What is consciousness, and how does it function?

1
The Architecture of Sleep

• What is consciousness, and how does it function?
• Why do we sleep 3 theories
• What is biological rhythm of our sleep?
• How does sleep loss effect us?

2
Theories of the Purpose of Sleep

• Restoration the body wears out during and sleep
  is necessary to put it back in shape
• Protection sleep emerged in evolution as an
  adaptations to preserve energy and protect during
  the time of day when there is considerable
  danger.
• Growth During sleep the pituitary gland releases
  growth hormone.

3
Stages of Sleep

• Awake and alert through Stage 2 (slide 13)
• Stage 3 through REM Sleep (slide 16)
• Methods of recording sleep and characteristics of
  the five stages (stages 1 through 4, or non-REM
  NREM and REM sleep). The typical EEG patterns
  are superimposed over the sleepers image.

4
Sleep Deprivation Site

• Symptoms of sleep deprivation
• Common symptoms of sleep deprivation include
• tiredness , irritability, edginess , inability
  to tolerate stress problems with concentration
  and memory , behavioral, learning or social
  problems frequent infections , blurred vision ,
  vague discomfort , alterations in appetite ,
  activity intolerance
• It must be noted that many of these symptoms can
  be related to disabling conditions. This overlap
  of symptoms may make it difficult to determine if
  they are caused by sleep deprivation or the
  disability.\
• Some suggestions to help you determine the cause
  of your sleep deprivation include talking to your
  health care provider, and keeping a log (that
  contains signs and symptoms, situations affecting
  your sleep, medications, diet, etc

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Sleep Deprivation Record Breakers

• Until recently, most sleep research tested the
  limits of how long people can stay up and the
  short term effects of sleep deprivation.
• Notorious cases of record-setters include disc
  jockey Peter Tripp who in 1959 stayed up for more
  than eight days as a promotional stunt. After a
  few days, he began to hallucinate, seeing
  kittens, mice, and cobwebs. He also became
  paranoid, insisting that an electrician had
  dropped a hot electrode into his shoe.
• Six years later, high school student Randy
  Gardner attempted to break the Guinness Book of
  World Records for the longest time awake -- 260
  hours. And after 11 days without sleep he
  suffered no hallucinations or paranoia and no
  psychotic symptoms.

6
Randy Gardners Sleep Experience

• Day 2 Difficulty focusing eyes and signs of
  astereognosis (difficulty recognizing objects
  only by touch).
• Day 3 Moodiness, some signs of ataxia (inability
  to repeat simple tongue twisters).
• Day 4 Irritability and uncooperative attitude,
  memory lapses and difficulty concentrating.
  Gardner's first hallucination was that a street
  sign was a person, followed by a delusional
  episode in which he imagined that he was a famous
  black football player.
• Day 5 More hallucinations (e.g., seeing a path
  extending from the room in front of him down
  through a quiet forest). These were sometimes
  described as "hypnagogic reveries" since Gardner
  recognized, at least after a short while, that
  the visions were illusionary in nature.
• Day 6 Speech slowing and difficulty naming
  common objects.
• Day 7 and 8 Irritability, speech slurring and
  increased memory lapses.
• Day 9 Episodes of fragmented thinking
  frequently beginning, but not finishing, his
  sentences.
• Day 10 Paranoia focused on a radio show host who
  Gardner felt was trying to make him appear
  foolish because he ws having difficulty
  remembering some details about his vigil.
• Day 11 Expressionless appearance, speech slurred
  and without intonation had to be encouraged to
  talk to get him to respond at all. His attention
  span was very short and his mental abilities were
  diminished. In a serial sevens test, where the
  respondent starts with the number 100 and
  proceeds downward by subtracting seven each time,
  Gardner got back to 65 (only five subtractions)
  and then stopped. When asked why he had stopped
  he claimed that he couldn't remember what he was
  supposed to be doing.

