Sleep physiology and disorder

Sleep
Is a recurrent, altered state of consciousness that occurs for sustained periods, restoring physical health and mental well being. It is a sensory experience and can be selective

Why do we sleep?

Sleep cycle
REM

Rapid eye movement NREM Non-rapid eye movement

Non-REM sleep
Reduced

body Minimal movement body capable of movement, but brain rarely commands to Low temperature & energy consumption Heart rate, respiration & kidney function slow down Increased digestive process

muscle tension through out

Non- REM sleep stages

Stage

1 transitional sleep; lightest stage. - eyes make slow rolling movements duration few minutes Stage 2 slightly deeper - eye movements almost stop - duration 5-15 minutes Stage 3 - large amplitude slow rhythms no eye or body movements Stage 4 deepest stage - duration 20-40 minutes

REM sleep

Dreaming period EEG almost indistinguishable from that of an active brain High oxygen consumption Increased and irregular heart & respiration rates Muscle atony exception: muscles controlling eye movements & tiny muscles in inner ear respiratory muscles barely operate eyes occasionally dart rapidly back & forth Body temperature drops

Timing

Sleep timing is controlled by the circadian clock sleep-wake homeostasis. The circadian clockan inner timekeeping, temperaturefluctuating, enzyme-controlling deviceworks in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. Homeostatic sleep propensity (the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode) must be balanced against the circadian element for satisfactory sleep.

Optimal amount in humans

Newborns (02 months)12 to 18 hours Infants (311 months)14 to 15 hours Toddlers (13 years)12 to 14 hours Preschoolers (35 years)11 to 13 hours School-age children (510 years)10 to 11 hours Adolescents (1017 years)8.5 to 9.25 hours Adults, including elderly7 to 9 hours

FACTORS AFFECTING SLEEP

1.
2.

DevelopmentalLifespan Considerations Psychological Stress

Motivation Desire

Anxiety Depression

3.

4.

Life style

to stay awake ..overcome sleepiness Opposite can occur also

Shift work Dietary Habits (caffein, smoking)

4.

Medication

Antidepressantssupress REM Narcotics--- supress REM Heart medicationsnightmares, insomnia Some Steroids, Decongestants, Antiparkinsonian can disrupt Hypothyroidism.less NREM Respiratory conditionscongestion Need to urinate Temperature increases.. less NREM and REM Discomfort from restricted movement

6.

Illnesses

Sleep disorder
1.

Insomnia It is a term applied to people who have a complaint of un-refreshing sleep, difficulty initiating or maintaining sleep. Also defined as less than 5.5hrs of sleep/24hrs Most patients with insomnia have daytime effects of the disturbed nighttime sleep such as fatigue, tiredness, irritability or inability to concentrate.

2.

Nocturnal Myoclonus Restless leg syndrome Urge to walk ,irritating ache or creepy feeling in calves and thighs Common in elderly It may be associated with nerve damage in the legs due to diabetes, kidney problems or alcoholism. Stress, diet may play a role in it.

3.

Primary Snoring :
also known as simple snoring, snoring without sleep apnea rhythmical snoring and continous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).

Hypersomnia Excessive sleep especially during the day Medical condition or frequently a coping mechanism to avoid a problem
4.

5.

Narcolepsia Is a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally Its usually accompanied by Cataplexy(sudden and transient episode of loss of muscle tone) A person with narcolepsy is likely to become drowsy or fall asleep or just be very tired throughout the day Patients with narcolepsy can be substantially helped, but not cured

6.

7.
8.

Sleep paralysis - inability to move especially the limbs durring sleep Hallucinations - vivid visual and or auditory imagines Parasomnia - Some disruptive event occurs during specific sleep periods and/or transitions.

Nightmare Disorder: Usually begins in children between the age of 3 and 6. It can persist into adulthood. The individual experiences repeated awakenings with detailed recall of frightening dreams. Episodes generally occur during second half of sleep period. 11. Sleep Terror Disorder : Occurs both among children and adults. Individual experiences repeated episodes of abrupt awakening during the first third of a sleep cycle. Individual awakes with a scream and physiological symptoms similar to those of a panic attack. Individual is generally unresponsive to attempts to be comforted and when finally awake, no memory of the dream.
10.

Sleepwalking Disorder: Begins in childhood and ends during adolescence. Initial onset of sleepwalking in adulthood is unusual. Involves the client getting up and walking around, usually during the first third of the sleep cycle. Very difficult to awake and no memory of the incident.
12.

Bibliography

Consciousness, 17 January 2013, http://en.wikipedia.org/wiki/Consciousness Non-rapid eye movement sleep, 10 January 2013 http://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep Rapid eye movement sleep, 9 January 2013, http://en.wikipedia.org/wiki/Rapid_eye_movement_(sleep) Sleep, 17 January 2013, http://en.wikipedia.org/wiki/Active_Sleep#Physiology Factors Affecting Sleep- Lifestyle, Videojug, http://www.videojug.com/interview/factors-affecting-sleep-lifestyle Insomnia, 15 January 2013, http://en.wikipedia.org/wiki/Insomnia Restless Legs Syndrome Center, WebMD, 01 February 2011,< http://www.webmd.com/brain/restless-legs-syndrome/restless-legssyndrome-rls >

Snoring, 10 January 2013, http://en.wikipedia.org/wiki/Snoring Sleep and Hypersomnia, 28 July 2012 ,http://www.webmd.com/sleep-disorders/guide/hypersomnia Narcolepsy, 17 January 2013, http://en.wikipedia.org/wiki/Narcolepsy Nightmare disorder, http://www.minddisorders.com/KauNu/Nightmare-disorder.html Sleep terror disorder, http://www.minddisorders.com/PyZ/Sleep-terror-disorder.html Sleep Disorders Health Center, WebMD,15 October 2011, http://www.webmd.com/sleep-disorders/guide/sleepwalkingcauses