week 8 - sleeep Flashcards
What is sleep?
“A periodic state of muscular relaxation, reduced metabolic rate, and suspended consciousness in which a person is largely unresponsive to events in the environment.” (Oxford Dictionary of Psychology)
Sleep is reversible
Five sleep stages: Wake, non-rapid eye movement sleep (Stages N1, N2, N3), and rapid eye movement sleep (REM).
What are the 5 stages?
Wake,
non-rapid eye movement sleep (Stages N1, N2, N3), and rapid eye movement sleep (REM).
How much sleep do we need?
Age Group sleep duration recommended New borns: 0 – 3 months: 14-17hrs Infants: 4 – 11 months: 12-15 hrs Toddlers: 1 – 2 years : 11-14hrs Preschoolers: 3 – 5: 10-13hrs School age children: 6 – 13: 9-11hrs Teenagers: 14 – 17 : 8-10 hours Young adults and adults: 18 – 64: 7-9 hours Older adults: 65+ - 7-8
What drives us to sleep?
The two-process model
Process S – homeostatic drive (Sleep pressure). The longer we stay awake, the greater the need for sleep (purple)
Process C – circadian wake drive. Internal body clock (green)
What drives us to sleep? Process S (Sleep Pressure)
Adenosine builds as a function of sleep pressure.
Caffeine – adenosine receptor antagonist (ARA)
Concept of a coffee-nap (sleep + ARA interaction)
Even during wakefulness, sleep pressure is demonstrated through increased power of slow EEG frequencies
Once asleep, amount of deep sleep (N3) correlates with the sleep drive (e.g., how much sleep deprivation has occurred)
What drives us to sleep? Process C (Circadian Rhythm/Body Clock)
Main biological clock – suprachiasmatic nucleus (SCN) of the hypothalamus
Body clock synchronised by many biological and social stimuli, most importantly light (particularly blue light)
Melatonin – a hypnogenic hormone released in the evening assisting us to sleep
Retina contains photosensitive melanopsin receptors with pathway to the SCN via the retinohypothalamic tract
What drives us to sleep? Process C (Circadian Rhythm/Body Clock) continued…
Blue light suppresses melatonin production, increases alertness, increases cognitive performance
Mobile devices including phones, tablets etc. output blue light extensively
Acute blue light exposure in the evening reduces frontal slow-wave power in the EEG
melatonin
Melatonin is a naturally occurring hormone
Declining melatonin with age can present a challenge to sleep
Prescription melatonin available in Aus
Indicated for short term insomnia in adults aged > 55 years
Brain processes behind sleep
Many brain regions involved in switching sleep on and off: particularly the brainstem, diencephalon, telencephalon
Arousal and waking: midbrain, posterior and lateral hypothalamus, basal forebrain
Pre-optic anterior hypothalamus: GABA-ergic neurons with increased activity in sleep. Responds to sleep promoting signals such as sleep pressure and body temperature increases
Measurement of Sleep – Polysomnography (PSG)
Poly (multiple) somno (sleep) graph (traced measurements)
The ‘gold standard’ for measuring sleep. Common signals acquired include EEG, EMG (chin, diaphragm, and leg), EOG, nasal pressure, thermo-oral flow, ECG, snoring, and respiratory effort.
Can be conducted in a sleep laboratory (best option, and essential for complex cases), or at home (acceptable for simple cases).
EEG allows for the quantification of sleep stages W, N1, N2, N3, REM
https://youtu.be/B2ozqK9T5Bw?t=3m10s
Measurement of Sleep – Polysomnography (PSG)
Alpha (8 – 13Hz) – wake
LAMF (Theta) - (Low Amplitude Mixed Frequency, 4 – 7Hz) – N1
LAMF with Spindles/K Complexes – N2
Delta (0.5 – 2Hz, 75µV amplitude) – N3
LAMF with Rapid Eye Movements and low EMG tone – REM
Measurement of Sleep – Polysomnography (PSG) (stage wake/eyes open, closed, eeg,
Stage Wake
Eyes open – fast beta waves
Eyes closed – slow alpha waves
EEG pattern appears in the eye trace
Alpha waves
8-12hz - eyes closed and awake
Measurement of Sleep – Polysomnography (PSG)
Stage N1
Stage N1
Shallow sleep – a transition between wake and sleep
Look for: EEG pattern no longer reflected in the eye trace, slow rolling eye movements, vertex sharp waves
At least 50% of the epoch is no longer ‘wake’
Measurement of Sleep – Polysomnography (PSG)
Stage N2
Stage N2
Theta/LAMF with spindles and K-complexes
Both spindles and K-complexes are normal phenomena, K-complex also a response to external stimuli
Measurement of Sleep – Polysomnography (PSG)
stage N3
Stage N3
Scored when 20% epoch is in slow, high amplitude delta waveforms
The deepest sleep stage, after waking from N3 a subject can be very drowsy (sleep inertia)
Measurement of Sleep – Polysomnography (PSG)
stage - rem
Stage REM
LAMF, low muscle tone, Rapid Eye Movements
Hypnogram
Hypnogram – shows the distribution of sleep stages
Normal values: N1: 5%, N2: 50%, N3: 20%, REM: 25%