Sleep is a biologically regulated process that occurs in stages, including REM and non-REM sleep. It serves important restorative and learning functions. While sleep patterns change with age, disorders like insomnia, sleep apnea, and REM behavior disorder can impact quality of sleep. Non-drug therapies and controlling stimuli are effective treatments for insomnia, though drugs are commonly used in the short-term. Dreams occur primarily in REM sleep and their purpose may be to rehearse threatening situations.

1. 健康與科技:以睡眠為例
蕭富仁

2. Sleeping and Waking
• 猜猜看？那件事我們大約每天花8個小時，每週56小時，每月224小
時，每年2,688個小時，來從事這項活動？
• 王子望著沈睡中的公主，忍不住地親了公主一下；就在那時侯沈睡一
百年的公主竟醒過來了！

3. What Is Sleep?
• Sleep is biologically regulated
• Circadian rhythms
• Melatonin secretion linked to light-dark cycles
• Some adults report needing 7-9 hours a night
• 70-year-old “Miss M.” gets by on one hour per
night!

4. Sleep Is an Altered State
of Consciousness
• Sleep: Awareness of the outside world is
turned off (mostly)
• So why don’t we fall out of bed?
• EEG: The brain is active in sleep

5. Stages of Sleep
• Sleep is not an “on-off” event
• Sleep stages
• Historically: 5 distinct stages
• Currently: Stages 3 & 4 are now joined

7. REM Sleep
• The sleep cycle reverses after about 90
minutes
• Enter REM (paradoxical) stage
• Most dreaming occurs in REM sleep
• Amount of time spent in REM increases
• Cycle through this pattern around 5 times per
night

9. Infant Sleep Patterns
• Infant mammals show a large percentage of REM sleep
• In human, 50% of sleep in the first 2 weeks of life is REM sleep (premature
infants: up to 80%)
• Human infants can move directly from an awake state to REM sleep, by
about 4 months of age, REM sleep is entered through a period of SWS
• REM sleep of infants is quite active: 可能與腦部神經之刺激與發育有關

10. 睡眠與年齡
• 隨著人老化，睡眠的型態也跟著改變。嬰兒的睡眠時間
較長，而且其快速動眼期也比大孩子和成人來的高。
• 例如：新生嬰兒每天大約睡16小時，其中有一半的
時間是在快速動眼期。老年人(50-85歲) 每天只睡
5.75-6 小時，其中13.8-15% 的時間是快速動眼期。

11. Pattern of Sleep in Elderly Persons
• 貓空夜未眠！
• A decline of total amount of sleep
• Increase in the number of awakening during a night
• Lack of sleep or insomnia（失眠）
• Dramatic progressive decline is in stage 3 and 4 sleep (by age 90,
stages 3 and 4 has disappeared, causing sleep dissatisfaction)
Young adult Elderly person

12. How I hate to get out of bed in the morning!

13. Sleep Is an Adaptive Behavior
• Sleep serves important biological purposes:
– Restoration
– Circadian rhythms
– Facilitation of learning

14. Restoration and Sleep Deprivation
• Restorative Theory: Sleep allows the body to
rest and repair itself
• The evidence:
– Sleep increases after strenuous physical activity
– Growth hormones secreted in sleep
– Replenishes the brain’s energy stores
– Strengthens the immune system

15. Restoration and Sleep Deprivation
Effects of sleep deprivation:
• Mood problems (e.g., irritability)
• Decrements in cognitive performance (e.g.,
attention and short-term memory lapses)
• May compromise the immune system
• Falling asleep for a few seconds to a minute
(microsleeps) can impair ability to perform
critical tasks (e.g., driving)

16. Nap
• 瞌睡
– 可愛小孩
– 可愛小貓
• 瞌睡
– 防瞌睡系統

17. Nap on refreshment and memory
Refreshment
4 *** *
3 **
Memory
SSS rating
***
2 *
* 5
1.5
1
Increase in Speed (Seq / Trial)
1.0 4
Increase in Word Pair
0 0.5
S2 SWS Wake 3
0.0
Before Nap *** : S2 vs. Wake, p < 0.001
After Nap S2 vs. SWS, p = 0.009
-0.5
** : SWS vs. Wake, p = 0.006 2
-1.0
* -1.5 1
1.0
* * -2.0
0.5 -2.5 0
S2 SWS Wake
Increase in Sleepiness
S2 SWS Wake
0.0
* : S2 vs.Wake, p = 0.005 S2
* : S2 vs.Wake, p = 0.001
-0.5 S2
SWS SWS
Wake Wake
-1.0
-1.5
-2.0
S2 SWS Wake
S2 vs. Wake, p < 0.001
S2
SWS S2 vs. SWS, p = 0.014
Wake SWS vs. Wake, p = 0.002
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18. Circadian Rhythms
Circadian rhythm theory:
• Many creatures are quiet and inactive during
the night because darkness is the time when
danger is highest
• Reduced risk of exposure to predators
• Humans: Are adapted to sleep at night
because our early ancestors were more at risk
in the dark

19. Facilitation of Learning
Sleep: Strengthens neural connections needed for learning
to occur
• Research shows memory in participants who slept was
greater than those who didn’t (Drosopoulos, Schulze,
Fischer, & Born, 2007)
• REM and slow-wave (stages 3 & 4) important for learning
to take place
• Participants who completed a complex task and later
dreamed about it subsequently performed better on the
task than non-dreaming participants (Wamsley, Tucker,
Payne, Benavides, & Stickgold, 2010)
• Students spend more time in REM during exam periods

20. preattentive scanning vs. focal attention
(visual discrimination)

21. Visual discrimination learning requires sleep after learning
Maquet, Nature Neurosci., 3, 1235-6, 2000.
Stickgold et al., Nature Neurosci., 3, 1237-8, 2000.

