DOCSLIB.ORG

A Practical Approach to the Medication Management of Insomnia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Practical Approach to the Medication Management of Insomnia A Practical Approach to the Medication Management of Insomnia Dr. Bruce McGee Utah Valley Outpatient Psychiatry Disclaimer • Represent myself only • I am a psychiatrist without sleep medicine fellowship • Biases Intention/Objectives: •Quick review of how sleep works •Review of DSM-5 and ICSD [International Classification of Sleep Disorders – 3rd Ed.] •Assess benefits vs. risks of medication management •Discuss considerations in medication selection •Not to dissuade sleep hygiene, therapy, CBT-I Not covering, but important • CBT • CBT-I • Stimulus control • Sleep restriction therapy • Cognitive control • Cognitive restructuring • Thought suppression • Paradoxical intention • Relaxation • Progressive muscle relaxation But first, a quick review of sleep Simplified Examples of Sleep Architecture https://slideplayer.com/slide/9220738/ Actual Examples of Sleep Architecture https://www.researchgate.net/figure/Hypnogram-before-upper-panel- and-after-treatment-with-5-OH-tryptophan-lower- panel_fig2_42587318 Sleep Architecture • Stage 1 (5%) • Typically the first 5 minutes; transitional stage • Low arousal threshold • Stage 2 (50-55%) • Typically the next 10-15 minutes • Stage 3 (previously classified as 3 & 4) (20%) • Typically the 20-40 minutes; “delta” slow-wave sleep • REM (Rapid Eye Movement) (20-25%) • Paralyzed, except for the eyes • If you remember a dream, it happened in REM Dreaming [REM sleep] • Dreams are critical for learning and memory • Dreams often play a key role in emotional healing • Nightmares disrupt sleep and can be terrifying • Conventional treatments of disturbing dreams/ nightmares include: • Pharmacological interventions [prazosin] • Psychotherapeutic approaches • Exposure • Relaxation • Re-scripting (Rewrite the ending of a repeating dream) REM is necessary Rats denied REM sleep will die within a few weeks! Suppression of REM sleep may be caused by: • Excessive sleep deprivation • Insomnia • Most antidepressants • Excessive light • Alarm clock awakenings Sleep cycle is part of a greater cycle Circadian Rhythm Circadian Rhythm • Circa = About • Dia = Day • Literally translates as “about daily” rhythm • Its homeostasis is controlled in hypothalmus • Like most everything else… This slide is intended to demonstrate that light exposure affects physiology and behavior. Circadian Rhythm • The average circadian rhythm of humans is 24h 11min. • After LIGHT exposure, signals travel from the retina to the brain through the retinohypothalamic tract within the optic nerve. • There the signal enters the suprachiasmatic nuclei (SCN) within the hypothalmus to regulate, reset, or correct the circadian rhythm. • Each SCN is the size of a grain of rice, contains ~20k neurons each, with one on the right, one on the left. Don’t panic on the next slide… Cascading of Protein Interactions After Light Exposure in the SCN Don’t panic on this one either… It is the concept that is important. Orexin produced in DMH, LH, and PH HYPOTHALAMIC STRUCTURES (in box): LDT = Laterodorsal tegmental nucleus [midbrain] SCN = Suprachiasmatic nuclei PPT = Pedunculopontine tegmental nucleus [pons] DMH = Dorsomedial hypothalamus VTA = Ventral tegmental area [midbrain] LHA = Lateral hypothalamic area LC = Locus coeruleus [pons] PH = Posterior hypothalamus DR = Dorsal raphe [midbrain/pons] VLPO = Ventrolateral preoptic area TMN = Tuberomammillary nucleus BST = Bed nucleus of the stria terminalis SNr = Substantia nigra pars reticulata [midbrain] http://www.nature.com/nrn/journal/v8/n3/fig_tab/nrn2092_F3.html Wakefulness Melatonin through the ages… How do you keep your circadian rhythm in check? • Zeitgebers (German for “time giver”, synchronizer): External cues that synchronize the circadian rhythm • Bright light, especially blue or green light • Exercise • Temperature changes • Smells (bacon in the morning…) • Social interactions • Medication • Eating HYPOTHALAMIC STRUCTURES (in box): LDT = Laterodorsal tegmental nucleus SCN = Suprachiasmatic nuclei PPT = Pedunculopontine tegmental nucleus DMH = Dorsomedial hypothalamus VTA = Ventral tegmental area LHA = Lateral hypothalamic area LC = Locus coeruleus PH = Posterior hypothalamus DR = Dorsal raphe BST = Bed nucleus of the stria terminalis TMN = Tuberomammillary nucleus VLPO = Ventrolateral preoptic area SNr = Substantia nigra pars reticulata http://www.nature.com/nrn/journal/v8/n3/fig_tab/nrn2092_F3.html