SLEEP

Altaf Qadir Khan

Types Of Sleep
Two Major Types of sleep
NREM (Non-Rapid Eye Movement) or SWS
(Slow Wave Sleep)
Stage I
Stage II
Stage III
Stage IV
REM (Rapid Eye Movement) Sleep
Stage 1 of NREM Sleep
Frequency 4-8 Hz
Wave Type Alpha, Theta
Transition state between sleep and
wakefulness
Somnolence or drowsy state. Eyes begin to roll
slightly
Consists mostly of theta waves (high
amplitude, low frequency (slow) with brief
periods of alpha waves
The hypnogogic hallucination may experience
Sudden twitches or hypnic jerks
Looses some muscle tone and conscious
awereness
Stage 2 of NREM Sleep
Frequency 4-15 Hz
Wave Type theta, sleep spindles, k-complexes
The EMG lowers, and conscious awareness of
the external environment disappears.
Again, only lasts for a few minutes
This occupies 4555% of total sleep
Stage 3 of NREM Sleep
Frequency 2 to 4 Hz
Wave Type Delta, Theta
Also called delta sleep or deep sleep
Very slow brain waves, called delta waves
(lower frequency than theta waves)
20 to 50% of brain waves are delta waves; the
rest are theta waves
Overall it occupies 38% of total sleep time
Stage 4 of NREM Sleep
Frequency 0.5 to 2 Hz
Wave Type Delta, Theta
Again, also called delta sleep or deep sleep
More than 50% of brain waves are delta waves;
the rest are theta waves
Last (and deepest) of the sleep stages before
REM sleep; stages reverse and then REM sleep
begins
It predominates the first third of the night and
accounts for 1015% of total sleep time
This is the stage in which night terrors, bed
wetting, sleepwalking, and sleep-talking occur
 R E M Sleep
Frequency >12 Hz
Wave Type Beta
Beta waves have a high frequency and occur
when the brain is quite active, both in REM
sleep and while awake
Frequent bursts of rapid eye movement, along
with occasional muscular twitches
Heart may beat faster and breathing may
become shallow and rapid
Most vivid dreaming occurs during this stage
Predominant in the final third of a sleep period
Sleep cycle
Sleep proceeds in cycles of NREM and REM
phases.
In humans, the cycle of REM and NREM is
approximately 90 minutes
Both REM sleep and NREM sleep stages 3 and
4 are homeostatically driven (selective
deprivation of each of these states
subsequently causes a rebound in their
appearance once the person is allowed to
sleep)
Optimal Sleep Amount
National Sleep Foundation maintains that
seven to nine hours of sleep for adult humans
is optimal
Studies have demonstrated that cognitive
performance declines with < 8 hours of sleep
A University of California, San Diego
psychiatry study found that people who live
the longest sleep for six to seven hours each
night
Lost sleep cannot be made up with a sleeping
binge
Biological clocks in the
brain
Supra chiasmatic nucleus (small region of
hypothalamus) circadian oscillator-light dark
cycle-fetal clocks
Pineal body light stimulus photosensitive
receptors retinal pathways
Ultradians: (e.g.) bouts of activity, feeding,
sleep cycles, release of hormones
Slow wave sleep, rapid eye movement sleep
or REM sleep
Circadian Rhythm Overview

Circadian coined by Franz Halberg comes

from the Latin circa, "around", and dies, "day",
meaning literally "about a day.
It is important in determining the sleeping and
feeding patterns of all animals, including human
beings
There are clear patterns of brain wave activity,
hormone production, cell regeneration and other
biological activities linked to it
Dreaming
Stimulated by the pons and mostly occurs
during the REM phase of sleep
Freud postulated that dreams are the
symbolic expression of frustrated desires that
had been relegated to the subconscious, and
he used dream interpretation in the form of
psychoanalysis to uncover these desires.
Another hypothesis is that dreaming allows an
animal to play out scenarios that may help the
animal avoid dangers when awake.
Dream Theory
Dreams are caused by random firings of
neurons in the cerebral cortex during the REM
period.

Forebrain then creates a story in an attempt

to reconcile and make sense of the
nonsensical sensory information presented to
it, hence the odd nature of many dreams.
Sleep Deprivation
May induce bizarre behavior, may mimic
schizophrenia like picture.
Hallucinations
Depression
Irritability
Impaired memory, thought processes &
concentration
Episodes of disorientation
There is progressive decline in alpha rhythm
Magnifies alcohols effects on the body
 Micro Sleep
Micro-sleeps are brief, unintended episodes of loss

of attention associated with events such as blank

stare, head snapping, and prolonged eye closure
which may occur when a person is fatigued but
trying to stay awake to perform a monotonous task
like driving a car or watching a computer screen
Last from a few seconds to several minutes

Often the person is not aware that a microsleep

has occurred
Micro Sleep
Microsleeps often occur when a person's eyes

are open
While in a microsleep, a person fails to respond

to outside information
Occur at certain times of the day, such as pre-

dawn hours and mid-afternoon hours when the

body is "programmed" to sleep
Increase with cumulative sleep debt
Sleep Disorders
Classified into 3 major groups

Dyssomnias
Parasomnias
Medical or Psychiatric Conditions that may
produce sleep disorders
Classification of primary sleep
disorders in DSM IV

Dyssomnia
Parasomnia
Sleep disorders (Mental disorders)
Dyssomnia
Insomnia
Hypersomnia
Narcolepsy
Breathing related sleep disorder
Circadian rhythm sleep disorder
Not otherwise specified
Narcolepsy
Excessive sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations
Parasomnias
Nightmare disorder
Sleep terror disorder
Sleepwalking disorder
Not otherwise specified
Nightmare
Awakening from REM sleep to full
consciousness with detailed dream recall.
Nightmares may be stimulated by frightening
experiences during the day.
Frequent nightmares usually occur during a
period of anxiety
Children experience nightmare s with a peak
frequency around the age of 5 or 6 years.
Night terror
Night terrors are much less common than
nightmares.
They are sometimes familial.
A few hours after going to sleep, the child,
while in stage 3-4 non-REM sleep, sits up and
appears terrified. They may scream and
usually appear confused.
After a few minutes the child slowly settles
and returns to normal calm sleep.
There is little or no dream recall.
Sleepwalking
An automatism that occurs during deep non-
REM sleep, usually in the early part of the
night.
Sleepwalking may be familial.
Most children may not actually walk, but sit
up and make repetitive movements. Some
walk around, usually with their eyes open.
They do not respond to questions, and are
very difficult to wake.
They can usually be led back to bed.
Sleep disorder related to another
mental disorder

Insomnia
Hypersomnia
Medical or Psychiatric
Conditions
Psychoses (Schizophrenia)
Mood disorders
Depression
Anxiety
Panic
Alcoholism
Snoring - Not a disorder in and of itself, but it
can be a symptom of deeper problems
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