7
How do sleeping pills work?

• Most sleeping pills are closely related to the
  drugs that are given for anxiety to help people
  feel calmer (sedatives). Drugs prescribed as
  sedatives will help you sleep if taken at night,
  while sleeping pills will sedate you if taken
  during the day. Generally speaking, the
  short-acting drugs are those that are prescribed
  as sleeping tablets, and the longer-acting are
  prescribed for anxiety.Sleeping drugs are more
  likely to be effective in cases where the
  difficulty getting to sleep or staying asleep
  (insomnia) is short-lived. They are less helpful
  when the insomnia has been going on for a long
  time. No sleeping pills should be used for
  long-term treatment.

8
Artificial Stimulants
Caffeine blocks the effect of adenosine, a
chemical in our brains that induces sleep.
Caffeine withdrawal can produce several side
effects. Headaches Irritability Nervousness
Restlessness Tiredness

• Caffeine, by any measure, is the worlds most
  popular drug, easily surpassing nicotine and
  alcohol, according to Bennett Alan Weinberg and
  Bonnie K. Bealer (The World of Caffeine,
  Rutledge 2001). Unlike other drugs, however,
  caffeine is an unregulated, easily accessible,
  normal part of life. Every day in America, 85
  percent of us use caffeine. Caffeine has become
  so popular because it serves as a stimulant. It
  increases metabolism, raises blood pressure and
  heart rate, and accelerates breathing. It also
  can offset the effects of sleep deprivation. In
  other words, it wakes you up Research suggests
  that caffeine blocks the effect of adenosine, a
  chemical in our brains that induces sleep. As a
  result, when we drink caffeine we are unable to
  become as tired or sleepy as we would otherwise,
  and we have difficulty falling asleep 38 of
  nighttime caffeinated beverage drinkers report
  awaking frequently during the night a few times a
  week or more (compared with 33 of those who do
  not drink caffeinated beverages at night) and
• 27 of nighttime caffeinated beverage drinkers
  (versus 15 of those who do not drink caffeinated
  beverages at night) experienced daytime
  sleepiness that interfered with their daily
  activities a few days a week or more.

9
Caffeine amounts in popular soft drinks per 12
oz cans

• SOFT DRINK/CAFFEINE LEVEL (mgs)
• Mountain Dew/55.0 (no caffeine in Canada)
• Diet Mountain Dew/55.0
• Coca-Cola/45.6
• Diet-Cola/45.6
• 7 Up/0
• Caffeine amounts per 7 oz cups of coffee and tea
• Espresso/100
• Brewed coffee/80 - 135
• Instant/65 - 100
• Decaf, brewed/3 - 4
• Decaf, instant /2 - 3
• Tea iced/70
• Tea brewed/40 - 60
• Tea instant/30
• Chocolate also contains caffeine. A 28 gram
  Cadbury chocolate bar contains about 15 mgs of
  caffeine

10
How Does Sleep Contribute to All of These Things?
Sleep architecture follows a pattern of
alternating REM (rapid eye movement) and NREM
(non-rapid eye movement) sleep throughout a
typical night in a cycle that repeats itself
about every 90 minutes.
11
What role does each state and stage of sleep
play?
NREM (75 of night) As we begin to fall
asleep, we enter NREM sleep,
which is composed of stages 1-4
12

• Stage 1
• Between being awake and falling asleep
• Light sleep
• temperature and blood pressure drop
• Shift to alpha waves
• muscles relax
• hypnagogic possible
• images occur
• easily awakened

13
What is a myoclonic jerk?

• This term denotes a common experience with sudden
  contractions of the big body muscles while
  falling asleep. This mostly causes a feeling of
  stumbling, falling or similar and subsequently
  waking up again
• "...you're heart rate gets very slow, and and
  your breathing slows down quicker than normal.
  You brain may interpret this as your body dying,
  so it sends an electrical pulse to your muscles.
  Like a jump start. This is similar to a Night
  Terror, when you wake up absolutely terrified
  about something, but have no idea why...."

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Stage 2

• Stage 2
• Onset of sleep
• Becoming disengaged from surroundings
• Breathing and heart rate are regular
• Body temperature drops (so sleeping in a cool
  room is helpful)
• Slower eye movement
• Sleep spindles and K-complex
• If aroused youll say..who me? Asleep?

