Continuum of Consciousness
- Controlled and Automatic Processes
- Altered States of Consciousness
- Psychoactive Drugs
- Sleep and Dreams
- Different Stages of Sleep (REM and N-REM)
- 4 Major Questions About Sleep
- Sleep Disorders
- The Unconscious Mind
- Unconsciousness
Continuum of Consciousness
- Controlled and Automatic Processes
- Altered States of Consciousness
- Psychoactive Drugs
- Sleep and Dreams
- Different Stages of Sleep (REM and N-REM)
- 4 Major Questions About Sleep
- Sleep Disorders
- The Unconscious Mind
- Unconsciousness
AQA A2 Psychology Unit 3 - Bio-rhythms and SleepSnowfairy007
AQA A2 Psychology Unit 3 - Bio-rhythms and Sleep
Overview of everything needed for this exam on the specification for this exam board on this topic. It might be applicable to other exam boards but please be careful if you are using it as revision for another exam board.
Alterative acupuncture (when nothing works try acupuncture)Ck Raju
A set of Points within the Acupuncturist's Toolbox become friendly to him - so they show an AlterAtive effect each time he attempts a treatment. This is explained here that the Yang natured Metal and Fire Element Points of Acupuncture Meridian system.are always powerfully efficacious in treatments.
Mitsui Onnetsu Therapy is a kind of thermal therapy that originated from Japan. It makes use of Mitsui Onnetsuki, the therapy device invented by Dr Tomeko Mitsui. This therapy applies the far infrared technology to the traditional moxibustion principle of Traditional Chinese Medicine (TCM).
AQA A2 Psychology Unit 3 - Bio-rhythms and SleepSnowfairy007
AQA A2 Psychology Unit 3 - Bio-rhythms and Sleep
Overview of everything needed for this exam on the specification for this exam board on this topic. It might be applicable to other exam boards but please be careful if you are using it as revision for another exam board.
Alterative acupuncture (when nothing works try acupuncture)Ck Raju
A set of Points within the Acupuncturist's Toolbox become friendly to him - so they show an AlterAtive effect each time he attempts a treatment. This is explained here that the Yang natured Metal and Fire Element Points of Acupuncture Meridian system.are always powerfully efficacious in treatments.
Mitsui Onnetsu Therapy is a kind of thermal therapy that originated from Japan. It makes use of Mitsui Onnetsuki, the therapy device invented by Dr Tomeko Mitsui. This therapy applies the far infrared technology to the traditional moxibustion principle of Traditional Chinese Medicine (TCM).
Primary sleep disorders:
Primary sleep disorders are those disorders not attributable to another cause, which includes dyssomnias and parasomnias.
Dyssomnias: are primary disorders of initiating or maintaining sleep/ excessive sleepiness, characterized by abnormalities in the amount, quality, or timing of sleep.
Insomnia:
Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 month and causes significant distress or impairment in social, occupational, or other important areas of functioning.
Hypersomnia:
Excessive sleepiness for atleast 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in social, occupational or other functioning.
Narcolepsy:
A rare sleep disorder in which a person, usually under the age of 20, has recurrent sudden episodes of irresistible sleep attacks of short duration 10 - 15 minutes (directly enters into REM sleep).
Breathing related sleep disorder:
Sleep disruption leading to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of sventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels).
Circadian Rhythm Sleep Disorder:
Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include; delayed sleep phase, jet lag, shift work and unspecified.
Delayed sleep phase: A persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time.
Jet lag: Sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone.
Shift work: Insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work.
Parasomnias: are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times during sleep.
Nightmare disorder:
Repeated occurrence of frightening dreams that lead to waking from sleep.
Sleep terror disorder:
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry.
Sleepwalking disorder (Somnambulism):
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.
Introduction
The sleep – wakefulness cycle is genetically determined rather than learned and is established sometime after birth.Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity and [inhibition of nearly all voluntary muscle during REM sleep] reduced interactions with surroundings.
Sleep can be regarded as a physiological reversible reduction of conscious awareness. Nearly one third of human life is spent in sleep. Disorders of sleep can affect activities of daily living (ADL) of an individual.
Definition
It is an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day.
The EEG recordings show typical features of sleep which is broadly divided into two broadly different phases:
1. D-sleep (desynchronised or dreaming sleep), also called as REM- sleep (rapid eye movement sleep),active sleep, or paradoxical sleep.
