Although sleep appears to be a passive and restful time, it actually involves a

highly active and well-scripted interplay of brain circuits, resulting in

sleep�s various stages
What is used to study human brain waves EEG or electroencephalography
stages of sleep were discovered in the 1950s through experiments using
electroencephalography (EEG)
EEG is used to examine human brain waves
over the course of the first hour or so of sleep, the brain progresses through a
series of stages during which brain waves slow down
Period of slow wave sleep is accompanied by relaxation of the muscles and the eyes.
Heart rate, blood pressure, and body temperature all fall. If awakened during this
time, most people recall only fragmented thoughts, not active dreams.
This sleep cycle is characterized by neocortical EEG waves similar to those
observed during waking REM sleep
deep slow wave is followed by REM sleep
REM stands for Rapid Eye Movement
Fast walking like EEG activity is found in REM Sleep
Paradoxically in REM Sleep although we see EEG waves similar to walking we also see
what Atonia
What is Atonia Paralysis of the Body Muscles
What muscles are active during REM sleep Only the muscles that allow breathing and
control eye movements remain active
Active Dreaming takes placed during REM Sleep
Heart rate, blood pressure, and body temperature become much more variable during
REM sleep
The first REM period usually lasts 10 to 15 minutes
During the night, these cycles of slow wave and REM sleep alternate with the
slow wave sleep becoming less deep and the REM periods more prolonged until waking
occurs
The first REM period usually lasts 10 to 15 minutes
Men have erections during which stage REM
Over the course of a lifetime, the pattern of sleep cycles changes
Infants sleep up to 18 hours per day, and they spend much more time in deep
slow wave sleep
Older adults may sleep only six to seven hours per night. What�s more, adults often
complain of early waking that they cannot avoid and spend very little time in
slow wave sleep
As children mature, they spend less time asleep and less time in deep slow
wave sleep.
Sleep is crucial for concentration, memory, coordination, and even emotional
health
We spend how much time of lives asleep one third
Sleep loss affects are comparable to preformance when drinking alcohol
lack of sleep increases the risk of a variety of health problems lke diabetes,
cardiovascular disease and heart attacks, stroke, depression, high blood pressure,
obesity, and infections.
difficulty falling asleep insomnia
Although a variety of short-acting sedatives and sedating antidepressant drugs are
available to help, none produces a truly natural and restful sleep state because
they
tend to suppress the deeper stages of slow wave sleep
The individual has difficulty breathing and wakes up without entering the deeper
stages of slow wave sleep. what is this disorder Obstructive sleep Apnea
as sleep deepens and the airway muscles in the throat relax to the point of
collapse, closing the airway. what is this called Obstructive Sleep Apnea
Obstructive sleep apnea can cause high blood pressure and may increase the risk
of heart attack
patient complains of day time sleepiness and feeling very sleepy during day time
driving , what will you check for Obstructive Sleep Apnea
What are some of the natural and simple strategies you will recomend to Obstructive
Apnea Patients to reduce airway collapse during sleep losing weight, avoiding
alcohol and sedating drugs prior to sleep, and avoiding sleeping on one�s back
how do devices like small masks help with obstructive sleep apnea induce
continuous positive airway pressure to keep the airway open
if sleep apnea is due to anatomical issues then surgery

