Sleep, Sleep
Disorders, and
Biological
Rhythms
• Knowledge (what is known and not known)
+ Choice = Power
• Power + Behavior = Enhanced Human Health
Sleep plays a major role in
preparing
the body and brain for an
alert, productive, psychologically
and physiologically
healthy tomorrow.
• For anyone who wants to be successful,
sleep is a necessity – not a luxury!
• If you understand exactly what the brain
accomplishes during various stages of a
night’s sleep and what your individual
requirement is, you are a position to
become a different (better) person.
• Sleep is an essential life process.
• Just as essential as air, food, and water.
• Unfortunately, sleep is taken for granted
• Sleep deprivation is a common feature of our
society, affecting children and adults alike.
Sleep Deprivation
• Lack of sleep reduces our alertness, impairs
our judgment, and affects our moods.
• Impairments to alertness and judgment due to
sleep deprivation not only lead to a loss of
productivity at school or work, but also
contribute to increased accident rates.
• It is especially important that young people
preparing to drive recognize the dangers of
drowsy driving.
What is SLEEP????
• Sleep is a behavioral state that is a natural part
of every individual’s life.
• We spend about one-third of our lives asleep.
• The precise functions of sleep remain a
mystery, but sleep is important for normal
motor and cognitive function.
• Rats deprived of sleep will die within two to
three weeks, a time frame similar to death due
to starvation.
Problem sleepiness may be
associated with difficulty
concentrating, memory lapses,
loss of energy, fatigue,
lethargy, and emotional
instability.
?????????
• Approximately how many car crashes
per year are related to falling asleep
at the wheel?
• 100,000
• What sex and age is most likely to fall
asleep at the wheel?
• Males under the age of 25
• Problem sleepiness can cause
difficulties with learning, memory,
thinking, and feelings, which may lead
to poor school and work performance
and difficulty with relationships.
Misconceptions about Sleep
1. Sleep is time for the body in general and the
brain specifically to shut down for rest.
2. Getting just one hour less sleep per night than
needed will not have any effect on daytime
functioning.
3. The body adjusts quickly to different sleep
schedules.
4. People need less sleep as they grow older.
5. A “good night’s sleep” can cure problems with
excessive daytime sleepiness.
1. Sleep is time for the body in general and the brain
specifically to shut down for rest.
• Sleep is an active process.
• There is modest decreases in metabolic rate, but
there is no evidence that any major organ or
regulatory system in the body shuts down during
sleep.
• Some brain and endocrine activity increase
dramatically.
• In REM sleep, parts of the brain are just as active
as when awake!
• 2. Getting just one hour less sleep per night than
needed will not have any effect on daytime
functioning.
• “Sleep Debt” develops when daily sleep time is not
met. If debt becomes too great, can lead to problem
sleepiness.
• Individual may not realize sleepiness, but can still
have powerful effects on performance, thinking and
mood.
• 3. The body adjusts quickly to different sleep
schedules.
• The biological clock that times and controls a
person’s sleep/wake cycle will attempt to function
according to a normal day/night schedule even
when that person tries to change it.
• The biological clock can be reset, but by one to two
hours per day at best.
• The task for a person who must be active at night
is to retrain the biological clock (by light cues).
4. People need less sleep as they grow older.
• Older people don’t need less sleep, but they often
get less sleep. That’s because the ability to sleep
for long periods of time and to get into the deep,
restful stages of sleep decreases with age.
• Older people are more easily disturbed by light,
noise and pain. They are also more likely to have
medical conditions that contribute to sleep
problems.
A “good night’s sleep” can cure problems with
excessive daytime sleepiness.
• Excessive daytime sleepiness can be associated
with a sleep disorder or other medical condition.
• Sleep disorders, including sleep apnea, insomnia,
and narcolepsy, may require behavioral,
pharmacological, or even surgical intervention to
relieve the symptoms.
• Extra sleep may not eliminate daytime sleepiness
that may be due to such disorders.