2. S-sleep (synchronised sleep), also called as NREM-sleep (non-REM sleep), quiet sleep, or orthodox sleep. S-sleep or NREM-sleep is further divided into four stages, ranging from stages 1 to 4. As the person falls asleep, the person fifi rst passes through these stages of NREM-sleep.
Stages of sleep
The EEG recording during the waking state shows alpha waves of 8-12 cycles/sec. frequency. The onset of sleep is characterised by a disappearance of the alpha-activity.
Stage 1, NREM-sleep is the first and the ligh test stage of sleep characterised by an absence of alphawaves, and low voltage, predominantly theta activity.
Stage 2, NREM-sleep follows the stage 1 within a few minutes and is characterised by two typical EEG changes:
i. Sleep spindles: Regular spindle shaped waves of 13-15 cycles/sec. frequency, lasting 0.5-2.0
seconds, with a charac teristic waxing and waning amplitude.
ii. K-complexes: High voltage spikes present intermittently.
Stage 3, NREM-sleep shows appearance of high voltage, 75 μV, δ-waves of 0.5-3.0 cycles/sec.
Stage 4, NREM-sleep shows predominant δ-activity in EEG. NREM-sleep is followed by REM-sleep, which is a light phase of sleep. The EEG is characterised by a return of α-waves (α-wave sleep); other changes are similar to stage 1 NREM-sleep. One of the most characteristic features of the REM-sleep is presence of REM or rapid (conjugate) eye move ments. The other features include generalised mus cular atony, penile erection, autonomic hyperactivity (increase in pulse rate, respiratory rate and blood pressure), and movements of small muscle groups, occurring intermittently. Although it is a light stage of sleep, arousal is diffificult. These stages occur regularly throughout the whole duration of sleep. The first REM period occurs typically after 90 minutes of the onset of sleep, although it can start as early as 7 minutes after going off to sleep, e.g. in narcolepsy, in major depression, and after sleep deprivation.
Sleep and rest, BSC NURSING FIRST YEAR NURSING FOUNDATION , UNIT X , MEETING NEEDS OF PATIENT , PHYSIOLOGY OF SLEEP, SLEEP DISORDERS, FACTORS AFFECTING SLEEP, PROMOTING SLEEP AND STAGES OF SLEEP.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. SLEEP
A revesible state of unresponsivnes to the enviroment
Brain is more responsive to internal than external stimuli
Less responsive to visual, auditory, and other environmental stimuli
during the transition from wake to sleep.
3. Milestones
1837 – Dickens – describes overweight/hypersomnolent
boy in the Posthumous Papers of the Pickwick Club (term
“pickwickian” used by Osler)
1928 – Berger – Human EEG alpha waves
1937 – Loomis – EEG Sleep stages
1953 – Aserinsky & Kleitman – REM sleep
1970s – Polysomnography
1972 – Guilleminault – coins term OSA
1990 – International Classification of Sleep Disorders
4. 2000 B.CEgypt
The Egyptians wrote these dreams on papyrus with dreams symbols.
Egyptians were among the early civilizations to attempt interpretation of their dreams.
Egypt was where the process of "dream incubation" began. When a person was having
troubles in their life and wanted help from their god, they would sleep in a temple, when
they would wake the next morning a priest, which was then called a 'Master of the Secret
Things', would be consulted for the interpretations of that night's dreams.
7. Mechanism of
normal sleep and
wakefulness
Homeostasis
process
REM sleep NonREM sleep
Circadian process
- Melatonin
- Body
temperature
- Cortisol.
8. Homeostatic process
Sleep homeostasis can be modeled by assuming there is a
quantitative need for sleep that builds while a person is
awake and declines during sleep.
The homeostatic pressure to sleep depends on how long
you are awake and how active you are while awake.
9. Circadian process
It helps keep the homeostatic process in line.
It helps us sleep through the night and not drop off during the day.
Physiologists who use this model often call the homeostatic process "Process S" and the
circadian one "Process C."
13. Functions of sleep
Energy conservation
Energy is conserved during sleep: muscular tension, heart rate, blood pressure,
temperature and rate of respiration are reduced.
Memory consolidation& learning
sleep, especially REM, may actively contribute through processes that consolidate
the learned material.
