SLEEP WAKING

Biorhythms
Individual Variations in Sleep Pattern 01

Sleep Patterns 02
SLEEP WAKING
Shift Work, Jetlags, and Daylight Saving Time 04
Today's Topics
The Body's Internal Clocks Manage Circadian Rhythms 05

Major Depressive Disorder with Seasonal Pattern 06

Side Effects 07
 Circadian Rhythm
The term circadian comes from Latin words for "about a day."

Circadian rhythms are 24-hour cycles that are part of the body’s internal
clock, running in the background to carry out essential functions and
processes. One of the most important and well-known circadian rhythms is
the sleep-wake cycle.
 Zeitgebers

Zeitgebers are light,

temperature, eating or drinking
patterns, etc. These external
cues help the internal biological
clock to be consistent with the
rhythmic cycle.
 Individual Variations in Sleep Patterns

Do you have family members or roommates who

wake up at the crack of dawn? Other people you
know might have difficulty getting to sleep before
midnight and struggle to awaken in time for work
or school?
LARKS CATCH THE EARLY WORM

Larks are people who have an underlying

preference to wake up early in the
morning and go to bed at a reasonable
hour. They understand that business gets
done before noon and they value
breakfast as the most important meal of
the day. There's a reason why
complimentary breakfasts at hotels
around the world end at like, 9:00 AM.
They're catering to the Larks among us.
Owls Burn the Midnight Oil
If you regularly find yourself up late at
night doing work, or going out with
friends and dreading the call of
morning, you might be an Owl. Though
not proven, some believe Owls might
have a higher IQ than Larks, due to
late night activities being an
evolutionary novel behavior, and thus
enacting our brain in ways not
naturally intended.
HUMMINGBIRD
Hummingbird people have no set preference on what
hours of the day they engage in the various activities of
life. They could wake up early one morning to go on a
hike with friends and then the next night go to a
concert to see their favorite band, not getting home
until 4:00 AM. People who are in between Lark and Owl
sleep patterns. If you find yourself on a changing
schedule and no serious side effects like fatigue or
sleep deprivation, you may very well be a hummingbird
type person. Many successful people are
Hummingbirds due to their relentless working around
the clock, which is a forced behavior that they've
adopted for themselves.
SHIFT MALADAPTATION SYNDROME
Workers on the 11 p.m. to 7:30 a.m. night shift
frequently experience disturbed sleep and a cluster of
symptoms referred to as shift maladaptive syndrome
CIRCADIAN RHYTHM SLEEP WAKE DISORDER
The Diagnostic and Statistical Manual of Mental Disorder
(DSM-V) recognizes " circadian rhythm sleep-wake
disorders-shift work type" as featuring both excessive
sleepiness at work and impaired sleep at home on the part
of workers who work outside the normal day shift (8 a.m.
to 6 p.m.)

SHIFT WORKERS
Shift workers obtain 1.5 hours less total sleep than workers
on other shifts, leading to frequent health, personality,
mood, and interpersonal problems.
JETLAGS
Conflicts between internal clocks and external
zeitgebers also result in the unsettling experience of
jetlag.

After crossing time zones, people often experience

fatigue, irritability, and sleepiness. Chronic jet lag might
have more serious consequences. Airline flight attendants
who crossed time zones at least once a week for four or
more years had reduced reaction times and made 9
percent more mistakes on memory task than local crews
who did not cross time zones.
Suprachiasmatic Nucleus The body's internal master clock is the
suprachiasmatic nucleus (SCN) in the
hypothalamus, the term suprachiasmatic
comes from the structure's location above
(supra) the optic chiasm. Input to the SCN
comes from axons of special cells known as
intrinsically photosensitive retinal ganglion cells
(ipRGCs), which leave the optic nerve and
project to the SCN, forming the
retinohypothalamic pathway. The ipRGCs do
not process information about visual images.
The ipRCGs contain a photopigment known as
melanopsin that is related to, but different
from, the other photopigment involved in vision.
As light decreases in the evening,
accompanied by reduced SCN activity, less
input from the sympathetic neurons allows the
pineal gland to synthesize and release more
MELATONIN, a neurochemical that modulates
brainstem structures related to waking and
sleep.