Fatal Familial Insomnia
• https://www.youtube.com/watch?v=AxjNay_TRRg
• SLEEP DIARY
• pg. 56 online book – NIH link
• orange5089
Need to be in groups of 4
• Need to find figure class average of:
• Bedtime
• Wake time
• Nighttime awakenings
• Hours of sleep
• # of caffeine drinks/ day
• Snorers
• # that report sleeping problems
Once averages reached:
• Develop a hypothesis, test it by using
the data in the sleep database, and
provide a short, written summary of
your findings.
People feel pressure to sleep in daily cycles.
Scientists refer to this need-to-sleep cycle as
“homeostatic regulation.”
https://www.youtube.com/watch?v=nNhDkKAvxFk
• Can people function well on 6-7 hours of sleep?
• Do men need more sleep than women?
• What is the best time to exercise for a good
nights sleep?
• What is the ideal temperature for your bedroom?
• Are naps good?
If you are getting less than eight hours of sleep
each night, including weekends, if you fall asleep
instantly, or need an alarm clock to wake up –
consider yourself one of the millions of chronically
sleep-deprived people.
Fun Facts
 We currently live in a society where sleep is not
valued.
 “If we operated machinery the way we now we
operate the human body, we would be accused of
reckless endangerment”. – Dr. Moore-Ede
Sleep is a dynamic process. (3.1)
• Sleep measured by:
• The patterns of activity in these three systems provide the
basis for classifying the different types of sleep. Record all
three at the same time.
– EEG (electroencephalogram)
• Measures brain wave activity
– EOG (electrooculogram)
• Measures eye movement
– EMG (electromyogram)
• Measures electrical activity of muscles, use the chin for
sleep studies.
1929 Hans Berger started doing
EEG’s
1935 Harvard University noticed from
EEG’s that sleep could be divided into
several distinct levels
• 2 basic stages of sleep: NREM and REM
• NREM sleep is divided into four stages according
to the amplitude and frequency of brain wave
activity.
• EEG pattern of NREM sleep is slower, often more
regular, and usually of higher voltage than that of
wakefulness.
• As sleep gets deeper, the brain waves get slower
and have greater amplitude
• NREM Stage 1 is very light sleep; NREM Stage 2
has special brain waves called sleep spindles and
K complexes; NREM Stages 3 and 4 show
increasingly more high voltage slow waves. In
NREM Stage 4, it is extremely hard to be
awakened by external stimuli.
• Eye movements normally do not occur during
NREM sleep, except for very slow eye movements.
• The EEG recorded during REM sleep shows very
fast and desynchronized activity that is more
random.
• REM sleep is characterized by bursts of rapid eye
movements.
• While muscle tone is normal in NREM sleep, we
are almost completely paralyzed in REM.
AWAKE
EEG
EOG
EMG
REM
NREM
• Sleep is a cyclical process.
• This cycle lasts approximately 90 to
110 minutes and is repeated four to
six times per night.
• Ultradian rhythm: A rhythm occurring
within a period of less than 24 hours
is used to describe this cycling
through sleep stages.
Hypnogram: chart recordings of
electrical activities (EEG, EOG, and
EMG) collected during a night’s sleep.
Physiological changes during sleep (3.2)
Stages of sleep each night disengage from the
environment and are delineated by changes
in: brain waves, muscle activity, eye
movement, body temperature, respiratory rate,
heart rate, hormone activity, and genital
arousal.
Neural activity only drops 10% during sleep
Physiological Process
During NREM
During REM
brain activity
decreases from
wakefulness
increases in motor and sensory
areas, while other areas are
similar to NREM
heart rate
slows from wakefulness increases and varies compared
with NREM
blood pressure
decreases from
wakefulness
increases (up to 30 percent) and
varies from NREM
blood flow to brain
does not change from
wakefulness in most
regions
increases by 50 to 200 percent
from NREM, depending on brain
region
Physiological Process
During NREM
During REM
respiration
decreases from
wakefulness
increases and varies from
NREM, but may show brief
stoppages (apnea);
coughing suppressed
airway resistance
increases from wakefulness
increases and varies from
wakefulness
body temperature
is regulated at lower set
point than wakefulness;
shivering initiated at lower
temperature than during
wakefulness
is not regulated; no
shivering or sweating;
temperature drifts toward
that of the local
environment
sexual arousal
occurs infrequently
increases from NREM (in
both males
and females
• Lesson 2 – Houston We Have A
Problem
• pg. 71 online NIH
• Need laptops (work by self or in pairs)
True or False
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
Newborns dream less than adults.