Body restoration & Immune function
16. Sleep Onset
Sleep begins at sleep onset even before a person reaches stage I NREM sleep
heaviness and drooping of the eyelids
clouding of the sensorium
inability to see, hear or perceive things
in a rational or logical manner
The person at this moment has no control of his brain and cannot respond logically and
adequately
17. Stages of Sleep
There are two general stages of sleep;
1. Rapid Eye Movement (REM) Sleep
2. Non-Rapid Eye Movement (NREM) Sleep
18.
19. Non-REM Sleep
Stage I
• Light sleep
• Eyes &
muscle
activity slows
• 3-8% of sleep
time
Stage II
• True sleep
• Stoppage of
eye
movements
• 40-50% of
sleep time
Stage III
• Deep sleep
or Slow-
wave sleep
(SWS)
• δ waves 20-
50%
Stage IV
• Deep sleep
or SWS
• No eye &
muscle
activity
• 20% of sleep
time
• δ waves >50%
American Academy of Sleep
Medicine (AASM)
now considered stage III & IV as
STAGE III
21. Evolution of sleep patterns with age
Newborns
Polyphasic, 16hrs/day, REM sleep : 50%,
Infants
3 months of age the NREM-REM cyclic pattern of adult
sleep is established
Preschool
Biphasic , 10hrs/day, REM sleep : 25%, high arousal
threshold
Adults
Monophasic, 8hrs/night, REM sleep: 25%, 40% reduction in
the time spent in the stage 3 & 4 of NREM & replaced by
stage 2
Elderly
Biphasic, marked attenuation of the amplitude of delta
waves , increased sleep fragmentation, Alzheimer's and
Parkinson's are characterized by decreasing amounts of
REM sleep as the diseases progress
22. REM SLEEP = Paradoxical sleep
The brain waves had a high frequency and low voltage = normal
awake state
A desynchronized EEG - fast rhythms & θ activity, sawtooth
appearance
20-25% of sleep time, in infants it is about 40%
23. REM sleep can be subdivided into two stages :
•Hypotonia or atonia of the major muscle
groups
•Depression of monosynaptic and
polysynaptic reflexes
Tonic
•Rapid eye movements in all directions
•Phasic swings in blood pressure & heart rate,
irregular respiration, spontaneous middle ear
muscle activity & tongue movements
•Few periods of apnea or hypopnea
Phasic
33. Insomnia is a sleep disorder that is characterized by difficulty
falling and/or staying asleep. People with insomnia have one
or more of the following symptoms:
Difficulty falling asleep
Waking up often during the night and having trouble going
back to sleep
Waking up too early in the morning
Feeling tired upon waking
34. Insomnia may be divided into three classes based on the duration
of symptoms.
•Insomnia lasting one week or less may be termed transient
insomnia
•short-term insomnia lasts more than one week but resolves
in less than three weeks
•long-term or chronic insomnia lasts more than three
weeks.
35. Transient and short-term insomnia
• Jet lag
• Changes in shift work
• Excessive or unpleasant noise
• Uncomfortable room temperature (too hot or
too cold)
• Stressful situations in life (exam preparation, loss
of a loved one, unemployment, divorce, or
separation)
• Presence of an acute medical or surgical
illness or hospitalization
• Withdrawal from drug, alcohol, sedative, or
stimulant medications
• Insomnia related to high altitude (mountains)
Causes
37. Physiological
• Chronic pain syndromes
• Chronic fatigue syndrome
• Congestive heart failure
• Night time angina (chest pain from heart disease
• Acid reflux disease (GERD)
• Chronic obstructive pulmonary disease (COPD)
• Nocturnal asthma (asthma with night time breathing
symptoms
• Obstructive sleep apnea
• Degenerative diseases, such as Parkinson's disease and
Alzheimer's disease (Often insomnia is the deciding factor
for nursing home placement.)
• Brain tumors, strokes, or trauma to the brain
38. Medication Related
Insomnia
• Asthma preparations
• high blood pressure
• depression, anxiety, and
schizophrenia.