International Classification of Sleep Disorders – Third Edition 1. Insomnia 2. Sleep-related breathing disorders 3. Central disorders of hypersomnolence 4. Circadian rhythm sleep-wake disorders 5. Parasomnias 6. Sleep-related movement disorders 7. Other sleep disorders International Classification of Sleep Disorders – Third Edition • Chronic insomnia disorder • Narcolepsy type 1 • Exploding head syndrome • Short-term insomnia disorder • Narcolepsy type 2 • Sleep-related hallucinations • Other insomnia disorder • Idiopathic hypersomnia • Sleep enuresis • OSA, adult • Kleine-Levin syndrome • Parasomnia due to a medical disorder • OSA, pediatric • Central sleep apnea with Cheyne-Stokes • Hypersomnia due to a medical disorder • Parasomnia due to a medication or breathing • Hypersomnia due to a medication or substance • Central sleep apnea due to a medical substance • Parasomnia, unspecified disorder without Cheyne-Stokes breathing • Hypersomnia associated with a psychiatric • Restless legs syndrome • Central sleep apnea due to high altitude- disorder • Periodic limb movement disorder periodic breathing • Insufficient sleep syndrome • Sleep-related leg cramps • Primary central sleep apnea • Delayed sleep-wake phase disorder • Sleep-related bruxism • Primary central sleep apnea of infancy • Advanced sleep-wake phase disorder • Sleep-related rhythmic movement • Primary central sleep apnea of prematurity • Irregular sleep-wake rhythm disorder disorder • Treatment-emergent central sleep apnea • Non-24-h sleep-wake rhythm disorder • Benign sleep myoclonus of infancy • Obesity hypoventilation syndrome • Shift work disorder • Propriospinal myoclonus at sleep onset • Congenital central alveolar • Jet lag disorder • Sleep-related movement disorder due to a hypoventilation syndrome • Circadian sleep-wake disorder not medical disorder • Late-onset central hypoventilation with otherwise specified • Sleep-related movement disorder due to a hypothalamic dysfunction • Confusional arousals medication or substance • Idiopathic central alveolar Sleepwalking Sleep-related movement disorder, hypoventilation • • • Sleep-related hypoventilation due to a • Sleep terrors unspecified medication or substance • Sleep-related eating disorder • Sleep-related hypoventilation due to a • REM sleep behavior disorder medical disorder • Recurrent isolated sleep paralysis • Sleep-related hypoxemia disorder • Nightmare disorder 73>57 DSM-5 Sleep-Wake Disorders • Insomnia disorder • Hypersomnolence disorder • Narcolepsy • Breathing-related sleep disorders: • • • • Circadian rhythm sleep-wake disorders • Parasomnias: • • • • DSM-5 Sleep-Wake Disorders • Insomnia disorder • Hypersomnolence disorder • Narcolepsy • Breathing-related sleep disorders: • Obstructive sleep apnea hypopnea • Central sleep apnea • Sleep-related hypoventilation • Circadian rhythm sleep-wake disorders • Parasomnias: • Non-rapid eye movement sleep arousal disorders • Nightmare disorder • Rapid eye movement sleep behavior disorder • Restless legs syndrome ~11 Dx DSM-5 Sleep-Wake Disorders • Insomnia disorder • Substance/medication- induced sleep disorder • Hypersomnolence disorder • Other specified insomnia • Narcolepsy disorder • Breathing-related sleep disorders: • Unspecified insomnia • Obstructive sleep apnea hypopnea disorder • Central sleep apnea • Other specified • Sleep-related hypoventilation hypersomnolence disorder • Unspecified • Circadian rhythm sleep-wake disorders hypersomnolence disorder • Parasomnias: • Other specified sleep-wake • Non-rapid eye movement sleep arousal disorders disorder • Nightmare disorder • Unspecified sleep-wake • Rapid eye movement sleep behavior disorder disorder • Restless legs syndrome 18 Dx Insomnia Disorder A) A predominant complaint of dissatisfaction with sleep quantity or quality 1. Difficulty initiating sleep [DFA] -OR- 2. Difficulty maintaining sleep [DSA] -OR- 3. Early-morning awakening with inability to return to sleep [EMA] B) Distress or impairment C) 3+ nights/week D) 3+ months already E) Adequate opportunity for sleep F) Not due to other sleep disorder G) Not due to a substance or medication H) Not explained by coexisting mental disorders or medical conditions Insomnia Disorder Subtypes • With non-sleep disorder mental comorbity • With other medical comorbity • With other sleep disorder • Episodic • Persistent • Recurrent Hypersomnolence Disorder A) Excessive sleepiness despite a main sleep period lasting at least 7h 1. Recurrent periods of sleep or lapses into sleep within the same day -OR- 2. A prolonged main sleep episode of more than 9h/day that is nonrestorative -OR- 3. Difficulty being fully awake after abrupt awakening B) 3+ nights/week for 3+ months C) Distress or impairment D) Not due to other sleep disorder E) Not due to a substance or medication F) Not explained by coexisting mental disorders or medical conditions Hypersomnolence Disorder Subtypes • With mental disorder • With medical condition • With another sleep disorder • Acute [<1m] • Subacute • Persistent [>3m] • Mild • Moderate • Severe Narcolepsy Narcolepsy Sleeping with dead people, right? Narcolepsy Comes from Greek narkē-lambanein, later narkē-lepsia,
