2-Basics of sleep and sleep technology with mentioning the basics

Basics of sleep and identify some of its disorders

1. Sleep disorders course Lecture 2 Al-Razi University Facu l t y of Medicine & Hea lth Sciences Respirat ory Care Dep

2. W O R K T O G E T H E R Basics of sleep

3. Saleem N. Hamilah, BS, RT, RCP, FNIV, MsRC Governor For Yemen | ICRC IERS Committee member | ICRC Elections and Nominations Committee member | ICRC RC Lecturer, Deputy H ead of RCD | Ibn Al- Nafis University , 21 Sept. UMAS Director of RCSA | Ministry of Public Health & Population . [email protected] | [email protected] @SaleemHamilah 3

4. 1. Identify the medical discoveries that led to the development of sleep medicine and technology . 2. List the key people involved in the development of sleep medicine and their contributions. 3. List hallmark publications related to sleep medicine and technology. 4. Provide an overview of technological advances in sleep medicine and technology.. 5. Explain how the sleep technologist position was created. 8. List the training and education required for credentialing. OBJECTIVES

5. Introduction History of sleep medicine and technology . THE SLEEP TECHNOLOGIST Future of Sleep medicine and technology. Impacts of Sleep disorders. Outlines

6. Objectives: Difference between sleep & coma. Why do we sleep? Types of sleep: NREM & REM. Stages of NREM sleep. Importance of REM sleep. Sleep cycle and effect of age. Sleep/awake cycle (Role of SCN). Mechanism of sleep (centers/ neurotransmitters).

7. Sleep is a state of loss of consciousness from which a subject can be aroused by appropriate stimuli. Coma is a state of unconsciousness from which a subject cannot be aroused Sleep is defined a natural a nd periodic state of rest during which consciousness the world is suspended.

8. Why is sleep important? Sleep is essential for our physical and mental health. It helps to: Repair our bodies and tissues Consolidate memories Process emotions Regulate our hormones Boost our immune system Improve our mood and cognitive function

9. PHYSIOLOGY FOR RECORDING SLEEP-RELATED PARAMETERS CIRCADIAN VARIATIONS RELATED TO WAKE AND SLEEP A circadian rhythm is a daily cycle of bioLogical activity influenced by regular variations in the environment, such as the alternation of night and day.

10. A circadian rhythm

11. has determined that circadian rhythms occur cyclically every 25 hours within the human body; however, because sunlight resets the brain, biological systems run on a 24hour cycle rather than the human internal 25 hour cycle. PHYSIOLOGY FOR RECORDING SLEEP-RELATED PARAMETERS

12. HOW THE BODY CHANGES BETWEEN SLEEP AND WAKE Several structures in the brain influence the sleep-wake regulation, including the thalamus, medulla oblongata, Hypothalamus, pons, SCN, midbrain, spinal cord, raphe nuclei, basal forebrain, hippocampus, and reticular formation neurons

13. NEUROTRANSMITTERS Several neurotransmitters act on the brain to initi-ate and terminate NREM and REM sleep . The sleep “on-switch” is thought to be located in the anterior hypothalamus at the ventrolateral preoptic nucleus (VLPO).

14. Role of neurotransmitters Serotonin: Serotonin appears to modulate sleep through its effect on other hypnogenic factors in the anterior hypothalamus and suprachiasmatic nucleus Serotonin is a melatonin precursor

15. Melatonin is synthesized and released by the pineal gland through sympathetic activation from the retino-hypothalamic tract M elatonin enhance slee p Prolonged bright light stimulation suppresses melatonin and sleep while subsequent melatonin injections can restore normal sleep pattern Role of neurotransmitters

16. Acetylcholine is the neurotransmitter thought to play the largest role in sleep. ACh-producing cells are situated in the forebrain and cerebral cortex and cause stimulation and arousal, resulting in wake. Although reticular formation functions maintain wakefulness, they are also involved in REM sleep. ACh release in the cortex is highest during both wakefulness and the REM sleep state.

17. Working Together in Sleep Brainstem Nucleus Neurotransmitter Activity State of Nucleus Wakefulness Peduncularpontine ACh Active Locus coeruleus NE Active Raphe 5-HT Active Non-REM Sleep Peduncularpontine ACh Silent Locus coeruleus NE Decreased Activity Raphe 5-HT Decreased Activity REM Sleep On Peduncularpontine ACh Active as REM Approaches Locus coeruleus NE Become Silent Raphe 5-HT Inactive REM Sleep Off Locus coeruleus NE Become Active Raphe 5-HT Become Active

18. SLEEP PHASES AND STAGES A night of human sleep is divided into NREM and REM phases, depicting the characteristic changes in eye movements noted in sleep stages. These two distinct phases occur in a pattern of three to five rhythmic cycles throughout the sleep period.

19. SLEEP PHASES AND STAGES

20. NREM sleep composes approximately 75% of a total night’s sleep and is divided into three distinct stages: stage N1, stage N2, and stage N3. The remaining 20%- 25% of sleep is composed of REM-phase sleep, also known as stage R Typically, adult sleep begins with light sleep, advancing into deeper sleep, and then lightening again with REM sleep occurring every 90-110 minutes. The length of REM sleep increases during the night and is most prominent in the last third of the night.

21. Recommended sleep duration (hours) across lifespan

22. The Brain Is Active during Sleep NREM Makes up about 80% of sleep Three stages Heart rate and breathing slow No dreams REM Makes up about 20% of sleep One stage Heart rate and breathing speed up Dreams Muscles of the body are paralyzed 24

23. Data from Berry R, Brooks R, Gamaldo C, Harding S, Marcus C, Vaughn B: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Version 2.0, Westchester, Ill, 2012, American Academy of Sleep Medicine.

24. Textbook references

25. Have a great day 28