Other Causes
• Caffeine and nicotine
• Alcohol
• A disruptive bed partner
with loud snoring or
periodic leg movements
40. Stick to a sleep schedule
Get out of bed when you're not sleeping
Avoid trying to sleep
Use your bed and bedroom only for sleeping
Find ways to relax
Avoid or limit naps
Make your bedroom comfortable for sleep
Exercise and stay active
Avoid or limit caffeine, alcohol and nicotine
Avoid large meals and beverages before bed
Check your medications
Don't put up with pain
Hide the bedroom clocks
42. Cognitive behavior therapy
Helps change incorrect beliefs and attitudes about sleep (e.g., unrealistic
expectations, misconceptions, amplifying consequences of sleeplessness);
techniques include reattribution training (i.e., goal setting and planning coping
responses), decatastrophizing (aimed at balancing anxious automatic thoughts),
reappraisal, and attention shifting.
Moderate-intensity exercise (should not occur just before bedtime)
Relaxation therapy : Tensing and relaxing different muscle groups; biofeedback or imagery
(visual and auditory feedback) to reduce somatic arousal; meditation; hypnosis
Sleep restriction (paradoxical intention therapy) Uses a paradoxical approach in which the
patient spends less time in bed .This state of minimal sleep deprivation eventually leads to
more efficient sleep
Stimulus control therapy :Avoid bright lights (including television); noise and temperature
extremes; and large meals, caffeine, tobacco, and alcohol at night
Minimize evening fluid intake; leave the bedroom if unable to fall asleep within 20 minutes;
limit use of the bedroom to sleep and intimacy
43. Initiate hypnotic use with identifying and addressing specific behaviors, circumstances,
and underlying disorders contributing to insomnia
Prescribe the lowest effective dose of the hypnotic
Prescribe hypnotics for short durations (two to four weeks) and intermittently
Avoid hypnotic use or exercise caution if patient has a history of substance abuse,
myasthenia gravis, respiratory impairment, or acute cerebrovascular accident
Watch for requests for escalating doses or resistance to tapering or discontinuing
hypnotic
Hypnotics should be discontinued gradually (i.e., tapered); physician should be alert for
adverse effects (especially rebound insomnia) and withdrawal phenomena
Guidelines for Prescribing Hypnotics
48. An apnea, which is the
cessation of breathing for
at least 10 seconds, can
occur as many as 20 to 60
times within an hour
The quality of one's sleep is
greatly compromised
leading to numerous
health conditions and a
decline in the quality of life
49. Obstructive sleep apnea - the most common type.
Occurs when the soft tissue in the back of throat relaxes
during sleep, causing a blockage of the airway and
snoring.
Central sleep apnea - much less common type.It involves
the CNS. It occurs when the brain fails to signal the
muscles that control breathing. Seldomly snore.
Complex sleep apnea – combination of both.
50.
51.
52. Definitions
Apnea Cessation of airflow for >10 s
Hypopnea A reduction in but not complete cessation of
airflow to <50% of normal, usually in association with a
reduction in oxyhemoglobin saturation
AHI The frequency of apneas and hypopneas per hour of
sleep; a measure of the severity of sleep apnea
OSA and hypopnea Apnea or hypopnea resulting from
complete or partial collapse, respectively, of the pharynx
during sleep
CSA and hypopnea Apnea or hypopnea resulting from
complete or partial withdrawal of central respiratory drive,
respectively, to the muscles of respiration during sleep
Oxygen desaturation Reduction in oxyhemoglobin
saturation, usually as a result of an apnea or hypopnea
57. overweight
male
over the age of 65
black, Hispanic, or a Pacific Islander
related to someone who has sleep apnea
a smoker
certain physical attributes - thick neck, deviated septum, receding
chin, or enlarged tonsils or adenoids.
Allergies or other medical conditions that cause to nasal congestion
58.
59. Polysomnography is usually done to diagnose sleep apnea.
There are two kinds of polysomnograms
An overnight polysomnography test involves monitoring brain waves,
muscle tension, eye movement, respiration, oxygen level in the blood
and audio monitoring. Home monitoring respiratory test.
They are painless tests.
60. Mild Sleep Apnea is usually treated by some behavioral changes
Losing weight, sleeping on your side
oral mouth devices (that help keep the airway open) help to reduce snoring in three different ways.
Some devices
bring the jaw forward
elevate the soft palate
retain the tongue (from falling back in the airway and blocking breathing).
61. Moderate to severe Sleep
Apnea is usually treated with a
C-PAP (continous positive
airway pressure). C-PAP is a
machine that blows air into your
nose via a nose mask, keeping
the airway open and
unobstructed.
