Sleep DisordersMaggie Hamilton

Current Issues in the BrainECE 275

Quick Sleep Facts

• There are 5 phases of sleep: 1, 2, 3, 4, and REM, which is when we experience dreams. We spend about 50% of our sleep time in stage 2, 20% in REM sleep, and the other 30% in the other stages (NINDS, 2007).

• Neurotransmitters control whether we are asleep or awake.

• Experts say if you feel drowsy during the day, you haven’t had enough sleep.

• Most adults need 7-8 hours of sleep, teenagers about 9, and infants require about 16 hours a day.

Quick Sleep Facts

• Sleep gives neurons that are used when we are awake a chance to shut down and repair themselves. Without sleep those neurons would be depleted of energy, polluted with byproducts, and normal cellular activities would begin to malfunction.

• Sleeping may also help learning because it gives the brain a chance to exercise neural connections that might deteriorate otherwise.

Narcolepsy• Narcolepsy is a chronic, neurological sleep

disorder that causes excessive sleepiness and frequent daytime sleep attacks.

• Usually occurs in people ages 15-30.

• The exact cause is unknown but it is linked to reduced amounts of a protein made in the brain called hypocretin. This lack of hypocretin could be the result of traumatic injury, stroke, or tumors.

• Hypocretin is a peptide derived from the hypothalamus that has been linked to regulatory functions including sleep/wake cycles (Peacock, 2010).

Narcolepsy Symptoms

• Periods of extreme drowsiness throughout the day lasting about 15 minutes each time although it may be longer.

• Sleep paralysis – a person cannot move as they start falling asleep or when they wake up, may last 15 min. This can be a frightening experience for the patient.

• Cataplexy – Sudden loss of muscle tone when awake that makes you unable to move, most of these attacks last less than 30 seconds and can sometimes be missed. The head will suddenly fall forward, jaw becomes slack, and knees buckle. In sever cases, a person may fall and stay paralyzed for several minutes.

Narcolepsy Video(Click on box to play)

Sleep Apnea

• Sleep disorder that occurs when a person’s breathing is interrupted during sleep. They stop breathing repeatedly during their sleep, sometimes hundreds of times.

• This means that the brain, and the rest of the body, may not get enough oxygen.

• Two types:– Obstructive Sleep Apnea (OSA), caused by blockage of the airway,

usually when the soft tissue in the back of throat collapses during sleep.

– Central Sleep Apnea (CSA), the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

Sleep Apnea• Snoring is common• Breathing pauses can last a

few seconds to a few minutes, typically when normal breathing starts again, it starts with a loud snort or a choking sound.

• Disturbs nightly sleep making the person excessively sleepy during the daytime.

*Interesting Fact*Some very young infants

experience a kind of apnea due to immaturity of the brain

stem.

Sleep Apnea:Brain Damage

• Obstructive Sleep Apnea (OSA) impairs vigilance and executive functioning. This is due to the effects of sleep fragmentation from repetitive apneas that the prefrontal cortex of the brain experiences. The prefrontal cortex also seems to be very sensitive to sleep deprivation which contributes to these impairments. (Wong, 2006).

Insomnia

• Insomnia is characterized by difficulty falling asleep, staying asleep, or getting good quality sleep.

• Insomnia can be acute (short-term) or chronic (ongoing).• It is often brought on by stress, traumatic events, anxiety or

physiological causes such as caffeine or alcohol. • Insomnia can cause daytime sleepiness, lack of energy and

trouble learning. This lack of learning occurs with lack of sleep because sleep gives the brain a chance to exercise important neural connections that were made that day that may otherwise deteriorate from lack of activity (NINDS, 2007).

“In 2001 Stephen Reitz claimed to be sleepwalking when he stabbed and beat his married girlfriend to death in their hotel room and later walked to the police station to turn himself in. Reitz claimed to be dreaming of attacking a male intruder in ‘flashbacks’, although he also claimed to remember nothing of the attack. Although Reitz had no apparent motive, he did have a history of violence and abuse. In 2004, Stephen Reitz was convicted of first-degree murder.” (Ciccarelli, 2010).Can watch story at: http://www.msnbc.msn.com/id/29658353/ns/dateline_nbc-crime_reports/t/deadly-dreams/

REM Behavior Disorder“Murder while Sleepwalking”

“In 2003, Jules Lowe of Manchester, England, attacked and killed his 82-year old father while sleepwalking. Lowe had a history of sleepwalking, was under great stress, and had no motive to kill his father. Sleep expert Dr. Irshaad Ebrahim testified that tests showed Lowe to be sleepwalking at the time of the attack. In 2005, Lowe was acquitted.” (Ciccarelli, 2010).

REM Behavior Disorder

• In this rare disorder, brain mechanisms that normally inhibit voluntary muscles fail, allowing the person to thrash around, sleepwalk, and even act out nightmares.

• During REM sleep the electrical activity in the brain is similar to the electrical activity that occurs when awake, but when in REM sleep, one experiences muscle paralysis. People with REM Behavior Disorder lack this muscle paralysis, permitting them to act out their dramatic or violent dreams.

• The only sensations the person “acting out” experiences is what is occurring in their dream. They may move around without waking or realizing that they are dreaming.– A 77-year old minister had been behaving violently in his sleep for 20 years,

sometimes even injuring his wife. – A 60-year old surgeon would jump out of bed during nightmares of being attacked by

"criminals, terrorists and monsters." – A 62-year old industrial plant manager who was a war veteran dreamt of being

attacked by enemy soldiers and fights back in his sleep, sometimes injuring himself. – A 57-year old retired school principal was inadvertently punching and kicking his wife

for two years during vivid nightmares of protecting himself and family from aggressive people and snakes. (National Sleep Foundation, 2011)

*Interesting Fact*

“Cats with lesions affecting the part of the brain stem that involves the inhibition of locomotor activity will have motor activity during REM sleep: they will arch their

backs, hiss and bare their teeth for no reason, while their brain waves register normal REM sleep.” (National Sleep Foundation, 2011).

REM Behavior Disorder

Annotated Bibliography

NINDS. (2007, May 21). Brain basics: Understanding sleep. Retrieved from http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm -This article provided some of the basic information on sleep. It went over the different stages of sleep and how lack of sleep and the benefits of sleep effects our brains.

*Ciccarelli, S. K., & White, J. N. (2010). Psychology. (2 ed.). Pearson College Div.-This book covers different sleep disorders and the role the brain plays in sleep. It also provided several stories regarding REM behavior disorder. It also had extensive information on sleep in general, not pertaining to sleep disorders.

*Wong, K. H., Grunstein, R. R., Bartlett, D. J., & Gordon, E. (2006). Brain Function In Obstructive Sleep Apnea:: Results from The Brain Resource International Database. Journal Of Integrative Neuroscience, 5(1), 111-121. -This peer reviewed article tests patients who have Obstructive Sleep Apnea (OSA). The tests examined the effects of OSA on the brain but yielded inconsistent results. Studies did show deficits in executive functioning which relates to the prefrontal cortex.

*Peacock, J., & Benca, R. M. (2010). Narcolepsy: Clinical features, co-morbidities & treatment. Indian Journal Of Medical Research, 131(2), 338-349.-This peer reviewed article talks in depth about narcolepsy, and how hypocretin is linked to patients having this disorder.

National sleep foundation. (2011). Retrieved from http://www.sleepfoundation.org/article/sleep- related-problems/rem-behavior-disorder-and-sleep -REM behavior disorder was discussed in this online article. It talks about the history, causes, and some potential treatments. It also gave some examples of how people who suffer from this disorder act during their sleep.