sleep

Patterns
PRESENTED TO:
MAAM SAMIA KHALID
Presented By:
Ummara Ahsan
Bakhtawar Mughal
Sheza Hanif
Farhat Shahzadi
Javeria
 SLEEP
Sleep is an important part of your daily
routine you spend about one-third of your
time doing it. Quality sleep and getting
enough of it at the right times is as
essential to survival as food and water.
Without sleep you can’t form or maintain
the pathways in your brain that let you
learn and create new memories, and it’s
harder to concentrate and respond quickly.
Sleep is important to a number of brain functions, including how nerve cells
(neurons) communicate with each other. In fact, your brain and body stay
remarkably active while you sleep. Recent findings suggest that sleep plays a
housekeeping role that removes toxins in your brain that build up while you are
awake.
Everyone needs sleep, but its biological purpose remains a mystery. Sleep affects
almost every type of tissue and system in the body from the brain, heart, and
lungs to metabolism, immune function, mood, and disease resistance. Research
shows that a chronic lack of sleep, or getting poor quality sleep, increases the risk
of disorders including high blood pressure, cardiovascular disease, diabetes,
depression, and obesity.
Sleep is a complex and dynamic process that affects how you function in ways
scientists are now beginning to understand. This booklet describes how your
need for sleep is regulated and what happens in the brain during sleep
 ANATOMY OF SLEEP
Several structures within the brain are involved with sleep.
The hypothalamus, a peanut-sized structure deep inside the brain, contains groups of nerve
cells that act as control centers affecting sleep and arousal. Within the hypothalamus is the
suprachiasmatic nucleus (SCN) – clusters of thousands of cells that receive information about light
exposure directly from the eyes and control your behavioral rhythm. Some people with damage to
the SCN sleep erratically throughout the day because they are not able to match their circadian
rhythms with the light-dark cycle. Most blind people maintain some ability to sense light and are
able to modify their sleep/wake cycle.
The brain stem, at the base of the brain, communicates with the hypothalamus to control the
transitions between wake and sleep. (The brain stem includes structures called the pons, medulla,
and midbrain.) Sleep-promoting cells within the hypothalamus and the brain stem produce a brain
chemical called GABA, which acts to reduce the activity of arousal centers in the hypothalamus
and the brain stem. The brain stem (especially the pons and medulla) also plays a special role in
REM sleep; it sends signals to relax muscles essential for body posture and limb movements, so
that we don’t act out our dreams.
 The thalamus acts as a relay for information from the senses to the cerebral cortex (the covering of
the brain that interprets and processes information from short- to long-term memory). During most
stages of sleep, the thalamus becomes quiet, letting you tune out the external world. But during REM
sleep, the thalamus is active, sending the cortex images, sounds, and other sensations that fill our
dreams.
The pineal gland, located within the brain’s two hemispheres, receives signals from the SCN and
increases production of the hormone melatonin, which helps put you to sleep once the lights go down.
People who have lost their sight and cannot coordinate their natural wake-sleep cycle using natural
light can stabilize their sleep patterns by taking small amounts of melatonin at the same time each day.
Scientists believe that peaks and valleys of melatonin over time are important for matching the body’s
circadian rhythm to the external cycle of light and darkness.
The basal forebrain, near the front and bottom of the brain, also promotes sleep and
wakefulness, while part of the midbrain acts as an arousal system. Release of adenosine (a chemical
by-product of cellular energy consumption) from cells in the basal forebrain and probably other regions
supports your sleep drive. Caffeine counteracts sleepiness by blocking the actions of adenosine.
The amygdala, an almond-shaped structure involved in processing emotions, becomes increasingly
active during REM sleep.
 SLEEP STAGES
There are two basic types of sleep:
Rapid eye movement (REM) sleep and non-REM sleep (which has three different
stages). Each is linked to specific brain waves and neuronal activity. You cycle through all
stages of non-REM and REM sleep several times during a typical night, with increasingly
longer, deeper REM periods occurring toward morning.