For more severe apnea, there is
a Bi-level (Bi-PAP) machine. The
Bi-level machine is different in
that it blows air at two different
pressures. When a person
inhales, the pressure is higher
and in exhaling, the pressure is
lower
62. TRACHEOSTOMY
UVULOPALATOPHARYNGOPLASTY
(UPPP)
MANDIBULAR MYOTOMY
LASER ASSISTED UVULOPLASTY
(LAUP)
RADIO FREQUENCY (RF)
PROCEDURE OR SOMNOPLASTY
Unfortunately, at this time the
procedure is so new and is still
seen as an experimental
procedure.
63.
64. What is RLS?
Neurological disorder characterized by
Uncontrollable, overwhelming urge to move leg (akathisia)
Occur at night or when relaxing or at rest
Movement → immediate relief of symptoms
Movement stop → return of symptoms
Ignoring symptoms → ↑ akathisia
Difficulty falling & staying asleep → exhaustion & daytime fatigue
65. ETIOLOGY
Related to dysfunction of basal ganglia circuits that use dopamine as neurotransmitter
In the evening dopamine levels fall → symptoms of RLS are often worse in the evening &
night
Brain iron depletion causes alteration of brain dopaminergic system .
66. TYPES
Primary RLS
• Idiopathic
• Gradual onset
• Before age 40-45
• Progressive with age
Secondary RLS
• 2ry to other conditions
• Sudden onset
• After age 40
•
67. 2ry RLS
Neurological
Medical
Drugs
✿ Multiple sclerosis
✿ Parkinson's
✿ Peripheral neuropathy
✿ Anaemia – iron & folate
✿ Uremia & renal failure
✿ Magnesium deficiency
✿ Hypothyroidism, DM
✿ Pregnancy
✿ Auto-immune - RA, celiac
disease, Sjögren’s syndrome
✿ Anti –nausea
✿ Anti –psychotic
✿ Alcohol
✿ Withdrawal from sedatives
or narcotic
✿ Ca channel blocker
May associated with these conditions
68. Diagnosis of primary RLS
Essential criteria
An urge to move the legs usually accompanied or caused by
uncomfortable sensations in the legs
The urge to move or unpleasant sensations beginning or worsening
during periods of rest or inactivity such as lying or sitting
The urge to move or unpleasant sensations are partially or totally
relieved by movements, such as walking or stretching, at least as
long as the activity continues
The urge to move or unpleasant sensations are worse in the evening
or night than during the day or only occur in the evening or night
Supportive features
Dopaminergic responsiveness
Presence of periodic limb movements in sleep or in wakefulness
Positive family history
Associated features
Usually progressive clinical course
Normal neurological examination in the idiopathic form
Sleep disturbance
71. abnormal movements or behavior
intruding into sleep
during the night intermittently or episodically
without disturbing the sleep architecture
72. 5 – 12 years old
abrupt motor activity arising out of
SWS during the first one third of
sleep
< 10 minutes
complex behavior, nonsensical talking,
eyes are commonly open
In the 2nd sleep cycle
73. fearful, vivid, and often frightening
dreams, mostly visual but sometimes
auditory, seen during REM sleep
accompany sleep talking and body movements
Begin 3-5 years
74. SE of certain medications
sudden withdrawal certain drugs
Reassurance
behavioral or psychotherapy
REM sleep-suppressant medications
75. 1. Excessive daytime sleepiness
2. Cataplexy
3. Hypnagogic hallucination
4. Sleep paralysis.
Narcolepsy is characterized by the classic tetrad of:
84. •Chronotherapy
•Bright light therapy
•Enhancing environmental cues
Behavioral
Treatment
•Sleep hygiene (avoid
napping,sleep & wake up on
same time each day, etc…)
Promoting A
Sound Sleep
•melatonin
•Melatonin receptor stimulantMedication
86. Sleep history
Patient bed time, time taken to fall asleep and duration of sleep
Sleep position
Detailed history of daytime sleepiness and how it affects individual
quality of life
How patient feels upon awakening
Any sleep behavior
Other history
History of CVD, nasopharyngeal problems, cerebral vascular disease
Family history:
Sleep apnea syndrome
Narcolepsy
RLS
89. 1. Polysomnography
Sleep-related
breathing disorders
Obstructive sleep
apnea
Central sleep
apnea syndrome
Obesity
hypoventilation
syndrome
Upper airway
resistance
syndrome
Neurologic and
