paterson explores the challenging area of health economics and how we judge whether we can afford new treatments in a cash-limited health service.
Lecture given to the West of Scotland Pain Group on Wednesday 28th November 2012 by Emma Mair, Specialist Physiotherapist in Pain Management about Complex Regional Pain Syndrome (CRPS) and its treatment with Graded Motor Imagery (GMI).
How early childhood experience determines our healthepicyclops
People in Glasgow are more likely than other UK citizens to die prematurely, even when socio-economic deprivation is taken into account. This excess mortality is largely due to problem substance use, suicide and violence: the 'Glasgow Effect'.
There are compelling reasons to believe that experiences in utero and early childhood largely explain the Glasgow Effect through programming of the hypothalamo-pituitary-adrenal axis, through learned patterns of attachment to caregivers and through other learned behaviours. Several early indicators of vulnerability can now be identified and doctors should pay attention to them in the same way as they pay attention to blood pressure readings.
Lecture given to the Glasgow Southern Medical Society on Thursday 8th November 2012 by Prof. Phil Wilson, Professor of Primary Care and Rural Health, University of Aberdeen.
http://www.gsms.org.uk
Greater Glasgow & Clyde Back Pain Service - Claire MacKelvieepicyclops
Lecture given by Clinical Physiotherapy Specialist, Claire MacKelvie to the West of Scotland Pain Group on Wednesday 30th November 2011. Claire describes the development and function of the back pain service.
Working with interpreters in healthcare settingsepicyclops
Lecture given to the West of Scotland Pain Group by Dr Sharon Doherty, Clinical Psychologist, on Wednesday 26th January, 2011.
Dr Doherty discusses the increasingly important role of professional interpreters and how to get the best out of an interpreted consultation.
www.wspg.org
The role of illness perceptions and medicine beliefs in adherence to chronic ...epicyclops
Presentation given by Dr Leanne Ramsay & Dr Martin Dunbar to the West of Scotland Pain Group on 7th October 2008 at the Royal College of Physicians and Surgeons of Glasgow.
Assessment Of Complex Regional Pain Syndrome Dr Candy Mccabeepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Candy McCabe. In this talk, Dr McCabe discusses the mechanisms and assessment of patients with complex regional pain syndrome.
Pain And Dependence Screening For Addiction In A Pain Setting Dr Steve Gi...epicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Steve Gilbert and Dr Alex Baldaccino. In this talk, they discuss the assessment and screening of patients in the pain clinic for evidence of drug dependence.
www.nbpa.org.uk
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Peter Murphy. In this talk, Dr Murphy discusses the psychological assessment and preparation of patients for implantable therapies including spinal cord stimulation.
www.nbpa.org.uk
Nursing Assessment Of The New Chronic Pain Patient Sr Christine Wakefieldepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Sr Christine Wakefield. In this talk, Sr Wakefield discusses the role of the nurse specialist in the assessment of the newly-referred patient with chronic pain. www.nbpa.org.uk
Referral For Invasive Procedures For Cancer Pain Dr Alison Mitchellepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Alison Mitchell. In this talk, Dr Mitchell discusses the indications for referral of patients with cancer pain for invasive procedures. She describes the new interventional cancer pain service being set up in Glasgow. www.nbpa.org.uk
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
The Wine Diet (healthy eating and drinking) - Prof. Alan Crozierepicyclops
Prof Alan Crozier, Professor of Plant Biochemistry and Human Nutrition, University of Glasgow speaks to the Glasgow Southern Medical Society on the benefits of a diet rich in phytoantioxidants.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. Sleep, Pain and Drugs
Paul Reading
Department of Neurology
The James Cook
University Hospital
2. 1. defining sleep and the sleep drive
2. how much sleep do we need?
importance of quantity and quality
3. the effects of sleep deprivation
4. the causes of excessive sleepiness
5. the relation between pain and sleep
6. effects of drugs for pain on sleep quality
3. Everyone and every animal
needs to sleep!
If sleep doesn’t serve some vital function it is
the biggest mistake evolution ever made.
