Neurobiology of Sleep-Wake States Neurobiology of Sleep-Wake States Daniel J. Buysse, M.D. Daniel J. Buysse, M.D. Professor of Psychiatry Professor of Psychiatry University of Pittsburgh School University of Pittsburgh School of Medicine of Medicine [email protected]Pittsburgh Mind-Body Center Short Course on Sleep Pittsburgh, PA December 8, 2006
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Neurobiology of Sleep-Wake States Daniel J. Buysse, M.D. Professor of Psychiatry University of Pittsburgh School of Medicine [email protected] Pittsburgh.
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Neurobiology of Sleep-Wake StatesNeurobiology of Sleep-Wake States
Daniel J. Buysse, M.D.Daniel J. Buysse, M.D.Professor of PsychiatryProfessor of PsychiatryUniversity of Pittsburgh School of MedicineUniversity of Pittsburgh School of [email protected]
Pittsburgh Mind-Body Center Short Course on SleepPittsburgh, PADecember 8, 2006
Neurobiology of Sleep-Wake StatesNeurobiology of Sleep-Wake States
Assessment of sleep-wake statesAssessment of sleep-wake states Characteristics of wakefulness, NREM, and REM Characteristics of wakefulness, NREM, and REM
sleepsleep Physiological regulation of sleep-wake statesPhysiological regulation of sleep-wake states Neuroanatomy and neurobiologyNeuroanatomy and neurobiology Neurochemical control of sleep-wake statesNeurochemical control of sleep-wake states Integration of sleep-wake states and circadian Integration of sleep-wake states and circadian
rhythmsrhythms
Overview: Functions of sleepOverview: Functions of sleep
Ecological/ environmental advantageEcological/ environmental advantage Improves the quality of wakefulnessImproves the quality of wakefulness
– AlertnessAlertness
– MoodMood
– Cognitive (especially frontal lobe) functionsCognitive (especially frontal lobe) functions Integration of experience; learningIntegration of experience; learning Resensitization of receptors (e.g., norepinephrine, Resensitization of receptors (e.g., norepinephrine,
Sleepiness and sleep deprivationSleepiness and sleep deprivationBelenky, Belenky, J. Sleep ResearchJ. Sleep Research, 2003, 2003
Performance and sleep deprivationPerformance and sleep deprivationBelenky, Belenky, J. Sleep ResearchJ. Sleep Research, 2003, 2003
Sleep deprivation effects on cognitive Sleep deprivation effects on cognitive function function Drummond et al., Drummond et al., NeuroreportNeuroreport, 1999, 1999
Normal sleep – Activation of PFC, parietal, pre-motor cortex
Following sleep deprivation – Decreased activation
fMRI during serial subtraction task
Effect of sleep and sleep deprivation on Effect of sleep and sleep deprivation on motor task performance motor task performance Walker and Strickgold, Walker and Strickgold, NeuronNeuron, 2004, 2004
Surgery:Surgery: 20% more errors and 14% 20% more errors and 14% more time required to perform more time required to perform simulated laparoscopy post-call (two simulated laparoscopy post-call (two studies) studies) Taffinder et al, 1998; Grantcharov et al, 2001Taffinder et al, 1998; Grantcharov et al, 2001
Internal Medicine:Internal Medicine: efficiency and efficiency and accuracy of ECG interpretation accuracy of ECG interpretation impaired in sleep-deprived interns impaired in sleep-deprived interns Lingenfelser et al, 1994Lingenfelser et al, 1994
Pediatrics:Pediatrics: time required to place an time required to place an intra-arterial line increased intra-arterial line increased significantly in sleep-deprived significantly in sleep-deprived Storer et al, Storer et al, 19891989
Sleep deprivation in medical traineesSleep deprivation in medical trainees
Effects of sleep deprivation on mood in Effects of sleep deprivation on mood in medical residentsmedical residents Baldwin and Daugherty, Baldwin and Daugherty, SleepSleep, 2004, 2004
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<4 4 to 5 5 to 6 6 to 7 >7
Average Hours of Sleep per Night
Res
iden
ts' R
atin
gs
Moodier & more shorttempered
Impaired my capacityto care for patients
Work hours too long
More conflict withprofessional staff
Misjudgements inpatient care
Sleep duration and body massSleep duration and body massTaheri et al., Taheri et al., PLoS MedPLoS Med, 2004, 2004
n = 1024
Bo
dy
Ma
ss I
nd
ex
Sleep duration, leptin, and ghrelin Sleep duration, leptin, and ghrelin Taheri et al., Taheri et al., PLoS MedPLoS Med, 2004, 2004
Leptin Ghrelin
Sleep restriction: Metabolic and endocrine Sleep restriction: Metabolic and endocrine effects effects Spiegel et al., Spiegel et al., J Clin End & MetabJ Clin End & Metab, 2004, 2004
n = 11
Assessment of sleep-wake statesAssessment of sleep-wake states
Self-report questionnairesSelf-report questionnaires Sleep-wake diariesSleep-wake diaries: Daily recording of sleep times and : Daily recording of sleep times and
characteristicscharacteristics Observer ratingsObserver ratings: Unreliable: Unreliable ActigraphyActigraphy: Motion-sensitive accelerometer worn on wrist: Motion-sensitive accelerometer worn on wrist PolysomnographyPolysomnography (PSG): Modification of (PSG): Modification of
Neurobiology of Sleep-Wake StatesNeurobiology of Sleep-Wake States
Assessment of sleep-wake statesAssessment of sleep-wake states Characteristics of wakefulness, NREM, and REM Characteristics of wakefulness, NREM, and REM
sleepsleep Physiological regulation of sleep-wake statesPhysiological regulation of sleep-wake states Neuroanatomy and neurobiologyNeuroanatomy and neurobiology Neurochemical control of sleep-wake statesNeurochemical control of sleep-wake states Integration of sleep-wake states and circadian Integration of sleep-wake states and circadian
rhythms rhythms
Wakefulness, NREM, and REMWakeWake NREM NREM REMREM
Neurobiology of Sleep-Wake StatesNeurobiology of Sleep-Wake States
Assessment of sleep-wake statesAssessment of sleep-wake states Characteristics of wakefulness, NREM, and REM Characteristics of wakefulness, NREM, and REM
sleepsleep Physiological regulation of sleep-wake statesPhysiological regulation of sleep-wake states Neuroanatomy and neurobiologyNeuroanatomy and neurobiology Neurochemical control of sleep-wake statesNeurochemical control of sleep-wake states Integration of sleep-wake states and circadian Integration of sleep-wake states and circadian
rhythms rhythms
Integration of circadian rhythms and sleep-wake states Pace-Schott and Hobson, 2002