Sleep Sleep Anil Rama, MD Anil Rama, MD Medical Director, Division of Sleep Medicine Medical Director, Division of Sleep Medicine The Permanente Medical Group The Permanente Medical Group Assistant Adjunct Clinical Faculty Assistant Adjunct Clinical Faculty Stanford School of Medicine Stanford School of Medicine
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SleepSleep
Anil Rama, MDAnil Rama, MDMedical Director, Division of Sleep MedicineMedical Director, Division of Sleep Medicine
The Permanente Medical GroupThe Permanente Medical Group
Assistant Adjunct Clinical FacultyAssistant Adjunct Clinical FacultyStanford School of MedicineStanford School of Medicine
Circadian Rhythm of Sleep
Wake
SleepBo
dy
tem
pe
ratu
re
7 AM
7 AM
Courtesy of R. Bogan, MD.
Time
Sleep Stages and Function
Vander et al. Consciousness and behavior. In: Human Physiology. 1990.
States Function
Active state of brain
functions in learning
and memory
Body’s rest and
metabolic restoration
Phasic eye movements
Loss of muscle tone
EEG neutral
Stage 3Stage 4
(REM)
Stage 1Stage 2
(NREM)
Sleep and Age
Hobson. Sleep and Dreaming. In: Fundamental Neuroscience. 1999.Roffwarg et al. Science. 1996;152:604.
24
0
8
16
-1 0 1 10 20 100
Conception Birth
Age (y)Death
Ho
urs
in
da
y
NREM sleep
Awake
REM sleep
Sleepy cabbie.wmv
How likely are you to doze off or fall asleep in the following s ituations, in contrast to feeling just tired? This refers to your way of life in recent times. Eve n if you have not done some of these things recently, try to work out how they would have affec ted you. Use the following scale to choose the most appropriate number for each situation.
Situation Chance of Dozing
Sitting and readingWatching TVSitting, inactive in a public place (eg, a theater or a meeting)As a passenger in a car for an hour without a breakLying down to rest in the afternoon when circumstances permitSitting and talking to someoneSitting quietly after a lunch without alcoholIn a car, while stopped for a few minutes in traffic
Epworth Sleepiness Scale (ESS)
Johns. Sleep. 1991;14:540.
0 = would never doze
2 = moderate chance of dozing
1 = slight chance of dozing
3 = high chance of dozing
Sleepiness: Clinical Presentation
• Pervasive drowsiness
• Sleep attacks
• Fatigue
• Microsleep episodes
• Visual disturbances
• Apathy
• Mood changes
• Automatic activity
• Impaired alertness
• Lethargy
• Impaired memory and concentration
• Poor performance in work/school
• Accident prone
Overeem et al. J Clin Neurophysiol. 2001;18:78. Bassetti and Aldrich. Neurol Clin. 1996;14:545.J. Black, MD. Personal communications. October 2002.
The Two-process Model of Sleep The Two-process Model of Sleep RegulationRegulation
Process S (Homeostatic Process)Process S (Homeostatic Process)– Increases during waking and decreases Increases during waking and decreases
during sleepduring sleep Process C (Circadian Process)Process C (Circadian Process)
– Clock-like process that is independent of Clock-like process that is independent of sleep and wakingsleep and waking
Time Zone ChangeTime Zone Change Shift WorkShift Work Delayed Sleep Phase SyndromeDelayed Sleep Phase Syndrome Advanced Sleep Phase SyndromeAdvanced Sleep Phase Syndrome Non-24 Hour Sleep-Wake SyndromeNon-24 Hour Sleep-Wake Syndrome Irregular Sleep-Wake PatternIrregular Sleep-Wake Pattern Short SleeperShort Sleeper
Movement Disorders Causing Movement Disorders Causing InsomniaInsomnia
Restless Legs SyndromeRestless Legs Syndrome Periodic Limb Movement DisorderPeriodic Limb Movement Disorder Sleep StartsSleep Starts Nocturnal SeizuresNocturnal Seizures