Sleep Physiology

A1 What is sleep
B1 Body causes
C1 Central nervous system
D1 Activating reticular formation
D2 Medulla oblagata, pons, midbrain
C2 Cycle is the circadian rhythm in humans (even bacteria have circadian
rhythms [4]
D1 Light (there is some endogenous input also)
D2 Light on the photosensitive ganglion cells in the retina sends a signal
along the retinohypothalamic tract to the suprachiasmatic nuclei
(SCN) via the optic nerve and the optic chiasm (whew)
D3 The SCN is in the anterior part of the hypothalamus and on top of the
optic chiasm
D4 The SCN directs the pineal gland (among others) to release melatonin
D5 Melatonin release varies over a 24 hour period
E1 It is released in darkness
E2 Regulates drowsiness and lowers body temperature
D6 As adenosine rises, melatonin falls [5]
B2 Why? Some theories, no hard data
C1 Brain recharging--some places in brain slow down and repair especially in
memory sorting, that is, what is important and not
C2 Less outside influence on body
C3 Lowers metabolic rate and energy consumption
C4 Lowers blood pressure
C5 Body repair, for example, wound healing is greater
C6 Growth hormone release in the young
C7 Immune system boost
B3 Different than coma or hibernation
C1 Arousable
C2 Different brain activity--some hibernating animals are sleep deprived when
coming out of hibernation

A2 Sleep Stages
B1 Rapid Eye Movement (REM)
C1 Facts
D1 More common in morning
D2 Has periods during sleep
D3 Sleep deprived individuals have more and more quickly
D4 The brain is active
D5 Voluntary muscles are paralyzed
B2 Non-rapid Eye Movement (NREM)
C1 N1
D1 First stage
D2 Less awareness of surroundings
D3 Less muscle tone
D4 Often muscle jerks
C2 N2
D1 Second stage
D2 Occurs at various times in sleep
D3 Less awareness
C3 N3
D1 Also termed delta sleep
D2 The last and usually only one time in sleep
B3 Progression of stages (based on update by The American Academy of Sleep
Medicine (AASM))
C1 N1
D1 Mostly at the beginning of sleep
D2 Slow eye movement
D3 Alpha waves disappear and theta waves appear
D4 Sometimes have muscle jerks
D5 ~5%
C2 N2
D1 No eye movement
D2 Dreaming is very rare
D3 Sleeper is easily awakened
D4 ~50%
C3 N3
D1 Used to be stages 3 and 4
D2 Deep sleep
D3 Delta waves appear
D4 Dreaming
E1 At least in NREM sleep) is most common (in REM sleep it is
more common)
E2 The dreams are not connected to each other, less vivid, and not
remembered.
D5 Also termed Slow-wave Sleep (SWS)
D6 Parasomnias are more common
D7 ~10%
C4 REM
D1 Occurs at various times in sleep
D2 Most dreaming
D3 Voluntary muscles paralyzed
 D4 ~25%
C5 Awake
B4 Length of stages
C1 Each stage or cycle lasts 90 to 110 minutes
C2 Distinct characteristics to each stage

A3 Sleep rhythm
B1 Our biological clock
C1 Sleep controlled by
D1 Circadian rhythm
E1 Actions
F1 Body time keeping
F2 Temperature timing
F3 Enzyme controlling
E2 Works
F1 With adenosine (high levels of adenosine increase s
leepiness)
F2 Sleepiness occurs when the circadian causes release of
melatonin and gradual decrease in body temperature
F3 Affected by a person's chronotype (whether someone is a
morning type, an evening type, or somewhere in
between).
F4 Awakening is controlled by the circadian also, so a person
who generally awakens early will not be able to sleep
later than normal even if sleep deprived
F5 The gene DEC2 controls sleep duration. A mutation in this
gene causes people to sleep less.
D2 Sleep-wake homeostasis
D3 Willed behavior