The SCN also manages other sleep-related

changes, including body temperature, hormone
secretion, production of urine, and blood
pressure changes.
 Biochemistry of Circadian Rhythms

MELATONIN levels are very low during the day, begin to rise in the hours
before sleep, and usually peak at about 4 a.m., a time when nearly
everybody finds it very difficult to stay awake.

- Totally blind people experience a melatonin peak at a different time each

day, often leading to sleep difficulties.
- People with pineal gland tumors or other medical conditions affecting
melatonin report sleep problems.
- Melatonin supplements have been reported to improve cases of a
number of sleep disorder.
 Biochemistry of Circadian Rhythms

Levels of the hormone CORTISOL also fluctuate with patterns of waking

and sleeping, cortisol levels are normally high early in the morning and
lower at night. Higher levels of cortisol are associated with higher blood
pressure, higher heart rate, and the mobilization of the body's energy
stores.
In addition to normal daily fluctuations, cortisol is also released during
times of stress. Ass a result, stress induced high cortisol levels during the
night are correlated with poor sleep quality.
 Major Depressive Disorder with Seasonal Pattern

During the winter months at higher latitudes (areas closer to the poles of
the earth), the reduction in daylight hours can interfere with the CIRCADIAN
RHYTHMS and thus lead to MAJOR DEPRESSIVE DISORDER (MDD) with
seasonal pattern, patients with this condition were diagnosed with
SEASONAL AFFECTIVE DISORDER (SAD).
Several mechanisms appear to lead to seasonal depression. Serotonin
levels typically drop in the fall and winter, and people vulnerable to
seasonal depression might experience a greater than normal decrease.
 SEROTONIN

Seasonal depression might also be influenced by disruptions in melatonin

release caused by uneven patterns of daily light. Serotonin not only serves
as precursor for melatonin synthesis in the pineal gland, but its own
synthesis is activated by light.
Variations in the genes that express melanopsin, the photopigment found
in ipRGCs, appear to predispose individuals to seasonal depression. As a
result of their melanopsin genes, some people are less sensitive to light in
general. The paler the light of winter is insufficient for maintaining their
normal circadian patterns, leading to circadian disruption and depression.
 LIGHT THERAPY

Light therapy—or phototherapy,

classically referred to as
heliotherapy—consists either of
exposure to daylight or some
equivalent form of light as a
treatment for seasonal affective
disorder, or exposure of the skin to
specific wavelengths of light using
polychromatic polarised light to
treat a skin condition.
Electroencephalogram Recordings
of Waking and Sleeping
We can evaluate waking and sleep using
electroencephalogram (EEG) recordings. EEG
provides a general measure of overall brain
activity. DESYNCHRONOUS brain activity
arises from the relatively independent action of
many neurons and is correlated with alertness.
SYNCHRONOUS activity occurs when neurons
are firing more in unison and characterize deep
stages of sleep. Consider the contrast
between a typical afternoon activity at the
community swimming pool (desynchronous)
and the actions of a team of synchronized
swimmers (synchronous)
Brain Wave
Researchers found that each night, over the course of the first hour or
so of sleep, the brain progresses through a series of stages during
which brain waves slow down. This period of slow wave sleep is
accompanied by relaxation of the muscles and the eyes. Heart rate,
blood pressure, and body temperature all fall. If awakened during this
time, most people recall only fragmented thoughts, not active
dreams.
 NREM and REM
Rapid Eye Movement (REM) sleep
A period of sleep characterized by
desynchronous brain activity, muscle paralysis,
eye movement, and story like dream behavior.
non-REM (NREM) sleep
A period of sleep characterized by slow,
synchronous brain activity, reductions in heart
rate, and muscle relaxation.

Stage 1 NREM - sleep is disturbed

occasionally by a muscle jerk, in arm or leg,
referred to as myoclonia.
Stage 2 NREM - reduction in heart rate and
muscle tension occur.
Stage 3 & 4 NREM - body temperature,
breathing, blood pressure, and heart rate are at
very low levels due to the activity of
parasympathetic nervous system.