Men need more sleep than women.
Not everyone dreams at night.
As you move from early to later adulthood you need less sleep.
By playing audiotapes during the night, you can learn while you sleep.
Chocolate candies provided on your hotel pillow will help you sleep better.
If you have insomnia at night, you should take a long nap during the day.
Sleeping pills are very helpful for people who have had insomnia for months.
Arousing a person who is sleepwalking can be very dangerous.
A soft mattress is better than a hard one for obtaining a good nights sleep
You are most alert when you first wake up.
To promote optimal sleep the best time to exercise is early in the morning.
A sound sleeper rarely moves during the night.
A boring meeting, heavy meal, or low dose of alcohol can make you sleepy, even if
you are not sleep deprived.
15) Sleep before midnight is better than sleep that begins after midnight.
• This reveals general knowledge of
sleep.
• ALL statements are false!
True or False
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I need an alarm clock in order to wake-up at the appropriate time.
It’s a struggle for me to get out of bed in the morning
Weekday mornings I hit the snooze button several times to get more
sleep.
I feel tired, irritable, and stressed-out during the week.
I have trouble concentrating and remembering.
I feel slow with critical thinking, problem solving, and being creative.
I often fall asleep watching TV.
I often fall asleep in boring meetings or lectures or in warm rooms.
I often fall asleep after heavy meals or after a low dose of alcohol.
I often fall asleep while relaxing after dinner.
I often fall asleep within 5 minutes of getting into bed.
I often feel drowsy while driving.
I often sleep extra hours on weekend mornings.
I often need a nap to get through the day.
I have dark circles around my eyes.
This checks to see if you are sleep
deprived.
If you answered true to 3 or more items;
you are probably not getting enough
sleep.
True or False
1)
I go to sleep at different times during the week and on weekends,
depending on my schedule and social life.
2) I get up at different times during the week and on weekends, depending
on my schedule and social life.
3) My bedroom is warm and often noisy.
4) I never rotate or flip my mattress.
5) I drink alcohol within 2 hours of my bedtime.
6) I have caffeinated drinks or chocolate after 6 pm.
7) I do not exercise on a regular basis.
8) I smoke.
9) I regularly take a sleep aid (prescription or OTC).
10) When I cannot fall asleep or remain asleep I stay in bed and try harder.
11) I often read frightening or troubling books (newspapers) before bedtime.
12) I do work or watch the news in bed just before turning out the lights.
This examines your sleep strategies.
If you answered true to more than one
item: it is likely that at least one aspect
of your lifestyle is interfering with your
sleep.
True or False
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
I have trouble falling asleep.
I wake up a number of times during the night.
I wake up earlier than I would like and have trouble falling back to
sleep.
I wake up terrified in the middle of the night and don’t know why.
I fall asleep spontaneously during the day in response to high arousal;
such as hearing a funny joke.
I have been told I snore loudly and stop breathing.
I walk and/or talk in my sleep.
I move excessively in my sleep.
I have hurt myself while asleep.
I become confused, afraid, and/or disoriented after sundown.
I cannot fall asleep until very late at night or cannot wake up in the
morning.
I cannot stay awake early in the evening and I wake up before dawn.
I feel pain and/ or tingling in my legs just before sleeping.
I physically act out my dreams during the night.
I am often too anxious, depressed, or worried to fall asleep.
This probes for possible sleep
disorders.
If you answered true to any answers,
you may have a sleep disorder.
3.4 Sleep patterns.
• Sleep patterns change during an individual’s life.
• One of the most prominent age-related changes in sleep is a
reduction in the time spent in the deepest stages of NREM
(stage 3) from childhood through adulthood.
• This change is prominent during adolescence, when about 40
percent of this activity is lost and replaced by Stage 2 NREM
sleep.