movement disorders
Periodic limb
movement disorder
Seizure disorders
Parasomnias such as
— sleepwalking
— nocturnal
movements
Narcolepsy or
hypersomnolence
REM-behavior
disorder
Therapeutic indications
Continuous positive
airway pressure
titration
Assessment of
adequacy of sleep-
related interventions
Respiratory
insufficiency (that is,
amyotrophic lateral
sclerosis) and the
titration of
noninvasive
ventilatory support
Indication
90. Polysomnography
This test records several body functions during sleep
brain activity
eye movement
oxygen and carbon dioxide blood levels
heart rate and rhythm
Respiratory rate and rhythm
The flow of air through your mouth and nose
Snoring
Body muscle movements
Respiratory effort: Chest and abdominal movement
Principle
91. Brain activity (EEG): Sleep time, stages of sleep(NREM and REM),
and awake time
Abnormal brain activity (such as a seizure) is
noted.
Eye movement (EOG): Slow eye movements are present at the
start of sleep and change to rapid eye
movements during REM sleep.
Muscle movement (EMG): Leg jerking or other abnormal muscle
movement
Blood oxygen (O2) level: Blood O2 level is greater than 90% in normal
Heart rate and rhythm (ECG): Heart rate changes (arrhythmias), such as
an abnormally slow or fast heart rate, are
noted.
Breathing effort (RDI): Reduced air flow (hypopnea) or no air flow
(apnea) to the lungs occurs fewer than 5
times in 1 hour in normal
Chest and abdominal movements: Observe for abnormal chest and abdominal
movement throughout the study.
Audio and video recordings: Observe for restful or disturbed sleep such as
night terrors, sleepwalking, and sleep
talking.
Snoring monitor: Observe for excessive snoring or abnormal
snoring patterns.
More than 5 times in an hour mean
the patient have sleep apnea
Epileptiform ECG finding diagnose
seizure
If present diagnose parasominia of
corresponding type.
Finding
92.
93. 2. Multiple sleep latency test (MSLT)
Patient complaining or suspected of having excessive daytime
sleepiness (EDS)
Indication
94. Multiple sleep latency test (MSLT)
It is a nap study.
The test consists of four to five daytime EEG, EMG, and EOG
recordings at 2-hour intervals
Each recording lasting for a maximum of 20 minutes
The test measures
The average sleep-onset latency
The presence of SOREMs (timed from sleep onset to the first REM sleep)
Principle
95. Patient is placed in a darkened room and asked to lie back, relax,
and to sleep if they feel like it.
They are allowed 20 minutes to achieve sleep
The time to falling asleep and the type of sleep that the patient goes
into is determined
This is repeated for 4 to 5 times at interval of 2 hours
How it is done?
96. Normal Abnormal
More than 10 minutes to
fall asleep
Mean of 5 minutes to fall
asleep
At most, one nap episode
with REM sleep in 4 to 5
naps opportunity
Two naps or more with
REM sleep in 4 to 5 naps
opportunity is indicative of
pathology
Finding
97. 3. Maintenance of wakefulness test (MWT)
Variation of MSLT
The principle is the same with MSLT except
Patient adopts a semireclining position in a chair and is instructed to resist
sleep
If the patient fall asleep, the time from lights out to the onset of sleep
for each nap is recorded
Principle
98. Normal Abnormal
Will not falling asleep in
less than 25 minutes after
light off
Falling asleep less than 25
minutes
The MWT is of most value in determining the
effects of treatment to relieve daytime
sleepiness.
Finding
99. 4. Actigraphy
Is a technique of motion detection that records activities during sleep
and waking
It complements a sleep diary or sleep log data.
The actigraphic instrument worn generally on the wrist and ankle for
1-2 weeks.
It is a cost-effective method for assessing a sleep-wake pattern.
Principle
100.
101. Actigraphy
circadian rhythm sleep disorders
sleep-state misperception
other types of insomnia.
To detect and quantify PLMS
Indication
102. Other investigation
Thyroid function test to confirm hypothyroidism
Liver functions
Biochemical screening done in patient with RLS to exclude renal impairment and
chemical abnormality