Stage 1 non-REM sleep is the changeover from wakefulness to sleep. During this short
period (lasting several minutes) of relatively light sleep, your heartbeat, breathing, and eye
movements slow, and your muscles relax with occasional twitches. Your brain waves begin to
slow from their daytime wakefulness patterns.
Stage 2 non-REM sleep is a period of light sleep before you enter deeper sleep. Your
heartbeat and breathing slow, and muscles relax even further. Your body temperature drops
and eye movements stop. Brain wave activity slows but is marked by brief bursts of electrical
activity. You spend more of your repeated sleep cycles in stage 2 sleep than in other sleep
stages.
Stage 3 non-REM sleep is the period of deep sleep that you need to feel
refreshed in the morning. It occurs in longer periods during the first half of the
night. Your heartbeat and breathing slow to their lowest levels during sleep. Your
muscles are relaxed and it may be difficult to awaken you. Brain waves become
even slower.
REM sleep first occurs about 90 minutes after falling asleep. Your eyes move
rapidly from side to side behind closed eyelids. Mixed frequency brain wave
activity becomes closer to that seen in wakefulness. Your breathing becomes faster
and irregular, and your heart rate and blood pressure increase to near waking
levels. Most of your dreaming occurs during REM sleep, although some can also
occur in non-REM sleep. Your arm and leg muscles become temporarily
paralyzed, which prevents you from acting out your dreams. As you age, you sleep
less of your time in REM sleep. Memory consolidation most likely requires both
non-REM and REM sleep.
 SLEEP CYCLE
A sleep cycle is the progression
through the various stages of
NREM sleep to REM sleep before
beginning the progression again
with NREM sleep. Typically, a
person would begin a sleep cycle
every 90-120 minutes resulting in
four to five cycles per sleep time,
or hours spent asleep.
One does not go straight from deep sleep to REM sleep, however. Rather, a sleep cycle progress
through the stages of non-REM sleep from light to deep sleep, then reverse back from deep sleep to
light sleep, ending with time in REM sleep before starting over in light sleep again.
For a majority of people, a sleep cycle begins with a short period of Stage 1 sleep whereby the
body begins to relax and a drowsy state occurs with slow rolling eye movements. Stage 2 occurs for
longer periods than Stage 1. For most, Stage 2 sleep comprises approximately 40-60% of total sleep
time.
Moving through the sleep cycle, Stage 3 is most often found next in the progression. This
restorative stage does not last as long as Stage 2, lasting between 5-15% of total time asleep for most
adults. For children and adolescents Stage 3 is much higher in duration.
REM can occur at time during the sleep cycle, but on average it begins 90 minutes following sleep
onset and is short in duration as it is the first REM period of the night. Following REM, the process
resumes starting with periods of Stage 1, 2 & 3 intermixed before returning to REM again for longer
periods of time as sleep time continues.
How long is a sleep cycle? The first sleep cycle takes about 90 minutes. After that, they average
between 100 to 120 minutes. Typically, an individual will go through four to five sleep cycles a night.
 DEEP SLEEP
Deep sleep occurs in Stage 3 of NREM sleep. Brain waves during Stage 3 are called delta waves due
to the slow speed and large amplitude. Of all of the sleep stages, Stage 3 is the most restorative and the
sleep stage least likely to be affected by external stimuli.
Waking a person from deep sleep can be difficult. Following a period of sleep deprivation, a person
experiences extensive time in Stage 3 sleep. Parasomnias such as sleep walking, sleep talking, night
terrors and bedwetting can occur. (There is muscle activity, that’s how people can talk or kick in their
sleep!)
Deep sleep reduces your sleep drive, and provides the most restorative sleep of all the sleep stages.
This is why if you take a short nap during the day, you’re still able to fall asleep at night. But if you
take a nap long enough to fall into deep sleep, you have more difficulty falling asleep at night because
you reduced your need for sleep.
