Sleep

SLEEP
Dr. 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 awareness
Lasts only for a few minutes before moving on to next stage
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 45–55% of total 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 3–8% of total sleep time
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 10 -
15% 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
But it disrupts the body's circadian rhythm and continues to
disrupt sleeping patterns over days
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
Classical tetrad
 Excessive sleepiness
 Cataplexy
 Sleep paralysis
 Hypnagogic hallucinations
Hypersomnia
There is an increase desire to fall asleep and a lack of energy
during the day even after an adequate night’s sleep
Excessive daytime sleepiness may be severe and constant,

with paroxysms during which patients may fall asleep without
warning (sleep attacks)
Epworth sleepiness scale

Cataplexy
Cataplexy is the sudden and transient loss of muscle tone that
is triggered by an emotional event
For example, laughter, joking, or excitement may cause a
temporary weakness
It typically lasts only a few minutes and consciousness remains
intact
Paralysis normally occurs when we are asleep so that we do
not act out our dreams
Sleep paralysis
Sleep paralysis is a common experience and consists of the
inability to move for one or two minutes upon awakening
In addition, there may be accompanying feeling of suffocation

or even a looming presence within the room
The episodes tend to be quite frightening

Hypnogogic hallucinations
These involve vivid, often frightening hallucinations that occur
in the transitions between sleep and wakefulness, with onset
most likely as a person is falling asleep or waking up
Hypnogogic hallucinations result when REM sleep, and

associated dreaming, mixes with wakefulness
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
.
THANK YOU

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SLEEP

Dr. Altaf Qadir Khan

REM (Rapid Eye Movement) Sleep

It is important in determining the sleeping and feeding patterns

There are clear patterns of brain wave activity, hormone

Freud postulated that dreams are the symbolic expression of

Another hypothesis is that dreaming allows an animal to play

Forebrain then creates a story in an attempt to reconcile and

Excessive daytime sleepiness may be severe and constant,

Epworth sleepiness scale

In addition, there may be accompanying feeling of suffocation

The episodes tend to be quite frightening

Hypnogogic hallucinations result when REM sleep, and

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