Chapter 028. Sleep Disorders (Part 4) ppsx

Chapter 028. Sleep Disorders (Part 4) Behavioral Correlates of Sleep States and Stages Polysomnographic staging of sleep correlates with behavioral changes during specific states and stages. During the transitional state between wakefulness and sleep (stage 1 sleep), subjects may respond to faint auditory or visual signals without "awakening." Memory incorporation is inhibited at the onset of NREM stage 1 sleep, which may explain why individuals aroused from that transitional sleep stage frequently deny having been asleep. Such transitions may intrude upon behavioral wakefulness after sleep deprivation, notwithstanding attempts to remain continuously awake (see "Shift- Work Disorder," below). Awakenings from REM sleep are associated with recall of vivid dream imagery >80% of the time. The reliability of dream recall increases with REM sleep episodes occurring later in the night. Imagery may also be reported after NREM sleep interruptions, though these typically lack the detail and vividness of REM sleep dreams. The incidence of NREM sleep dream recall can be increased by selective REM sleep deprivation, suggesting that REM sleep and dreaming per se are not inexorably linked. Physiologic Correlates of Sleep States and Stages All major physiologic systems are influenced by sleep. Changes in cardiovascular function include a decrease in blood pressure and heart rate during NREM and particularly during slow-wave sleep. During REM sleep, phasic activity (bursts of eye movements) is associated with variability in both blood pressure and heart rate mediated principally by the vagus. Cardiac dysrhythmias may occur selectively during REM sleep. Respiratory function also changes. In comparison to relaxed wakefulness, respiratory rate becomes more regular during NREM sleep (especially slow-wave sleep) and tonic REM sleep and becomes very irregular during phasic REM sleep. Minute ventilation decreases in NREM sleep out of proportion to the decrease in metabolic rate at sleep onset, resulting in a higher P CO2 . Endocrine function also varies with sleep. Slow-wave sleep is associated with secretion of growth hormone, while sleep in general is associated with augmented secretion of prolactin. Sleep has a complex effect on the secretion of luteinizing hormone (LH): during puberty, sleep is associated with increased LH secretion, whereas sleep in the postpubertal female inhibits LH secretion in the early follicular phase of the menstrual cycle. Sleep onset (and probably slow-wave sleep) is associated with inhibition of thyroid-stimulating hormone and of the adrenocorticotropic hormone–cortisol axis, an effect that is superimposed on the prominent circadian rhythms in the two systems. The pineal hormone melatonin is secreted predominantly at night in both day- and night-active species, reflecting the direct modulation of pineal activity by the circadian pacemaker through a circuitous neural pathway from the SCN to the pineal gland. Melatonin secretion is not dependent upon the occurrence of sleep, persisting in individuals kept awake at night. In addition, exogenous melatonin increases sleepiness and increases sleep duration when administered to healthy adults attempting to sleep during daylight hours, at a time when endogenous melatonin levels are low. The efficacy of melatonin as a sleep-promoting therapy for patients with insomnia is currently not known. Sleep is also accompanied by alterations of thermoregulatory function. NREM sleep is associated with an attenuation of thermoregulatory responses to either heat or cold stress, and animal studies of thermosensitive neurons in the hypothalamus document an NREM-sleep-dependent reduction of the thermoregulatory set-point. REM sleep is associated with complete absence of thermoregulatory responsiveness, effectively resulting in functional poikilothermy. However, the potential adverse impact of this failure of thermoregulation is blunted by inhibition of REM sleep by extreme ambient temperatures. . Chapter 028. Sleep Disorders (Part 4) Behavioral Correlates of Sleep States and Stages Polysomnographic staging of sleep correlates with behavioral changes. after NREM sleep interruptions, though these typically lack the detail and vividness of REM sleep dreams. The incidence of NREM sleep dream recall can be increased by selective REM sleep deprivation,. REM sleep. Respiratory function also changes. In comparison to relaxed wakefulness, respiratory rate becomes more regular during NREM sleep (especially slow-wave sleep) and tonic REM sleep