During deep sleep, human growth hormone is released and restores your body and muscles from the
stresses of the day. Your immune system also restores itself. Much less is known about deep sleep than
REM sleep. It may be during this stage that the brain also refreshes itself for new learning the
following day.
 IN WHAT STAGE OF SLEEP DO
DREAMS OCCUR?
As an active sleep state, REM is the time when the most vivid dreams occur. The rapid eye
movements that occur can be seen as sharp, rapid movements. Brain waves during REM sleep are
considered to be of low amplitude and mixed frequency consistent with higher activity than that
seen in Stages 2 and 3.
A person may dream 4 to 6 times each night. A French study found that all people do in fact
dream, whether they remember their dreams or not. However, if awoken during REM sleep, a
person often can remember their dreams.
Muscle paralysis often accompanies REM sleep. This muscle atonia or muscle paralysis occurs
as a protective means to keep one from acting out their dreams. Obstructive Sleep Apnea is often
the worst during REM periods due to the lack of muscle tone within the muscles of the airway.
Scientists believe this may be to help prevent us from injury while trying to act out our dreams.
During REM respirations are irregular and shallow and irregularities in heart rate and body
temperature also occur.
HOW SLEEP CYCLE CHANGES WITH AGE
Sleep changes throughout a person’s life. From a newborn, through toddler years, school age,
adolescent and adulthood, sleep is changing.
Newborn (0 – approximately 4 months): Do not have distinctive sleep waves. Sleep is
categorized as “Active”, “Quiet” and “Indeterminate”. Active sleep is the equivalent to REM sleep
and quiet sleep is equivalent to non-REM sleep. A majority of the time, newborns are in active
sleep which allows for frequent arousals or awakenings; this is necessary for regular periods of
feeding.
Infants (Approximately 4 months – 1 year): Standard sleep stage distinction is now
apparent. Sleep becomes more consolidated and sleeping routines can be developed, sleep is
typically 10-13 hours per 24 hour period with 2-3 daytime naps occurring.
Toddlers (1 year – 3 years): With sleeping patterns fully developed, children spend
approximately 25% in Stage 3 deep sleep with almost an equal amount of time in REM. Average
sleep time is 9.5-10.5 hours per 24 hour period. Typically naps will reduce to 1 per day most likely
occurring early in the afternoon to allow for proper nighttime sleep.
Pre-School (3 – 6 years): Sleep time is similar to that of toddlers,
approximately 9-10 hours per 24 hour period. The afternoon nap usually subsides
around 3-4 years for a majority of children. Stage 3 sleep still remains high in
relation to total sleep time.
School Age (6 years – 12 years): Sleep time remains unchanged; 9-10
hours per 24 hour period and Stage 3 remains approximately 20-25% of total sleep
time. Restorative sleep is important for growth and development.
Adolescent (12 years and beyond): Sleep time for adolescents is
approximately 9-9.5 hours per 24 hour period. There are physiological changes in
circadian rhythm that occur causing sleep onset to be later. This internal shift is the
cause for many adolescents to have later lights out and the desire to want to “sleep
in” in the morning. As a person ages, the circadian rhythm shifts back and sleep
again appears to regulate to approximately 6.5-8 hours of sleep per 24 hour period
as adult.
 HOW TO GET A BETTER NIGHT'S SLEEP
There are some things that a person can do to improve their sleep
hygiene to feel well-rested and refreshed, including:
1.Exercising regularly and eating a healthful diet
2.Avoiding foods that are sugary, fatty, processed or have caffeine
3.Avoiding spicy foods or having caffeine at bedtime
4.Stopping the use of computers, TVs, cellphones, and other
electronic devices at least 30 minutes before bed
5.Maintaining a dark and quiet sleeping place
 SLEEP DISORDERS
Sleep disorders are conditions that result in changes in the way that you sleep. A
sleep disorder can affect your overall health, safety and quality of life. Sleep
deprivation can affect your ability to drive safely and increase your risk of other
health problems.