Load more

Recommended publications
  • ENO Directory Over 20 Years Ago We Pioneered the Hammock Counter-Culture
    ENO Directory Over 20 years ago we pioneered the hammock counter-culture. Environmental Conservation As a hammock company, we know the importance of trees and so do our customers. Since then, we’ve ventured We believe that when given the chance, individuals will use their purchasing power from mountains to sea, to protect the planet, which is why we plant two trees in an area of need for every hammock sold. Additionally, we proudly pledge 1% of our annual sales to support from backyard to backcountry, nonprofit organisations focused on environmental solutions. and everywhere in between. — MEMBER — No matter your passion or pursuit, our tried-and-true products outfit Materials & Chemistry you with an all-access pass to We are committed to the journey of building more sustainable and responsibly made explore, connect and relax... products. This includes sourcing high-quality materials with post-consumer recycled content and bluesign® approved chemistry, as well as adopting safer ingredients for water repellents, colour dyes, and beyond. We have adopted the industry leading bluesign® Restricted Substances List (RSL) which provides a comprehensive system for managing chemical hazards, workplace safety, and environmental impacts during material production. To support our RSL, we have set up a testing program with an accredited third-party laboratory and have placed an emphasis on priority chemicals of concern established by the outdoor industry. We look forward to sharing our progress along the way. Hammocks 3 - 6 Social Responsibility We protect the welfare of our community and the planet from the beginning to the end Specialist Hammocks 7 - 9 of our product life cycle through a strict code of conduct, product repair and take- back programs.
    [Show full text]
  • Rapid Eye Movement Sleep Deprivation Induces an Increase in Acetylcholinesterase Activity in Discrete Rat Brain Regions
    Brazilian Journal of Medical and Biological Research (2001) 34: 103-109 Acetylcholinesterase activity after REM sleep deprivation 103 ISSN 0100-879X Rapid eye movement sleep deprivation induces an increase in acetylcholinesterase activity in discrete rat brain regions M.A.C. Benedito Departamento de Psicobiologia, Universidade Federal de São Paulo, and R. Camarini São Paulo, SP, Brasil Abstract Correspondence Some upper brainstem cholinergic neurons (pedunculopontine and Key words M.A.C. Benedito laterodorsal tegmental nuclei) are involved in the generation of rapid · REM sleep deprivation · Departamento de Psicobiologia eye movement (REM) sleep and project rostrally to the thalamus and Acetylcholinesterase Universidade Federal de São Paulo · caudally to the medulla oblongata. A previous report showed that 96 Brain regions Rua Botucatu, 862 · Thalamus h of REM sleep deprivation in rats induced an increase in the activity 04023-062 São Paulo, SP · Medulla oblongata Brasil of brainstem acetylcholinesterase (Achase), the enzyme which inacti- · Pons vates acetylcholine (Ach) in the synaptic cleft. There was no change in Research supported by FAPESP and the enzymes activity in the whole brain and cerebrum. The compo- Associação Fundo de Incentivo à nents of the cholinergic synaptic endings (for example, Achase) are Psicofarmacologia (AFIP). not uniformly distributed throughout the discrete regions of the brain. R. Camarini was the recipient of In order to detect possible regional changes we measured Achase a FAPESP fellowship. activity in several discrete rat brain regions (medulla oblongata, pons, thalamus, striatum, hippocampus and cerebral cortex) after 96 h of Received December 6, 1999 REM sleep deprivation. Naive adult male Wistar rats were deprived of Accepted September 25, 2000 REM sleep using the flower-pot technique, while control rats were left in their home cages.