22. Two-stage improvement during sleep after learning
Gais et al., Nature Neurosci., 3, 1335-9, 2000.
Karni and Sagi, Nature, 365, 250-2, 1993.

23. Miller, Science, 315, 1360-1363, 2007.

26. EEGs during waking and sleep

31. Block diagram
TI CC2430
EEG × 2
EOG × 1 Time1 8051
EMG × 1 Storing
Airflow × 1 ADC RAM
Micro-SD Card
TI CC2430
ECG × 1 Time1 8051
Respiratory
Storing
Bands × 2 ADC RAM
Micro-SD Card
TI CC2430
Time1 8051
SaO2 × 1
SpO2 × 1 ADC RAM Storing
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Micro-SD Card

32. 眼罩型睡眠記錄分析
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33. People Dream while Sleeping
• Dreams: Products of an altered state of
consciousness in which images and fantasies
are confused with reality

34. REM Dreams and Non-REM Dreams
• REM dreams: More likely to be bizarre and
include intense emotions, visual and auditory
hallucinations, and uncritical acceptance of
illogical events
• Non-REM dreams: Relatively dull (e.g., what
sweater should I wear?)

35. REM Dreams and Non-REM Dreams
Explanation:
• Non-REM: General de-activation of many
brain regions
• REM: Brain structures associated with
motivation, emotion, reward, vision are
active; pre-frontal cortex is not

37. What Do Dreams Mean?
Freud: Dreams contain hidden content that represents
unconscious conflicts
• Manifest content: The plot of a dream; the way the dream
is remembered
• Latent content: What a dream symbolizes; the material
that is disguised in a dream to protect the dreams from
confronting direct reality
• No scientific evidence that dreams represent hidden
conflicts or for the special symbolic meaning of dream
images

38. Activation-Synthesis Theory
The theory:
• The brain tries to make sense of random brain
activity that occurs during sleep by synthesizing
the activity with stored memories (Hobson et al.,
2000)
• Emotion centers (limbic system) in the brain are
active, which explains the intense emotions;
frontal cortices are not active, which explains the
uncritical acceptance of illogical events

39. Activation-Synthesis Theory
The critics:
• Dreams are not as chaotic as the activation-
synthesis theory suggests (Domhoff, 2003)
• Often similar to “everyday life” waking
experience

40. Evolved Threat-Rehearsal Theory
• Thought question: Why do people often dream
about threatening events?
• Answer: Perhaps dreams help us prepare to cope
with real waking events.
• Dreams sometimes simulate threatening events
so that people can rehearse strategies for coping
(Revonsuo, 2000)
• Dreams may have adaptive value if rehearsal
helps us survive and reproduce

41. Sleep Disorders
• Insomnia: Difficulty falling or staying asleep[12-
20% adults, female > male, elderly > young]
• Obstructive Sleep Apnea (OSA): Breathing may
stop hundreds of times per night
• Narcolepsy: Sufferers unexpectedly fall asleep
• REM Behavior Disorder: Sufferers act out their
dreams
• Somnambulism: Sleep walking

42. Clinical Features of OSA
無法熟睡
打鼾 晨醒頭痛
夜間頻尿
注意力不集中 性情改變
白天嗜睡

43. Obstructive sleep apnea and treatment

44. Obstructive sleep apnea and continuous
positive airway pressure (CPAP)

45. insomnia失眠症
• Most common sleep disorder
• primary insomnia(原發性失眠) >1 month secondary
insomnia (次發性失眠) --- about 80%
( heart and lung diseases, pain, anxiety, depression, sleep
apnea, restless legs syndrome)
• PSG ---- R/O apnea, RLS
• lifestyle changes, avoid substances, good bedtime habits
include, cognitive-behavioral therapy, medicines

46. 失眠治療的方式
藥物治療
衛生署許可的藥物治療，常見的有benzodiazepine (BZD)、non-BZD用藥
(台灣一年吃下的安眠鎮靜藥丸超過13億顆，藥費超過10億元。藥物治
療雖然能幫助入睡，但患者隔天的精神、活動力都大受影響，也易有藥
物依賴的困擾。)
off label use(適應症外使用)如鎮靜性抗鬱劑、抗癲癇劑、抗精神病劑、
抗組織胺和褪黑激素可供使用
非藥物治療
包含了認知和行為方面的治療，方法有：
刺激控制治療法( stimulus control instructions )
睡眠限制治療法( sleep restriction therapy)
放鬆訓練(relaxation trainings)
生理回饋法(biofeedback)
認知治療(cognitive therapy)
光照治療(light therapy)
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