INSOMNIA

Insomnia facts
(read whats in ppt – primary)
- Primary insomnia may be caused by stress related to big life events, physical disturbances like
noise, light, and temperature, changes in sleep schedule like jetlag, and other bad sleep habits.

(read whats in ppt – secondary)

-Secondary insomnia may be cause by mental health problems like depression and anxiety,
medications, pain, caffeine, alcohol use, hyperthyroidism and others.

Sleep apnea
-Sleep apnea is a particular form of insomnia. It is a sleep disorder in which breathing is briefly
and repeatedly interrupted during sleep. Nearly everyone, especially the people who snore
during sleep experience an episode of sleep apnea once in a while.
-During a period of sleep apnea, the level of carbon dioxide in the blood stimulates
chemoreceptors (or the neurons that detect the presence of certain chemicals), and the person
wakes up, grasping for air.
- There are two types of sleep apnea.
(read ppt)
-The more common one is the obstructive sleep apnea.
-Some people use a device that attaches to the sleeper’s face and provides pressurized air that
keeps the airway open.

Treatment
(read whats in ppt – pharmacological)
-These drugs has side effects that may lead to sleepiness and difficulty concentrating during the
following day.
-Chronic use of these drugs may lead to tolerance and rebound insomnia, which means a return
and increase in insomnia.

NARCOLEPSY

Narcolepsy facts
-Narcolepsy is a disorder wherein a person sleeps at inappropriate times.

Sleep attacks
-The primary symptom of having narcolepsy is sleep attack. (read ppt)

Cataplexy
-The most striking symptom of narcolepsy is cataplexy. (read ppt)
-A person experiencing total cataplexy stays awake and is aware of what is happening, but
cannot move. 
-Some individuals avoid emotions that may bring on cataplexy.
-The loss of muscle tone in cataplexy occurs because of the inability to regulate sleep and
awake states. It that elements of each can overlap. During normal rapid eye movement (REM)
sleep, there is a natural loss of muscle tone. In the case of cataplexy, that characteristic of REM
sleep occurs suddenly during the day, causing weakness or full paralysis, even in waking time.

Sleep paralysis
(read ppt – sleep paralysis)
-Sometimes, the mental components of REM sleep intrude into sleeping paralysis wherein the
person dreams while lying awake, paralyzed. These episodes are called hypnagogic
hallucinations. (read ppt)

Physiological basis of narcolepsy

-In 1998, two research groups independently discovered orexin A and orexin B (aka hypocretin
1 and hypocretin 2), small neuropeptides produced solely by neurons in the lateral
hypothalamus. Derived from a precursor protein (prepro-orexin), orexin A and orexin B have
excitatory effects on postsynaptic neurons via the orexin 1 receptor (OX1R) and OX2R. Soon
after, researchers found that narcolepsy is caused by a highly selective and severe loss of the
orexin neurons that results in low levels of orexins in the brain and cerebrospinal fluid (CSF).
The classic phenotype, Narcolepsy Type 1, is characterized by chronic sleepiness plus cataplexy,
and CSF orexin levels in this disorder are very low or undetectable, owing to severe loss of the
orexin neurons. NT2 has generally less severe symptoms, and 90% of patients have normal CSF
orexin levels.
(NT2 affects up to half of all narcolepsy patients and may be caused by a partial loss of the
orexin neurons, but little is known about its underlying neuropathology. In rare cases,
narcolepsy results from brain injuries that damage the orexin neurons or their projections, and
narcolepsy-like symptoms occur in some families, although the underlying genetics remain
unknown. In NT1, the rate of orexin neuron loss is unknown, but the loss may be rapid in some
patients who develop severe narcolepsy symptoms over just a few days and slower in others
who develop cataplexy many years after the onset of sleepiness; some small studies have also
shown a decrease in CSF orexin levels over several months from the onset of sleepiness.)
(Orexin neurons have several other functions in addition to controlling sleep–wake behaviour.
For example, through their projections to mesolimbic pathways, orexins promote reward-
seeking. Mice that lack orexin neurons or that have been treated with an OX1R antagonist show
much weaker conditioned preference for places associated with rewards such as morphine or
cocaine. Orexins also increase home-cage locomotor activity, heart rate, brown fat
thermogenesis and metabolic rate in rodents. Overall, orexins may help to generate a high
arousal state in which an animal is motivated, attentive and autonomically primed for action.)

Treatment
-Ritalin is a catecholemine agonist
-Antidepressant drugs facilitate both serotonergic and noradrenergic activities
-Modafinil is a stimulant drug that is found to increase the expression of Fos protein in
orexinergic neurons, which means the neurons have been activated.

REM SLEEP BEHAVIOR DISORDER

(read ppt)
-There are 2 systems involved in normal REM sleep; one generates muscle atonia and other for
suppresses motor-skeletal activity. Muscle atonia involves active inhibition by neurons in the
medulla. Locomotion involves input from forebrain, and the thalamus influences spinal motor
neurons. Several brainstem pontine regions  have been implicated in RBD pathophysiology
including the peri-locus coeruleus region, pedunculo-pontine nucleus (PPN) and laterodorsal
tegmental nucleus (LDTN). Supra-spinal mechanism handles REM atonia. During REM sleep,
nuclei from the pons excite neurons in the medulla, which then transmit descending inhibitory
projections to spinal alpha motor-neurons resulting in hyperpolarization and muscle atonia. It is
the disinhibition of these neurons that leads to muscle activity during the REM stage of sleep.

PROBLEMS ASSOCIATED WITH SLOW WAVE SLEEP

(read ppt)
Bedwetting
(read ppt)
-It can be treated by training methods such as having a special electronic circuit ring a bell when
first few drops of urine are detected in the bed sheet.
Sleepwalking
(read ppt)
-Changing a few lifestyle habits might help you stop sleepwalking. Stick to a sleep schedule and
have a relaxing bedtime routine. If you drink or use drugs, stop.
Night terrors
(read ppt)
-Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream
and may remember details, but a person who has a sleep terror episode remains asleep.
Children usually don't remember anything about their sleep terrors in the morning. Adults may
recall a dream fragment they had during the sleep terrors.
Sleep related eating disorders
-Sleep-related eating disorder usually occurs during non-rapid eye movement sleep in the first
half of the night and is associated with the transition from non-rapid eye movement to arousal
during sleep.
-It can also be dangerous because you could injure yourself during food preparation or eat
inedible or toxic items. Sleep-related eating disorder can also have an impact on your health
due to weight gain and obesity from eating high-carbohydrate and high-fat foods.