Stage 5 REM - Most dreaming takes place in

stage five as a result of heightened,
desynchronized brain waves, almost similar to
being awake. This stage of sleep revitalizes the
brain, supporting sharp and alert daytime
function.
 BENEFITS OF SLEEP

Getting sufficient sleep is one the most

important driver of health, according to
adults in the Philippines as well as their
counterparts across the region. While
Filipino adults would ideally like to get 8.2
hours of sleep a night, in reality they only
sleep 6.8 hours on average. This sleep
deficit of 1.4 hours is one of the highest
among the 15 markets.
 BENEFITS OF SLEEP
1. Sleep can boost your Immune System.
2. 8 hours of sleep can help prevent
weight gain.
3. Sleep can strengthen your heart.
4. Better Sleep = better mood.
5. Sleeping can increase productivity.
6. Lack of sleep can be dangerous.
literally.
7. Sleep can increase exercise
performance.
8. Sleep improves memory.
 COMMON SLEEP DISORDER

INSOMIA
The most common sleep-wake disorder is insomnia, in which a person has
difficulty initiating or maintaining enough sleep to feel rested. Individual needs for
sleep vary widely. In one case of "healthy insomnia;' an elderly female participant
slept only one hour per night without any apparent detrimental effects (Meddis,
Pearson, & Langford, 1973).

Onset insomnia occurs when a person is unable to go to sleep. Sleep can be

delayed by multiple factors, including stress, anxiety, and use of stimulant drugs.
Maintenance insomnia occurs when sleep is frequently interrupted or early
waking occurs. Frequent waking can result from stress, substance use, or
psychopathology.
 COMMON SLEEP DISORDER

Narcolepsy
Probably the most dramatic of the sleep-wake disorders is narcolepsy.
Narcolepsy consists of extreme levels of daytime sleepiness and "sleep
attacks;· in which aspects of REM sleep intrude into wakefulness (Dahl. Holttum,
& Trubnick, 1994).

These sleep attacks usually last from 10 to 20 minutes, although they can
continue for as long as an hour. In a sleep attack, people with narcolepsy enter
REM sleep immediately and awaken feeling refreshed. Sleepiness soon returns,
however, with attacks occurring approximately every two to three hours.
 COMMON SLEEP DISORDER
ICataplexy is a condition in which the muscle paralysis that is normally associated with
REM sleep occurs when the person is completely awake. Cataplexy does not cause a
loss of consciousness. The muscle paralysis can be fairly minor, affecting part of the
face, for example, or large-scale enough to cause the person to collapse in a heap on
the floor.

Cataplexy is nearly always precede by a strong emotional reaction or stress.

Unfortunately, having sex is a common emotional trigger for the disorder. Many
patients with narcolepsy also experience sleep paralysis, or muscle paralysis that
either precedes actual sleep or lingers once the person has awakened. In some
patients, REM dreaming phenomena intrude into wakefulness in the form of
hypnogogic hallucinations (preceding sleep) or hypnopompic hallucinations (upon
awakening). The imagery in these hallucinations is similar to REM dreaming, but the
person remains awake.
 COMMON SLEEP DISORDER

Breathing-Related Sleep Disorders

The breathing-related sleep disorders include obstructive sleep apnea hypopnea and
central sleep apnea (APA, 20 13). In hypopnea, the person experiences shallow
breathing or a very low rate of breathing, while in apnea, breathing stops more
completely.

Obstructive sleep apnea hypopnea is typically caused by obstruction of the airways,

while central sleep apnea is caused by deficits in the brain functions that maintain
breathing during sleep.
 COMMON SLEEP DISORDER

Sleep Talking and Sleep Walking

Sleep talking typically occurs in lighter stages of sleep of both REM and NREM. Sleep
talking is most common in young people and diminishes with age. The talking person
is often responsive to external stimuli.

Sleepwalking is probably a deep NREM phenomenon because episodes occur during

the first three hours of sleep, awakened individuals show considerable disorientation,
and the paralysis accompanying REM makes walking during this stage unlikely.
 COMMON SLEEP PROBLEM AND DISORDER

Sleep Talking and Sleep Walking

Sleep talking typically occurs in lighter stages of sleep of both REM and NREM. Sleep
talking is most common in young people and diminishes with age. The talking person
is often responsive to external stimuli.

Sleepwalking is probably a deep NREM phenomenon because episodes occur during

the first three hours of sleep, awakened individuals show considerable disorientation,
and the paralysis accompanying REM makes walking during this stage unlikely.
Thank you!