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• Stages 3 and 4 slower larger delta wavesin
  stage 4 delta waves increase 50
• Deepest and most restorative sleep
• Blood pressure drops, heart rates slows
• Breathing becomes slower
• Muscles are relaxed, no eye movement, hard to
  wake up
• Blood supply to muscles increases
• Tissue growth and repair occurs
• Energy is restored
• Hormones are released, such as Growth
  hormone, essential for growth and development,
  including muscle development

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REM (25 of night) First occurs about 90 minutes
after falling asleep and recurs about every 90
minutes, getting longer later in the night
Provides energy to brain and body, blood pressure
rises, heart and respiration increase
Supports daytime performance Brain is active
and dreams occur Eyes dart back and forth
Body becomes immobile and relaxed, as muscles are
turned off
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In addition, levels of the hormone cortisol dip
at bed time and increase over the night to
promote alertness in morning. Sleep helps us
thrive by contributing to a healthy immune
system, and can also balance our appetites by
helping to regulate levels of the hormones
ghrelin and leptin, which play a role in our
feelings of hunger and fullness. So when were
sleep deprived, we may feel the need to eat more,
which can lead to weight gain. The one-third of
our lives that we spend sleeping, far from being
unproductive, plays a direct role in how full,
energetic and successful the other two-thirds of
our lives can be.
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Sleep Disorders
Bruxism Sleep Apnea Insomnia Restless Leg
Syndrome Night Terrors Sleep Walking Periodic
Limb Movement Bed Wetting
21
Bruxis

• Sleep bruxism, also known as nocturnal tooth
  grinding, is the medical term for clenching or
  grinding teeth during sleep
• estimated that 8 of adults grind their teeth at
  night and a study shows that more than a third of
  parents report symptoms of bruxism in their
  children.

22
Causes

• factors as
• anxiety
• stress
• alcohol consumption
• cigarette smoking
• caffeine
• sleep apnea
• snoring and excessive daytime sleepiness

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Symptoms of sleep bruxism include Worn down
teeth Headaches Earaches Sore gums, teeth,
jaw, and face

• Symptoms

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Sleep Apnea

• Breathing is Briefly and repeatedly interrupted
  during sleep
• sleep apnea refers to a breathing pause that
  lasts at least ten seconds
• Obstructive sleep apnea occurs when the muscles
  in the back of the throat fail to keep the airway
  open, despite efforts to breathe. Another form of
  sleep apnea is central sleep apnea, in which the
  brain fails to properly control breathing during
  sleep. Obstructive sleep apnea is far more common
  than central sleep apnea.

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Continued.

• Obstructive sleep apnea, or simply sleep apnea,
  can cause fragmented sleep and low blood oxygen
  levels. For people with sleep apnea, the
  combination of disturbed sleep and oxygen
  starvation may lead to hypertension, heart
  disease and mood and memory problems
• Sleep apnea also increases the risk of
  automobile crashes. Sleep apnea can be
  life-threatening and you should consult your
  doctor immediately if you feel you may suffer
  from it.

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Symptoms

• Chronic snoring is a strong indicator of sleep
  apnea
• they may suffer from daytime sleeplessness
• other symptoms such as difficulty concentrating
• depression, irritability,
• sexual dysfunction, learning and memory
  difficulties
• falling asleep while at work, on the phone, or
  driving
• Left untreated, symptoms of sleep apnea can
  include
• disturbed sleep,
• excessive sleepiness during the day
• high blood pressure,
• heart attack, congestive heart failure,
• cardiac arrhythmia,
• stroke
• depression.

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Insomnia

• Insomnia, which is Latin for "no sleep," is the
  inability to fall asleep or remain asleep.
• Insomnia is also used to describe the condition
  of waking up not feeling restored or refreshed
• insomnia refers to the inability to get the
  amount of sleep you as an individual need to wake
  up feeling rested.
• people experience chronic-intermittent insomnia,
  which means difficulty sleeping for a few nights,
  followed by a few nights of adequate sleep before
  the problem returns.