• Most humans maintain REM sleep throughout life, but brain
disorders like Alzheimer’s and Parkinson’s are characterized
by decreasing amounts of REM sleep
• Sleep does occur in response to boredom or
mental or physical fatigue.
• Sleep isn’t necessary to conserve energy
because rest alone can.
• Sleep is not determined by eating or the resulting
stomach vapors or by will.
• You are probably getting the correct amount of
sleep if you feel alert all during the day.
• If you are not sleepy in sedentary situations you
are among the alert minority.
• If you fall asleep immediately when you get into
bed; this is a sign of sleep deprivation. The wellrested person takes 15-20 minutes to fall asleep.
• Most people need at least 8 hours of sleep to cancel
16 hours of continuous alertness.
• A 1 hour sleep loss every night for an entire week is
equivalent to having pulled one all-nighter.
• As soon as we lose 1 hour of sleep; we are prone to
inattentiveness, mistakes, illness, and accidents.
– In the 4 days after we lose 1 hour of sleep following
the spring shift to DST; there is a 7% increase in
accidental deaths compared to the week before and
week after (study at the University of British
Columbia).
“If you are a contributor to the national
sleep debt; than you are far from being
the person you can be --- you are
hurting yourself and perhaps innocent
others as well”.
– Dr. William Dement
• Teenagers, on average, require about nine or
more hours of sleep per night to be as alert as
possible when awake.
AGE
# of hours of sleep
Newborn
14-16/ day
1-3 years
12-14/ day
3-5 years
12/ day
5-9 years
10-12/day
10-13 years
10/ day
14-18 years
8-10/ day
19-30 years
8/ day
33-45 years
6-8/ day
50-80 years
6-7/ day
3.5 Biological clock.
• An internal biological clock regulates the timing for sleep in
humans.
• This clock cycles with an approximately 24-hour period and
is called a circadian clock.
• The biological clock is genetically programmed.
• The most important function of a biological clock is to
regulate overt biological rhythms like the sleep/wake cycle.
• In humans, this clock is located in the suprachiasmatic
nucleus (SCN) of the hypothalamus in the brain.
2 types of biological rhythms
• Exogenous rhythms are directly produced by an
external influence, such as an environmental cue.
– not generated internally by the organism itself
• Endogenous rhythms, by contrast, are driven by
an internal, self-sustaining biological clock rather
than by anything external to the organism.
Because the circadian clock in most humans has
a natural day length of just over 24 hours, the
clock must be entrained, or reset, to match the
day length of the environmental photoperiod
(that is, the light/dark, or day/night, cycle).
• The release of melatonin, a hormone produced by the
pineal gland, is controlled by the circadian clock in the
SCN.
• Biological clocks exist in a wide range of organisms.
• Clocks enable organisms to adapt to their
surroundings
• Clocks are maintained by a biochemical process
known as a negative feedback loop.
Jet Lag
Jet lag results from the inability of our circadian clock to
make an immediate adjustment to the changes in light
cues that an individual experiences when rapidly
crossing time zones.
The body is in conflict:
This conflict between external and internal clocks and
signals is called desynchronization, and it affects more
than just the sleep/wake cycle
Circadian rhythm problems include
• Monday morning blues.
• Seasonal affective disorder (SAD).
• Shift work.
Monday Morning Blues
• By staying up and sleeping in an hour or more
later than usual on the weekends, we provide our
biological clock different cues that push it toward
a later nighttime phase. By keeping a late sleep
schedule both weekend nights, our internal clock
becomes two hours or more behind our usual
weekday schedule. When the alarm rings at 6:30
a.m. on Monday, our body’s internal clock is now
set for 4:30 a.m. or earlier.
Seasonal affective disorder (SAD).
• Symptoms include decreased appetite, loss of
concentration and focus, lack of energy, feelings of
depression and despair, and excessive
sleepiness. Too little bright light reaching the
biological clock in the SCN appears to bring on
this recognized form of depression in susceptible
individuals. Consequently, treatment often involves
using light therapy.
• Humans are active during daylight hours. This
pattern is called diurnal activity.
• For humans and other diurnally active animals, light
signals the time to awake, and sleep occurs during
the dark.