A4 Sleep Problems
B1 Parasomnias [1]
C1 Types
D1 Arousal disorders
E1 Sleep walking, etc
F1 Sleep walking, sleep eating, even driving and other
strange things
F2 Normal day time actions, but asleep and no or little
remembrance of it
E2 Confusional arousals
F1 A partial awakening from deep NREM sleep
F2 Characteristics
 G1 Confusion
G2 Disorientation
G3 Logical errors
E3 Sleep Terrors
F1 Characteristics
G1 Sits up and screams in terror
G2 Dilated pupils, increased breathing and heart rate
G3 Usually doesn't awaken fully
F2 Different than nightmares because there are no dreams
D2 Sleep-wake transition disorders
G1 Characteristics
H1 Muscle/limb movements
H2 Sleep talking
H3 Jerks and muscle cramps
G2 Occur during the short arousal periods while in
NREM sleep
G3 Types
H1 Rhythmic Movement Disorder
I1 Movements of head, neck, body
sometimes hitting something
hard and causing injury
H2 Sleep Starts
I1 Muscle/limb jerks that wake us up
I2 Most all have these, but if they occur
often can affect sleep quality
H3 Sleep Talking
H4 Nocturnal Leg Cramps
D3 Parasomnias usually associated with REM sleep
E1 Characteristics
F1 These happening during REM sleep
F2 Include nightmares, sleep paralysis, sleep related painful
erections, sinus arrest, and behavior disorders
E2 Types
F1 Nightmares
G1 Happen during the second half of REM sleep
G2 Easily remembered (the opposite of night terrors)
G3 Increased nightmares from stress, personality
disorders, emotional trauma, drugs, and/or
sleep deprivation
F2 Sleep Paralysis
G1 The short term ability to move
G2 Last up to 3 minutes after waking
 G3 Often cause anxiety
F3 Sleep-Related Painful Erections
F4 Sleep-Related Sinus Arrest (waking up because the heart
has stopped)
F5 REM sleep behavior disorder (RBD)
G1 A sleep disorder that causes people to act during
their dreams
G2 A person may be dreaming that someone is trying
to kill them, so they start fighting, which is kind
of hard of their bed partner. Other actions may
include laughing, punching, kicking, shouting
in anger
D4 Other parasomnias
F1 Bruxism/Teeth Grinding
F2 Sleep Enuresis/Bed-Wetting
F3 Nocturnal Paroxysmal Dystonia (NPD)
G1 Seizure like muscle contractions
G2 Can lead to injury
G3 Can last for months, even years
G4 Best treatment in carbamazepine (Tegretol)
C2 Defined
E1 Sleep disorders
E2 Often include strange acts as sleep walking, night terrors, bruxism, [2]
E3 Can happen in NREM and REM sleep
E4 Not remembered
E5 The brain still functions while we sleep
E6 Through skeletal muscle or autonomic nervous systems signals
originating in the brain manifest these behaviors in people with
parasomnias.
B2 Sleep debt
C1 Amount of sleep needed.
D1 For adults 7 to 9 hours of sleep is needed
D2 For children more hours
C2 Defined
D1 Not enough sleep for whatever reason
D2 Builds up, so if you miss 1 hour a week every week, you will have a loss
of 52 hours a year.
C3 Characteristics
D1 Decreased Alertness and Maintaining Focus
D2 Mood--usually mood swings, that is, laughing one minute and crying
the next
D3 Decreased Energy and Motivation
 D4 Less Control, Coordination, and greater Impulsiveness
D5 Pain, for example, headaches
C4 Cure: sleep--for every hour missed, a hour of sleep is needed
B3 Insomnias
C1 Defined
D1 Types
E1 Transient
F1 Lasts less than one week
F2 May be caused by
G1 The room environment
G2 Stress
G3 Depression
E2 Acute: lasts between one week and less than one month
E3 Chronic: lasts longer than one month
D2 Patterns in insomnia
E1 Onset
F1 Hard to fall asleep
F2 Sometimes associated with anxiety disorders
E2 Middle on the night: can fall asleep OK but have difficulty falling
back asleep
E3 Middle insomnia
F1 Difficult maintaining asleep
F2 Sometimes associated with pain or medical illness
E4 Terminal
F1 Awakens too early in the morning
F2 Sometimes associated with clinical depression
D3 Causes
E1 Drugs
F1 Over the counter--herbs, caffeine, nicotine, etc
F2 Prescriptions--Fluoroguinolones
F3 Nonprescription--cocaine, amphetamines, etc
E2 Medical as pain, hormone shifts, circadian rhythm disturbances
(shift work, jet lag), hyperthyroidism, rheumatoid arthritis
E3 Rebound insomnia from over use of drugs to sleep
E4 Noise
E5 Psychological as depression, bipolar, anxiety, OCD, etc
E6 Neurological disorders as brain lesions, brain injuries (traumatic)
E7 Physical exercise before bedtime
D4 Treatment
E1 Non-pharmacological
F1 Sleep hygiene--drowning out noise and other obnoxious
things, so use white noise, music, etc
 F2 Stimulus control--some people associate bed with
unpleasantness, so training to overcome this
F3 Behavioral interventions--somewhat related to stimulus
control
F4 Sleep restriction therapy--trying to stay awake longer
F5 Paradoxical intention--doing everything possible to stay
awake, instead of trying to fall asleep
F6 Patient education
F7 Relaxation therapy
E2 Cognitive behavior therapy
F1 Taught improved sleep habits
F2 Correcting wrong assumptions about sleep
E3 Medications--all have some problems
F1 Benzodiazepines
G1 Method of action: Benzodiazepines bind
nonselectively to the GABAa receptor.
G2 Examples: temazepam, flunitrazepam, triazolam,
flurazepam, midazolam
G3 Problems
H1 Help to fall asleep but decrease deep sleep
H2 Addictive
H3 Withdrawal dangers
F2 Non-Benzodiazepines
G1 Method of action: alpha1 selective on GABAa
receptors
G2 Examples: zolpidem, eszopiclone
G3 Problems
H1 Psychological and physical dependence
H2 Memory and cognitive disturbances
F3 Alcohol
G1 Can be used
G2 Problems
H1 Can cause insomnia
H2 Decrease in NREM
H3 Frequently awake with headaches, need to
void (due to ADH inhibition),
dehydration, diaphoresis
H4 Glutamine
I1 Alcohol inhibits glutamine production
I2 When stopping drinking, the body
increases glutamine production
to catch up
 I3 This increases brain activity
F4 Opioids
G1 To treat pain
G2 May break up sleep
G3 May decrease REM and stage 2 (N2) sleep
F5 Antidepressants
G1 Examples: amitriptyline, doxepin, mirtazapine, and
trazodone
G2 Problems: their side effects
F6 Melatonin and melatonin agonists
G1 Some evidence that melatonin has the same effect
as Lunesta (zopiclone)
G2 Some other examples: 5-HTP and L-Tryptophan
G3 Long term studies are not available
F7 Antihistamines
G1 Problems
H1 Effect lowers after time
H2 Possible of day time drowsiness (hang over
effect)
H3 Anticholinergic side effects
G2 Examples: benadryl, etc
F8 Atypical antipsychotics
G1 Examples: atypical antipsychotics such as
quetiapine, olanzapine and risperidone
G2 Problems
H1 Some lose effectiveness after time
H2 Lower doses needed, yet higher doses
often needed for psychological
diagnosis
F9 Other
G1 Herbs as valerian, chamomile, lavender, hops, and
passion-flower
G2 Magnesium deficiency sometimes causes
insomnia
C2 Possible problems caused by lack of sleep [3]
D1 Mental
E1 Irritability
E2 Cognitive impairment
E3 Memory lapses or loss
E4 Impaired judgment (moral and otherwise)
E5 Yawning
E6 Hallucinations
 E7 ADHD similar symptoms
D2 Cardiac
E1 Increased changes in heart rate
E2 Increased risk of heart disease
D3 Muscle/skeletal
E1 Decreased reaction times and accuracy
E2 Tremors
E3 Muscle aches/pains
D4 Impaired immune system and type 2 diabetes mellitus
D5 Other
E1 Growth suppression
E2 Risk of obesity
E3 Decreased temperature