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Insomnia

• Half of all those who have experienced insomnia
  blame the problem on stress and worry
• The prevalence of insomnia is higher among older
  people and women
• Some medications can lead to insomnia, including
  those taken for
• colds and allergies
• high blood pressure
• heart disease
• thyroid disease
• birth control
• asthma
• pain medications
• depression (especially SSRI antidepressants)

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Insomnia Continued

•  Some common sleep disorders such as restless
  legs syndrome and sleep apnea can also lead to
  insomnia.
• Sleep is as essential as diet and exercise.
  Inadequate sleep can result in fatigue,
  depression, concentration problems, illness and
  injury.
• Symptoms of insomnia include
• difficulty falling asleep
• waking up frequently during the night
• difficulty returning to sleep
• waking up too early in the morning
• unrefreshing sleep
• daytime sleepiness
• difficulty concentrating
• irritability

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Treatment

• bedtime routines or the bedroom itself may become
  linked with anxiety for a person who is
  experiencing insomnia because they dread the
  thought of another sleepless night.
• Some examples of behavioral treatments are
• Stimulus Control Therapy creating a sleep
  environment that promotes sleep
• Cognitive Therapy learning to develop
  positive thoughts and beliefs about sleep
• Sleep Restriction following a program that
  limits time in bed in order to get to sleep and
  stay asleep throughout the night
• Relaxation techniques, such as yoga, meditation,
  and guided imagery may be especially helpful in
  preparing the body to sleep. Exercise, done early
  in the day, can also be helpful in reducing
  stress and promoting deeper sleep.

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Sleeping Pills

• A sedative is a substance that depresses the
  central nervous system, resulting in calmness,
  relaxation, reduction of anxiety, sleepiness, and
  slowed breathing, as well as slurred speech,
  staggering walk, poor judgment, and slow,
  uncertain reflexes. Sedatives may be referred to
  as tranquilizers, depressants, anxiolytics,
  soporifics, sleeping pills, downers, or
  sedative-hypnotics. Sedatives can be abused to
  produce an overly-calming effect (alcohol being
  the classic and most common sedating drug). At
  high doses or when they are abused, many of these
  drugs can cause unconsciousness and even death.

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Restless Leg Syndrome

• Restless Legs Syndrome (RLS) is a neurologic
  sensorimotor disorder that is characterized by an
  overwhelming urge to move the legs when they are
  at rest.
• Symptoms of RLS are most severe in the evening
  and nighttime hours and can profoundly disrupt a
  patient's sleep and daily life.
• RLS affects approximately 10 of adults in the
  U.S. Researchers believe that RLS is commonly
  unrecognized or misdiagnosed as insomnia or other
  neurological, muscular or orthopedic condition.
• More than 80 percent of people with RLS also
  suffer from a condition know as periodic limb
  movement disorder (PLMD). Characteristics of PLMD
  include involuntary leg twitching or jerking
  movements during sleep that occur repeatedly
  throughout the night and result in disrupted
  sleep.
•  

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Treatment

• Requip (ropinirole hydrochloride) that is
  commonly used to treat Parkinson disease was
  given FDA approval at lower doses for the
  treatment of moderate-to-severe primary RLS
• Mirapex was also approved by the FDA for the
  treatment of moderate-to-severe primary RLS

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Night Terrors

• The sleep disorder of night terrors typically
  occurs in children aged 3-12 years, with a peak
  onset in children aged 3½ years.
• Night terrors are distinctly different from the
  much more common nightmares, which occur during
  REM sleep. Night terrors are characterized by
  frequent recurrent episodes of intense crying and
  fear during sleep, with difficulty arousing the
  child. Night terrors are frightening episodes
  that disrupt family life.  

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Causes

• Night terrors may be caused by the following 
• Stressful life events
• Fever
• Sleep deprivation
• Medications that affect the central nervous
  system (the brain)

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Night Terrors Symptoms

• In addition to frequent recurrent episodes of
  intense crying and fear during sleep, with
  difficulty arousing the child, children with
  night terrors may also experience the following 
  