• These individuals no longer have synchrony between
their internal clocks and external daylight and
darkness signals, and they may experience mental
and physical difficulties similar to jet lag and SAD.
Shift work
Do you have Rhythm?
How did you celebrate the new millennium? Like many of you, Frenchman
Michel Siffre rejoiced in a New Year’s celebration. Yet unlike most of you,
Michel celebrated three days late!
Michel Siffre, a 61-year-old cave explorer, descended 2,970 feet into a cave
located in southern France as part of an experiment. In this deep cave, Michel
lived for two months with no contact with the outside world. He had no
instrument to measure the time of day. He found it difficult to keep track of time
while living without cues of any kind to help him tell if it was day or night. While
in the cave, Michel used artificial light to read novels and journals and to cook.
Of course, he napped. The naps were the key to throwing off Michel’s sense of
time. Scientists were (and still are) interested in learning about human sleep
patterns. They wanted to study Michel’s sleep habits while he was in the cave.
Michel wore electrodes on his body that allowed scientists at the cave opening
to monitor his sleep. They observed that Michel’s sleep/wake cycles varied
considerably. His “day” (the time between major sleep periods) varied between
18 and 52 hours (average “day” = 27.5 hours). Scientists are using information
from monitoring Michel and from other experiments to help astronauts follow
healthy sleep habits during long space voyages.
This was not Michel’s first journey underground for a great length of time. He
spent two months in a cave on the French-Italian border in 1962, and another
205 days in a Texas cave in 1972.
• Explain why Siffre’s “day” varied so much, and
why his average “day” was longer than 24 hours.
• How do you know when it is time to sleep?
• How does your body tell when it is time to
sleep?
The Biological Clock
• The timing for sleep in humans is regulated by our internal biological
clock. Biological clocks are not like other clocks with which we are all
familiar. Rather, they are physiological systems that allow organisms to
live in harmony with the rhythms of nature, such as day/night cycles and
the changing of seasons.
• The most important function of our biological clock is that it regulates our
sleep/wake cycle. Our clock, because it cycles once per day, is called a
circadian clock. In humans, this clock is located in a very small area of the
brain called the suprachiasmatic nucleus (SCN). The SCN receives light
signals from the retina, interprets them, and sends signals to another area
of the brain, the pineal gland, to release hormones that affect our
sleep/wake cycle. Clock genes maintain the clock cycle by directing the
synthesis of proteins that slowly enter the cell nucleus and turn off the
clock genes.
• Over a period of about 24.5 hours, these proteins break down and the
genes become active again. This type of biochemical cycle is called a
negative feedback loop.
• Why don’t you experience a day-lengthening
effect similar to Michel Siffre’s?
Resetting the Clock
• The circadian clock in humans actually cycles at just over 24
hours. This means that the clock must be reset to match the
environmental photoperiod (that is, the light/dark, or day/night,
cycle). The cue for resetting the clock is light. Light receptors in
the eye transmit signals to the SCN, which in turn directs the
pineal gland to secrete a hormone called melatonin. Melatonin
levels rise during the night and decline at dawn. The rhythmic
secretion of hormones such as melatonin influences our
sleepiness. If the clock fails to reset properly, it becomes out of
sync with the environment and can produce various problems
such as jet lag, seasonal affective disorder, and Monday
morning blues.
• What happened to Michel Siffre’s sleep cycle
after he left the cave?
Golden Rules of Sleep
1.
2.
3.
4.
Get an adequate amount of sleep each night.
Establish a regular sleep schedule.
Get continuous sleep.
Make up for lost sleep.
3.6 Homeostasis and sleep
• Relationship of circadian rhythms to sleep is
relatively well understood
• Studies in genetics and molecular biology to
increase knowledge between circadian clocks and
behavioral states.
• Recent evidence suggest that adenosine is an
important sleepiness factor; may induce sleep.
• Caffeine binds to the same receptors that recognize
adenosine.
3.7. Dreams
• Reports of dreaming are most frequent and vivid
when an individual is aroused from REM sleep.
• Dreams do occur at sleep onset and during
NREM sleep as well.