Name a benzodiazepine clonazepam

clonazepam can be used to treat REM behavior disorder
What happens in REM behavior disorder muscles fail to become paralyzed during
REM sleep, As a result, people literally act out their dreams by getting up and
moving around
REM behavior disorder is common in people with what diseaseParkinsons disease
Periodic limb movements and REM behavior disorder can be treated by using drugs
given to parkinson patients and benzodiazepine like clonazepam
In what disorder the switching mechanisms controlling the transitions into sleep,
particularly REM sleep, do not work properly Narcolepsy
Is Narcolepsy very common No only one case per 3000
What causes Narcolepsy due to the loss of nerve cells in the lateral
hypothalamus that contain the neurotransmitter orexin (also known as hypocretin).
Another name for neurotransmitter orexin hypocretin
sleep attacks during the day, in which they suddenly fall asleep. what is the
problem Narcolepsy
People with narcolepsy tend to enter REM sleep very quickly as well and may even
enter a dreaming state while still partially awake, a condition known as
hypnagogic hallucination
People with Narcolepsy also have attacks during which they lose muscle tone � a
state similar to what occurs during REM sleep but instead happens while they are
awake. These attacks of paralysis, known as cataplexy, can be triggered by
emotional experiences, even by hearing a funny joke.
Nerve cells containing orexin, in the hypothalamus, are also important in
wakefulness and their loss causes narcolepsy
Wakefulness is maintained by several brain systems, each regulating different
aspects of this state. Many of the systems are located in the upper brainstem,
where nerve cells using the neurotransmitters acetylcholine, norepinephrine,
serotonin, and glutamate connect with the forebrain
Hypothalamic nerve cells containing the neurotransmitter histamine play a key role
as well in wakefulness
Activation of the thalamus and the basal forebrain by acetylcholine is
particularly important in maintaining activity in the cerebral cortex and
consciousness. This level of alertness is reflected in an activated, low-voltage
EEG.
During non-REM sleep, these arousing systems become much less active, and the
transmission of information from the senses through the thalamus is curtailed.
Consciousness lessens, and wakefulness gives way to the slow wave pattern typical
of the first stage of sleep. During this state, there is active suppression of
arousal systems by a group of nerve cells
in the hypothalamus, called the ventrolateral preoptic (VLPO) nucleus
VPLO stnads for ventrolateral preoptic nucleus
Damage to the VLPO nucleus produces irreversible insomnia
The cells in the VLPO contain the inhibitory neurotransmitters galanin and
GABA
The state of REM sleep is characterized by an internally activated brain and
an activated EEG � but with external input suppressed.
Internal activation during REM comes from a cyclically active REM sleep
generator made up of neurons in the brainstem. Signals from these neurons cause the
forebrain to become excited and lead to the rapid eye movements and muscle
suppression � hallmark signs of this state.
In the absence of external input, forebrain excitation from internal sources is the
driving force behind the vivid dreams experienced during REM sleep.
Interestingly, our motor cortex nerve cells fire as rapidly during REM sleep as
they do during waking movement, a fact that explains why movement can coincide with
dreams.
The periodic recurrence of REM sleep about every 90 minutes during sleep is
thought to be caused by the on-off switching of REM-generating neurons, which
produce acetylcholine and glutamate, and REM-suppressive neurons, which produce
norepinephrine, serotonin, and GABA
Why do we get sleepy? There are two main determining factors: the circadian
system (time of day or night) and how long we have been awake
The circadian timing system is regulated by the suprachiasmatic nucleus, a
small group of nerve cells
in the hypothalamus that acts as a master clock.
suprachiasmatic nucleus cells express clock proteins, which go through a
biochemical cycle of about 24 hours, setting the pace for daily cycles of activity,
sleep, hormone release, and other bodily functions
Researchers first identified these clock proteins and determined their important
roles in sleep by studying the fruit fly Drosophila melanogaster
The suprachiasmatic nucleus also receives input directly from the retina, and
the clock can be reset by light so that it remains linked to the outside world�s
day-night cycle
the suprachiasmatic nucleus provides signals to an adjacent brain area, called the
subparaventricular nucleus, which in turn contacts the dorsomedial nucleus of
the hypothalamus. The dorsomedial nucleus then contacts the ventrolateral preoptic
nucleus and the orexin neurons in the lateral hypothalamus. It is these neurons
that directly regulate sleep and arousal
Orexin provides an excitatory signal to the arousal system, particularly to the
norepinephrine neurons.
Indeed, recent work using selective stimulation of orexin neurons by artificially
inserted receptors sensitive to fiberoptic light pulses � a process referred to as
optogenetic stimulation
� produces arousal
This arousal is mediated by orexin activation of norepinephrine neurons in the
locus coeruleus.
Orexin activation plays a critical role in preventing abnormal transitions into REM
sleep during the day, as occurs in narcolepsy. In experiments with mice, in which
the gene for the neurotransmitter orexin was experimentally removed, the animals
became narcoleptic. In humans with narcolepsy, the orexin levels in the brain and
spinal fluid are abnormally low.
The second system regulating sleepiness is the homeostatic system, which responds
to progressively longer wake periods
by increasing the urge to sleep.
The subjective sense of the increasing need to sleep coinciding with increasing
wakefulness suggests that there might be a brain physiological parallel; that
is, the longer a person is awake, the greater
the likelihood of an increase in sleep-inducing factor(s).
Evidence now suggests that one important sleep factor is the inhibitory
neurochemical adenosine. With prolonged
wakefulness, increasing levels of adenosine are evident in the brain, initially in
the basal forebrain and then throughout the cortex. The increased levels of
adenosine serve the purpose of slowing down cellular activity and diminishing
arousal. Adenosine levels then decrease during sleep.
These studies of adenosine prompted examination of the compound adenosine
triphosphate (ATP), the cellular energy source that powers nerve cells in the
brain.
Brain adenosine may be produced by ATP breakdown in the course of the high brain
activity that takes place during wakefulness.
Since nerve cell activity decreases and adenosine levels decline in non- REM
sleep, the logical assumption is that ATP increases during sleep.
Indeed, studies in animals found that brain ATP levels soared during the initial
hours of non-REM sleep.
Because ATP is needed to produce adenosine, which is essential for wakefulness, it
makes sense that ATP is produced during sleep.
This finding also supports the commonly held notion that sleep is necessary for
providing restorative energy.
the brain controls our reaction to danger, manifested as the �fight or flight�
response