Alan Rechtschaffen
Sleep is of the brain, by the brain and
for the brain
William Dement
The best bridge for repair between despair
and hope is a good night’s sleep
Joseph E Crossman
4. 1 2 3 4 5 6 7
Time (hours through night)
WAKING
REM
Sleep
I
II
III
IV
Typical Hypnogram
of Young Adult
REMREM REM REM
6. Borbély’s two factor hypothesis (1982) :
the need for sleep dependent on :
• homeostatic factors
(process S)
• “hour glass”
• circadian factors
(process C)
• nadirs of alertness at ~ 4 am & ~ 3 pm
The Triggers for Sleep
SKIN MITOSIS
7. We still don’t really know!
There is clear inter-individual variation
e.g. Einstein v Thatcher and Napoleon
but whole populations fairly homogenous :
~ 7 hrs of quality sleep needed for most
In Western society we [probably] sleep less
than 90 years ago (young adults 6.8 v 8.2h)
The idea of a chronic “sleep debt” (that must
be repaid) has become a widespread concept …
How much Sleep do we Need?
8. British Medical Journal :
editorial – Sept 29th
“The subject of sleeplessness is once more
under public discussion. The hurry and
excitement of modern life is held to be
responsible for much of the insomnia of which
we hear; and most of the articles and letters
are full of good advice to live more quietly
and of platitudes concerning the harmfulness
of rush and worry. The pity of it is that so
many people are unable to follow this good
advice and are obliged to lead a life of anxiety
and high tension.”
1894
9. 8 hrs/night
0 14 140
6 hrs/night
4 hrs/night
0 hrs/night
Data suggest increasing signs of sleepiness
with regular 6 hours of nocturnal sleep
but subjective sleepiness ≠ objective sleepiness
Van Dongen et al Sleep 2002
PVT = psychomotor vigilance test
How much Sleep does the Brain Need?
0 14 0 14
10. animals will die in about 2 weeks
• both REM and non-REM needed
• mechanism of death?
Acute Sleep Deprivation
in animals
11. The Effects of Acute Sleep Deprivation
in humans
Sleepy!
12. The risks of sleepiness
Selby Rail Crash
06:12h: car drifts off road, down embankment onto railway.
Hit by passenger train - derailed, then hit by goods train 100 fatal & serious injuries
13.
14. in late 1960’s landmark studies on prolonged SD
students paid on a sliding pay scale (up to 205 hours)
• day 3 - significant concentration problems,
visual symptoms also prominent
• day 5 - intermittent confusion, numerous lapses
• day 7 - hallucinations / delusions,
psychomotor retardation (“dementia”)
no consistent biochemical abnormalities (cortisol higher)
no long lasting psychological / cognitive sequelae
Acute Sleep Deprivation
in humans
15. The Effects of Acute Sleep Deprivation
Involuntary “micro sleeps” occur
Reaction times slower
Attention becomes unstable
• vigilance poor, lapses increase
• short term memory suffers
• unable to sustain performance
• note effects on driving
Problem solving and judgement deteriorate
• frontal lobe function particularly affected
Pain threshold reduced?
16. Dawson & Reid (Nature 1997)
Effect of Sleep Deprivation on Psychomotor Performance
Compared With Blood Alcohol Concentration
17. The Effects of Acute Sleep Deprivation
Brain imaging
after 24hr SD
prefrontal
cortex (PFC)
underactive
during cognitive tasks
PFC and thalamus
appear overactive
similar to old age
brain has to work
“harder”?
18. impaired sense of humour (Sleep 2006)
The Effects of Acute Sleep Deprivation
Headline 1:
Vet investigates failed
panda mating
Headline 2:
Panda mating fails:
vet takes over
19. all drugs improved PVT scores
placebo performance 1 SD below expected
modafinil improves visual joke appreciation
due to improved frontal lobe function?
Results
20. greater risk taking and reduced learning about losses (Sleep 2007)
The Effects of Acute Sleep Deprivation
• If 24h SD, overactivation in nucleus accumbens
when taking a risky gamble
• higher expectation of reward?
• If 24h SD, under-activation of orbitofrontal cortex
following a loss
• reduced learning about losses?