• The avg. night is 2 hours of fictional dreaming,
mostly in REM.
• REM sleep and dreams are associated with
each other, but they are not synonymous.
– Controlled by different areas of the brain.
• REM sleep and dreaming can be dissociated
from one another, as seen after the
administration of certain drugs or in cases of
brain damage either to the pons (loss of REM
sleep but not of dreaming) or to the frontal areas
(no dreaming but REM sleep cycle unaffected).
• Consequently, REM sleep appears to be just
one of the triggers for dreaming.
Brain Function and Dreams
• During REM sleep dream
• Inactive parts: intelligence, conscious
thought, and higher-order reasoning.
– HOR: processing experiences into memory
and regulating vision while we are awake
• Active: motivation, emotion, memory
formation, arousal, and visual
processing.
3.8 Functions of sleep
Scientists still do not fully understand the
functions of sleep.
Hypothesis: Restoration and recovery of body
systems.
Hypothesis: Energy conservation.
Hypothesis: Memory consolidation.
Hypothesis: Protection from predation.
Hypothesis: Brain development.
Hypothesis: Discharge of emotions.
3.9 Evolution of sleep
Sleep is ubiquitous among mammals,
birds, and reptiles, although sleep
patterns, habits, postures, and places of
sleep vary greatly.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
brown bat 19.9
python 18.0
owl monkey 17.0
human infant 16.0
tiger 15.8
squirrel 14.9
golden hamster 14.3
lion 13.5
gerbil 13.1
rat 12.6
cat 12.1
mouse 12.1
rabbit 11.4
jaguar 10.8
duck 10.8
dog 10.6
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
bottle-nosed dolphin 10.4
baboon 10.3
chimpanzee 9.7
guinea pig 9.4
human adolescent 9.0
human adult 8.0
pig 7.8
gray seal 6.2
goat 5.3
cow 3.9
sheep 3.8
elephant 3.5
donkey 3.1
horse 2.9
giraffe 1.9
Species and average sleep time
4 Sleep Disorders
• Problems with sleep can be due to lifestyle choices and
can result in problem sleepiness—that is, feeling sleepy at
inappropriate times.
• More than 70 sleep disorders have been described; most
common are
–
–
–
–
–
–
Insomnia
Obstructive Sleep Apnea (OSA)
Restless Legs Syndrome (RLS)
Narcolepsy
Parasomnias
Hypersomnia
Insomnia
• Most prevalent of the disorders
• Inability to fall asleep and/or by waking up during
the night and having difficulty going back to sleep.
• Three types:
– Primary
– Secondary
– Short-term/ transient
• Primary: more common in females and increases with age
• Secondary: results from a combination of physical and/ or
mental disorders, undiagnosed or uncontrolled sleep
disorders, and effects of medications.
• Short-term/ transient: from medication, jet lag, stress,
emotional or physical discomfort.
• Treatment will differ with each type and each person –
alcohol does not assist with the problem, only makes it
worse.
• Considered chronic if lasting longer than 3 weeks.
Obstructive Sleep Apnea (OSA)
• Potentially life-threatening disorder
• An estimated 12 million Americans suffer from
OSA
• OSA occurs related to sleep-induced failure of
throat muscles to hold the airway open.
• Cessation of breathing for 30-90 seconds, up to
600 times/ night.
• Alternating with periods of apnea are loud
snores, gasps of air, and whole body
movements.
• Individuals must awaken to resume breathing.
• Sufferers do not realize they wake up multiple
times at night; therefore are very sleep
deprived.
• Side effects include morning headaches, high
blood pressure, heart attacks, heart-rhythm
disorders, stroke, and decreased life
expectancy.
OSA
• Adult treatment of OSA can include:
 behavioral therapy
 use of mechanical devices
 surgery to increase the size of the airway
People with OSA are twice as likely to have a
heart attack or stroke
Restless Legs Syndrome (RLS)
• This is a neurologic movement disorder.
• Patients usually have unpleasant leg sensations
and an almost irresistible urge to move the legs.
• Sufferers report experiencing creeping, crawling,
pulling, or tingling sensations in the legs (or
sometimes the arms) that are relieved by moving
or rubbing them.