Some of the signs and symptoms of sleep disorders include excessive daytime
sleepiness, irregular breathing or increased movement during sleep. Other signs and
symptoms include an irregular sleep and wake cycle and difficulty falling asleep.
There are many different types of sleep disorders. They're often grouped into
categories that explain why they happen or how they affect you. Sleep disorders can
also be grouped according to behaviors, problems with your natural sleep-wake
cycles, breathing problems, difficulty sleeping or how sleepy you feel during the
day.
 Insomnia
Sleep disorder in which you have difficulty falling asleep or staying asleep throughout the
night.
The condition can be short-term (acute) or can last a long time (chronic). It may also
come and go.
Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens
at least 3 nights a week for 3 months or more.
Types of Insomnia
There are two types of insomnia: primary and secondary.
Primary insomnia: This means your sleep problems aren’t linked to any other
health condition or problem.
Secondary insomnia: This means you have trouble sleeping because of a
health condition (like asthma, depression, arthritis, cancer, or heartburn); pain;
medication; or substance use (like alcohol).
 TREATMENT OF INSOMNIA
Changing your sleep habits and addressing any issues that may be associated with insomnia, such as
stress, medical conditions or medications, can restore restful sleep for many people. If these measures
don't work, your doctor may recommend cognitive behavioral therapy, medications or both, to help
improve relaxation and sleep.
Cognitive behavioral therapy for insomnia
Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative
thoughts and actions that keep you awake and is generally recommended as the first line of treatment
for people with insomnia. Typically, CBT is equally or more effective than sleep medications.
Stimulus control therapy. This method helps remove factors that condition your mind to
resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid
naps, use the bed only for sleep and sex, and leave the bedroom if you can't go to sleep within 20
minutes, only returning when you're sleepy.
Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises
are ways to reduce anxiety at bedtime. Practicing these techniques can help you control your
breathing, heart rate, muscle tension and mood so that you can relax.
Remaining passively awake. Also called paradoxical intention,
this therapy for learned insomnia is aimed at reducing the worry and
anxiety about being able to get to sleep by getting in bed and trying to
stay awake rather than expecting to fall asleep.
Light therapy. If you fall asleep too early and then awaken too
early, you can use light to push back your internal clock. You can go
outside during times of the year when it's light outside in the evenings,
or you can use a light box. Talk to your doctor about recommendations.
Sleep restriction. This therapy decreases the time you spend in
bed and avoids daytime naps, causing partial sleep deprivation, which
makes you more tired the next night. Once your sleep has improved,
your time in bed is gradually increased.
 SLEEP APNEA
In which you experience abnormal patterns in breathing while you are asleep. Sleep apnea is a
potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly
and feel tired even after a full night's sleep, you might have sleep apnea.
Treatment:
For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing
weight or quitting smoking. If you have nasal allergies, your doctor will recommend treatment for your
allergies.
If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a
number of other treatments are available.
Therapies
Continuous positive airway pressure (CPAP).
If you have moderate to severe sleep apnea, you might benefit from using a machine that delivers air
pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater
than that of the surrounding air and is just enough to keep your upper airway passages open,
preventing apnea and snoring.
Other airway pressure devices. If using a CPAP machine continues to be a
problem for you, you might be able to use a different type of airway pressure
device that automatically adjusts the pressure while you're sleeping (auto-CPAP).
Units that supply bi-level positive airway pressure (BPAP) also are available.
These provide more pressure when you inhale and less when you exhale.
Oral Appliances. Another option is wearing an oral appliance designed to keep
your throat open. CPAP is more reliably effective than oral appliances, but oral
appliances might be easier to use. Some are designed to open your throat by
bringing your jaw forward, which can sometimes relieve snoring and mild
obstructive sleep apnea.
Surgery
Surgery is usually only an option after other treatments have failed. Generally, at
least a three-month trial of other treatment options is suggested before considering
surgery. However, for a small number of people with certain jaw structure
problems, it's a good first option.
 RESTLESS LEGS SYNDROME (RLS)
A type of sleep movement disorder. Restless legs syndrome, also
called Willis-Ekbom.