21. The Effects of Acute Sleep Deprivation
• After 24h SD, “angry” and “happy” emotions less recognised
recovery after sleep period
22. The Adverse “Emotional” Effects of
Sleep Deprivation
Sleep loss in medical residents amplified negative emotional
consequences of disruptive daytime experiences while positive
benefits of rewarding activities were blunted (Zohar 2005)
In test of emotional memory,
f-MR scans show limbic areas
overactive to negative stimuli
> 1 night SD (Yoo et al 2007)
“hyper-limbic state”
due to loss of functional
connectivity with PFC?
note similarities to depression
i.e. over-reactive to negative events
23. Does chronic severe sleep deprivation
and/or pain shrink (age) the brain?
gray matter changes in
brains of severe OSA in
middle-age men
Eun Yeon Joo et al
Sleep 2010
gray matter changes in
brains of sufferers of
chronic back pain and
fibromyalgia
Apkarian et al
J Neurosci 2004
Kuchinad et al
J Neurosci 2007
24. (Possible) Systemic Effects of
Chronic (partial) Sleep Deprivation
Sleep loss may affect metabolism
• resistance to insulin, pre-diabetic state
due to increased sympathetic activity / cortisol?
especially in OSA + metabolic syndrome
• hunger signals increased
resistance to leptin, the “satiety hormone”
Sleep loss and inflammatory responses
• altered immunity
e.g. less effective vaccinations, increased cancer? (note Danish ruling)
• inflammatory markers in blood increased (e.g. CRP)
blood “stickier”, vascular complications
29. Pain and Sleep
a bi-directional relationship
Pain ↑ → Sleep ↓
5-HT ↓ → Pain ↑ and Sleep ↓
Sleep ↓ → Pain ↑
Clinical observations in burns patients (Raymond et al Pain 2001)
subjective sleep quality predicts pain scores subsequent day
but pain intensity during day does not predict sleep quality
Sleep deprivation in animals (REM) lowers pain threshold
and reduces opiate efficacy
pressure pain and heat tolerance affected, not general sensation
30. Sleep deprivation (REM?) decreases pain thresholds
poor sleep quality also affects QOL and ability to cope
Roehrs et al Sleep 2006
Pain and Sleep
0 hrs8 hrs 4 hrs
8 hrs NRem Rem 0 hrs
31. commonly used drugs to treat nocturnal pain may
facilitate sleep onset and increase duration
but not improve its quality :
Opiates REM ↓↓ SWS ↓↓ arousals ↑↑↑
AED’s REM ↓ SWS ↑
Anti-dep REM ↓(↓) SWS ↓↔ sleep maintenance ↓↔
BZ’s / alc REM ↓ SWS ↓ sleep maintenance ↑
Pain, Drugs and Sleep
32. Sleep architecture “improved” by Pregabalin
Pregabalin compared to placebo and BZ over 3 nights in volunteers
Hindmarch et al Sleep 2005
after pregabalin, control subjects have:
1. increased SWS (absolute and proportional values)
2. reduced overall sleep latency and REM latency
3. sleep reported as more “refreshing”
Pregabalin and Sleep
33. RCT (n=370)
• twice daily PGB
• improved pain
scores
• improved sleep
interference
(sleep diaries)
Van van Seventer et al 2006
Pregabalin, Pain and Sleep Interference
in post-herpetic neuralgia
34. Gabapentin
Tiagabine (Gabatril)
Xyrem (sodium oxybate, GHB)
Melatonin?
Cannabis?
Other drugs that “improve” or increase
deep (slow wave ) sleep
35. Fibromyalgia
Fibromyalgia common (3%?)
Defined by pain symptoms but sleep abnormal
poor sleep efficiency, reduced stage 4
“alpha intrusions” into stage 4, fewer spindles (stage 2)
Several studies have looked at Pregabalin
recent phase III, 748 patients, pain and sleep improved
Mease et al, J Rheumatology (Mar 2008)
Sodium Oxybate also appears effective
small open study (n=18) but sleep, pain and fatigue improved
36. Fibromyalgia
Very recent randomised controlled trial
Moldofsky J Rheum 2010
195 FM patients randomised to
oxybate (4.5, 6G) or placebo
fatigue improved on VAS
pre-Rx: sleep efficiency 76%
SWS 41 min
post-Rx: sleep efficiency 85%
6G SWS 61 min
subjective sleep ratings correlated
with pain scores