• Increase breathing
• Sweating
• Increase heart rate

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Sleep Walking

• is a disorder characterized by complicated
  actions that result in walking during sleep.
• Sleepwalking behavior can range from simply
  getting out of bed and walking around the room to
  driving a car. 
• Sleepwalking usually occurs during the slow-wave
  stages of non-rapid eye movement (NREM) sleep
  (stages of sleep in which eye movement does not
  take place for details of stages of sleep see
  Sleep Understanding the Basics.)
• . Persons affected with this disorder usually
  have their eyes wide open in a stare.
• Sleepwalking occurs most commonly in middle
  childhood and preadolescence, with a peak
  incidence in children aged 11-12 years.
• Can last through adulthood

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Causes

• schedules
• Fever
• stress
• magnesium deficiency
• alcohol intoxication can trigger sleepwalking
• sedative/hypnotics
• narcoleptics (drugs used to treat psychosis)
• minor tranquilizers
• stimulants
• antihistamines

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Symptoms

• Episodes range from quiet walking about the room
  to agitated running or attempts to"escape."
• Typically, the eyes are open with a glassy,
  staring appearance as the person quietly roams
  the house.
• On questioning, responses are slow or absent. If
  the person is returned to bed without awakening,
  the person usually does not remember the event.
• Older children, who may awaken more easily at the
  end of an episode, often are embarrassed by the
  behavior (especially if it was inappropriate).
• Sleepwalking is not associated with previous
  sleep problems, sleeping alone in a room or with
  others, achluophobia (fear of the dark), or anger
  outbursts.
• Some studies suggest that children who sleepwalk
  may have been more restless sleepers when aged
  4-5 years, and more restless with more frequent
  awakenings during the first year of life.

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Periodic limb movement disorder

• repetitive cramping or jerking of the legs during
  sleep.
• It is the only movement disorder that occurs
  only during sleep, and it is sometimes called
  periodic leg (or limb) movements during sleep
• "Periodic" refers to the fact that the movements
  are repetitive and rhythmic, occurring about
  every 20-40 seconds
• PLMD is also considered a sleep disorder,
  because the movements often disrupt sleep and
  lead to daytime sleepiness.

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Causes

• Actually no known cause
• Has been linked with abnormal nerve travel from
  brain to limbs
• There are secondary reason like diabetes, spinal
  cord injuries, tumors sleep apnea
• Drug withdrawal
• Linked with Restless Leg Syndrome
• Treatment
• Medication that with relaxes the muscles
• Or allows the patients to sleep through it

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Nocturnal Enuresis

• Medical term for wetting the bed
• There are both primary and secondary forms of
  bedwetting
• primary bedwetting, the child has never had
  nighttime control over urination
• The secondary form is less common and refers to
  bedwetting that occurs after the child has been
  dry during sleep for 6 or more months
• Secondary bedwetting is usually caused by
  psychological stress
• may be the result of an underlying medical
  condition such as constipation or urinary tract
  obstruction

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Symptoms

• Bedwetting may occur at any point during the
  night but usually occurs during the first few
  hours of sleep
• Occasional bedwetting for children over the age
  of 5 is not uncommon but if it happens more often
  than 2-3 times per month, parents should consult
  their pediatrician.

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Treatment

• Establishing a regular bedtime routine that
  includes going to the bathroom
• Waking your child during the night before he/she
  typically wets the bed and taking him/her to the
  bathroom
• Developing a reward system to encourage your
  child, such as stickers for dry nights
• Talking to your child about the advantages of
  potty-training, such as not having to wear
  diapers and becoming a "big kid"
• Limiting beverages in the evening - even those
  last minute water requests
• Using a "bell-and-pad" which incorporates an
  alarm that goes off whenever your child's pajamas
  or bed become wet during an accident. These
  systems teach your child to eventually wake up
  before the bedwetting occurs
• Last resort contact physician for medication

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Tips for good Sleep

• 1. Maintain a regular bed and wake time schedule
  including weekends.
• Our sleep-wake cycle is regulated by a "circadian
  clock" in our brain and the body's need to
  balance both sleep time and wake time. A regular
  waking time in the morning strengthens the
  circadian function and can help with sleep onset
  at night. That is also why it is important to
  keep a regular bedtime and wake-time, even on the
  weekends when there is the temptation to sleep-in.