• RLS may affect between 10 and 15 percent of
the population.
• Peak onset is middle age adults
• More common in females
• Usually treated with relaxation therapy,
exercises, leg massages, and/ or medications
RLS
Narcolepsy
• Chronic sleep disorder that usually becomes
evident during adolescence or young adulthood
and can affect both men and women.
• Affects as many as 250,000 people, although
fewer than half are diagnosed (~80%).
• This is a genetically linked disorder
• Cataplexy
– sudden muscle weakness often triggered by
emotions such as anger, surprise, laughter, and
exhilaration (can last 30 seconds – 30 minutes)
• Sleep Paralysis
– temporary inability to talk or move when falling
asleep or waking up (usually last 1-2 minutes)
• Hypnagogic Hallucinations
– dreamlike experiences that occur while dozing or
falling asleep
• Treatment is primarily by medications,
but lifestyle changes are also
important.
• This is a lifelong problem but with
proper treatment people can lead a
satisfactory life.
Parasomnias
• Sleep disorders that involve a range of behaviors
that occur during sleep.
• These include REM Sleep Behavior Disorder,
sleepwalking, sleep talking, enuresis (bedwetting), bruxism, SIDS and sleep terrors.
• People actually attempt to act out their dreams.
• Sufferers will also have a neurological disorder.
• They will kick, punch, jump, and/ or run from bed;
injuring themselves or others.
• Men more likely with women to develop, risk also
increases with age.
REM Sleep Behavior
Disorder
• NREM disorder
• More common in children
• Have no memory of such events, usually do not require
treatment, and usually outgrow the disorder.
• Genetically linked
• Usually spontaneously ends after adolescents.
• Generally safe to wake a child walker, be careful waking
the adult walker as they may attack you.
• Can be triggered by fever, sleep deprivation, and/ or
emotional upset.
Sleepwalking
(Somnambulism)
Sleep talking
• NREM disorder
• More common in children
• Have no memory of such events, usually do not require
treatment, and usually outgrow the disorder
• Can be observed during sleepwalking episodes
• Communication may or may not be understandable
• Person usually does not remember conversation
Bed-wetting (Enuresis)
• NREM disorder
• More common in children
• May respond to drug treatment
• Only considered a disorder after the age of 5
• Less than 1% has an emotional source
Tooth-grinding (Bruxism)
• 85- 90% occasionally grind teeth, while 5% do
it chronically.
• Normal part of teething process
• In adults usually caused by stress which can
then lead to dental injury, damage, facial pain,
and/ or TMJ.
• Treatment: relaxation techniques, mouth
guards
Sleep terrors
• Sudden arousal from slow-wave sleep with a
piercing scream or cry.
• Similar to having a panic attack in your sleep.
• Occurs without dream recall.
• Sleepwalking is not uncommon during sleep
terrors.
• People injure themselves or others during these
episodes.
•
• Estimated 15% of children and adolescents
experience this disorder, between ages 4-12.
• More common in males.
• Can be induced by stress, sleep deprivation, and/
or sleeping in a different bed.
• Treatment includes medication, exercise, and/or
adequate sleep.
SIDS
• #1 cause of neonatal and infant death
• Occurs in about every 2 of 1,000 live
births.
Hypersomnia
• Implies too much sleep
– Prolonged nocturnal sleep
– Excessive daytime sleep
• 4 types:
–
–
–
–
Recurrent Hypersomnia
Idiopathic Hypersomnia
Posttraumatic Hypersomnia
“Healthy” Hypersomnia
• Recurrent Hypersomnia
– Periodic episodes of hypersomnia lasting up to several
weeks.
– May or may not be accompanied by binge eating and
hypersexuality.
• Idiopathic Hypersomnia
– Similar to narcolepsy but does not include cataplexy.
– Posttraumatic Hypersomnia
• Occurs as a result of a head injury.
• Usually seen immediately after head injury; but
onset can be 6 – 18 months later.
– “Healthy” Hypersomnia
• Some people just sleep a lot
• Typically more than 10 hours/ day
• Only a problem if interferes with daily schedule