Treatment
Sometimes, treating an underlying condition, such as iron deficiency, greatly
relieves symptoms of restless legs syndrome. Correcting an iron deficiency may
involve receiving iron supplementation orally or intravenously. However, take iron
supplements only with medical supervision and after your doctor has checked
your blood-iron level.
If you have RLS/WED without an associated condition, treatment focuses on
lifestyle changes. If those aren't effective, your doctor might prescribe
medications.
Medication therapy
Several prescription medications, most of which were developed to treat other diseases, are
available to reduce the restlessness in your legs. These include:
Medications that increase dopamine in the brain.
These medications affect levels of the chemical messenger dopamine in your brain. Ropinirole
(Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug
Administration for the treatment of moderate to severe RLS/WED.
Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin),
gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS/WED.
Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting
if used in high doses. Some examples include codeine, oxycodone (OxyContin, Roxicodone),
combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and
acetaminophen (Norco, Vicodin).
Muscle relaxants and sleep medications. Known as benzodiazepines, these drugs help
you sleep better at night, but they don't eliminate the leg sensations, and they may cause daytime
drowsiness. A commonly used sedative for RLS/WED is clonazepam (Klonopin). These drugs are
generally only used if no other treatment provides relief.
 NARCOLEPSY
A condition characterized by extreme sleepiness during the day and falling asleep
suddenly during the day.
Treatment
There is no cure for narcolepsy, but medications and lifestyle modifications can
help you manage the symptoms.
Medications
Medications for narcolepsy include:
Stimulants. Drugs that stimulate the central nervous system are the primary
treatment to help people with narcolepsy stay awake during the day. Doctors often
try modafinil (Provigil) or armodafinil (Nuvigil) first for narcolepsy. Modafinil
and armodafinil aren't as addictive as older stimulants and don't produce the highs
and lows often associated with older stimulants. Side effects are uncommon, but
may include headache, nausea or anxiety.
Selective serotonin reuptake inhibitors (SSRIs) or serotonin and
norepinephrine reuptake inhibitors (SNRIs). Doctors often prescribe these
medications, which suppress REM sleep, to help alleviate the symptoms of
cataplexy, hypnagogic hallucinations and sleep paralysis. They include fluoxetine
(Prozac, Sarafem, Selfemra) and venlafaxine (Effexor XR). Side effects can
include weight gain, insomnia and digestive problems.
Tricyclic antidepressants. These older antidepressants, such as protriptyline
(Vivactil), imipramine (Tofranil) and clomipramine (Anafranil), are effective for
cataplexy, but many people complain of side effects, such as dry mouth and
lightheadedness.
Sodium oxybate (Xyrem). This medication is highly effective for cataplexy.
Sodium oxybate helps to improve nighttime sleep, which is often poor in
narcolepsy. In high doses it may also help control daytime sleepiness. It must be
taken in two doses, one at bedtime and one up to four hours later.
 Lifestyle and home remedies for
Sleep Disorders
In some cases, self-care might be a way for you to deal with obstructive sleep apnea
and possibly central sleep apnea. Try these tips:
Lose excess weight. Even a slight weight loss might help relieve constriction of
your throat. In some cases, sleep apnea can resolve if you return to a healthy weight,
but it can recur if you regain the weight.
Exercise. Regular exercise can help ease the symptoms of obstructive sleep apnea
even without weight loss. Try to get 30 minutes of moderate activity, such as a brisk
walk, most days of the week.
Avoid alcohol and certain medications such as tranquilizers and
sleeping pills. These relax the muscles in the back of your throat, interfering with
breathing.
Sleep on your side or abdomen rather than on your back.
Sleeping on your back can cause your tongue and soft palate to rest against the
back of your throat and block your airway. To keep from rolling onto your back
while you sleep, try attaching a tennis ball to the back of your pajama top. There
are also commercial devices that vibrate when you roll onto your back in sleep.
Don't smoke.
If you're a smoker, look for resources to help you quit.