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• Establish a regular, relaxing bedtime routine
  such as soaking in a hot bath or hot tub and then
  reading a book or listening to soothing music.
• A relaxing, routine activity right before bedtime
  conducted away from bright lights helps separate
  your sleep time from activities that can cause
  excitement, stress or anxiety which can make it
  more difficult to fall asleep, get sound and deep
  sleep or remain asleep. Avoid arousing activities
  before bedtime like working, paying bills,
  engaging in competitive games or family
  problem-solving. Some studies suggest that
  soaking in hot water (such as a hot tub or bath)
  before retiring to bed can ease the transition
  into deeper sleep, but it should be done early
  enough that you are no longer sweating or
  over-heated. If you are unable to avoid tension
  and stress, it may be helpful to learn relaxation
  therapy from a trained professional. Finally,
  avoid exposure to bright before bedtime because
  it signals the neurons that help control the
  sleep-wake cycle that it is time to awaken, not
  to sleep.

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• Create a sleep-conducive environment that is
  dark, quiet, comfortable and cool.
• Design your sleep environment to establish the
  conditions you need for sleep cool, quiet,
  dark, comfortable and free of interruptions. Also
  make your bedroom reflective of the value you
  place on sleep. Check your room for noise or
  other distractions, including a bed partner's
  sleep disruptions such as snoring, light, and a
  dry or hot environment. Consider using blackout
  curtains, eye shades, ear plugs, "white noise,"
  humidifiers, fans and other devices.

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. Use your bedroom only for sleep

• It is best to take work materials, computers and
  televisions out of the sleeping environment.
• Use your bed only for sleep to strengthen the
  association between bed and sleep.
• If you associate a particular activity or item
  with anxiety about sleeping, omit it from your
  bedtime routine. For example, if looking at a
  bedroom clock makes you anxious about how much
  time you have before you must get up, move the
  clock out of sight.
• Do not engage in activities that cause you
  anxiety and prevent you from sleeping.

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Exercise regularly. It is best to complete your
workout at least a few hours before bedtime.

• In general, exercising regularly makes it easier
  to fall asleep and contributes to sounder sleep.
• exercising sporadically or right before going to
  bed will make falling asleep more difficult. In
  addition to making us more alert, our body
  temperature rises during exercise, and takes as
  much as 6 hours to begin to drop.
• A cooler body temperature is associated with
  sleep onset... Finish your exercise at least 3
  hours before bedtime. Late afternoon exercise is
  the perfect way to help you fall asleep at night.

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Avoid caffeine (e.g. coffee, tea, soft drinks,
chocolate) close to bedtime.

• Caffeine is a stimulant, which means it can
  produce an alerting effect.
• Caffeine products, such as coffee, tea, colas and
  chocolate, remain in the body on average from 3
  to 5 hours, but they can affect some people up to
  12 hours later.
• Even if you do not think caffeine affects you, it
  may be disrupting and changing the quality of
  your sleep.
• Avoiding caffeine within 6-8 hours of going to
  bed can help improve sleep quality.

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Finish eating at least 2-3 hours before your
regular bedtime.

• Eating or drinking too much may make you less
  comfortable when settling down for bed.
• It is best to avoid a heavy meal too close to
  bedtime. Also, spicy foods may cause heartburn,
  which leads to difficulty falling asleep and
  discomfort during the night.
• Try to restrict fluids close to bedtime to
  prevent nighttime awakenings to go to the
  bathroom, though some people find milk or herbal,
  non-caffeinated teas to be soothing and a helpful
  part of a bedtime routine.

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Avoid nicotine (e.g. cigarettes, tobacco
products). Used close to bedtime, it can lead to
poor sleep.

• Nicotine is also a stimulant.
• Smoking before bed makes it more difficult to
  fall asleep.
• When smokers go to sleep, they experience
  withdrawal symptoms from nicotine, which also
  cause sleep problems.
• Nicotine can cause difficulty falling asleep,
  problems waking in the morning, and may also
  cause nightmares.
• Difficulty sleeping is just one more reason to
  quit smoking. And never smoke in bed or when
  sleepy!

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Avoid alcohol close to bedtime.

• Although many people think of alcohol as a
  sedative, it actually disrupts sleep, causing
  nighttime awakenings.
• Consuming alcohol leads to a night of less
  restful sleep.

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