A5 Tests
B1 Polysomnography
C1 Sleep study
C2 Measurements
D1 EEG
D2 Electrooculography (EOG) (This is the recording of eye movements)
D3 Electromyography (EMG) (This is the recording of skeletal muscle
movements)
B2 Graph
C1 Hypnogram

C2 EEG
D1 Stage 1
D2 Stage 2
D3 Stage 3 (Stage 3 and 4 have been combined in 2007)
D5 REM
 The red line in the REM, the red box is the EEG

Sources:

The American Academy of Sleep Medicine (AASM)

http://science.education.nih.gov/supplements/nih3/sleep/guide/info-sleep.htm

http://healthysleep.med.harvard.edu/glossary/g-j

http://en.wikipedia.org/wiki/Insomnia

http://www.sleepdex.org/patho.htm

http://www.ajpe.org/legacy/pdfs/aj620216.pdf
http://www.nhlbi.nih.gov/about/ncsdr/index.htm

http://emedicine.medscape.com/article/1188226-overview

1. http://www.stanford.edu/~dement/para.html

2. http://www.end-your-sleep-deprivation.com/parasomnias.html

3. http://en.wikipedia.org/wiki/File:Effects_of_sleep_deprivation.svg

4. http://en.wikipedia.org/wiki/Circadian_rhythm

5.
http://www.associatedcontent.com/article/66094/sleep_physiology_and_sleep_disorders.html

©2010lganeRN