    [Show full text]
  • Excessive Daytime Sleepiness in Children and Adolescents Across the Weight Spectrum
    Excessive Daytime Sleepiness in Children and Adolescents across the Weight Spectrum by Lilach Kamer A thesis submitted in conformity with the requirements for the degree of Master of Science Institute of Medical Science University of Toronto © Copyright by Lilach Kamer 2011 Excessive Daytime Sleepiness in Children and Adolescents across the Weight Spectrum. Lilach Kamer Master of Science Institute of Medical Science University of Toronto 2011 Abstract A relationship between overweight and excessive daytime sleepiness (EDS) has been suggested in the adult population, and to a limited extent in the pediatric population. Daytime sleepiness can interfere with various components of daytime function. In light of the increase in the rates of pediatric overweight and obesity, the aim of this study was to investigate the relationship between weight and EDS in a pediatric population. Using a retrospective approach, data collected in a pediatric sleep clinic was analyzed. Objective measures of EDS were correlated with age, gender, body mass index percentile, and overnight sleep test recording variables. In males and in all children under the age of 13 years old, EDS was more common in those weighing above the normal range, EDS was present particularly during mid-morning hours. Additionally, weight above the normal range correlated with evidence of EDS after adjusting for measures of sleep pathologies. - ii - Acknowledgments First and foremost, I would like to thank my supervisor, Dr. Colin Shapiro for the opportunity to work and learn at the Youthdale Child and Adolescent Sleep Center, and for patiently developing my budding research skills. To the staff at the Youthdale Child and Adolescent Sleep Center, especially Dragana Jovanovic and Inna Voloh, for introducing me into the intricate world of pediatric sleep testing as well as Dora Zalai and Rose Lata for their patience, advice, dedication and willingness to accommodate my research needs…and for smiling while they do this.
    [Show full text]
  • Contemporary DIY Four Poster Bed
    Contemporary DIY Four Poster Bed Here are a few housekeeping items before you start that will make this project even easier to tackle. First, this bed needs to be assembled in the space in the bedroom it will be in. The assembled parts are larger than a doorway. I stained and waxed my wood pieces before assembling. Since the wood was already finished, I placed a heavy moving blanket on the floor to protect the wood from scratches. Time to complete: 2-3 days Lumber: 2 - 1” x 2” x 8ft poplar 16 - 1” x 3” x 6ft poplar 2 – 2” x 2” x 6ft poplar 6 - 1” x 6” x 6ft maple 3 – 2” x 2” x8ft maple 2 – 2” x 3” x 8ft maple 2 – 2” x 6” x 6ft maple 4 – 3” x 3” x 8ft maple Materials: Pocket screws 1 ¼ Pocket screws 2 ” Wood screws 1 ¼ ” Wood screws 1 ½ “ Wood glue Sand paper Stain or paint to finish Cut List: Maple 4 - 3” x 3” at 78 ¾” bed posts 2 - 2” x 2” at 60 ½“ top rails 2 - 2” x 6” at 60 ½” footboard and lower headboard planks 6 – 1” x 6” at 60 ½” headboard planks 2 – 2” x 2” at 80 ½” upper rails 2 – 2” x 4” at 80 ½” lower side rails Poplar 2 – 1’ x 2’ at 80 ½” slat cleat 1 – 2’ x 2’ at 80 ½” center support 1 – 2” x 2” at 9 ¼” center support legs 16 – 1” x 3” at 60 ½” slats Preparation Cut, sand and finish all of the maple pieces.
    [Show full text]
  • Parasomnias: a Comprehensive Review
    Open Access Review Article DOI: 10.7759/cureus.3807 Parasomnias: A Comprehensive Review Shantanu Singh 1 , Harleen Kaur 2 , Shivank Singh 3 , Imran Khawaja 1 1. Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA 2. Neurology, Univeristy of Missouri, Columbia, USA 3. Internal Medicine, Maoming People's Hospital, Maoming, CHN Corresponding author: Harleen Kaur, [email protected] Abstract Parasomnias are a group of sleep disorders characterized by abnormal, unpleasant motor verbal or behavioral events that occur during sleep or wake to sleep transitions. Parasomnias can occur during non- rapid eye movement (NREM) and rapid eye movement (REM) stages of sleep and are more commonly seen in children than the adult population. Parasomnias can be distressful for the patient and their bed partners and most of the time, these complaints are brought up by their bed partners because of the possible disruption in their quality of sleep. As clinicians, it is crucial to understand the characteristics of various parasomnias and address them with detailed sleep history and essential diagnostic approach for proper evaluation. The review aims to highlight the epidemiology, pathophysiology and clinical features of various types of parasomnias along with the appropriate diagnostic and pharmacological approach. Categories: Internal Medicine, Neurology, Psychiatry Keywords: parasomnia, sleep walking, confusional arousals, sleep terror, nightmares, rem behavior disorder, sleep paralysis, rem parasomnias, nrem parasomnias Introduction And Background Parasomnias are a group of sleep disorders that are characterized by abnormal, unpleasant motor, verbal or behavioral events that occur during sleep or wake to sleep transitions [1]. The term ‘parasomnia’ was first coined by a French researcher Henri Roger in 1932 [2].
    [Show full text]
  • Sleeping While Awake Lant
    CONSCIOUSNESS REDUX “It was literally true: I was going through life asleep. My body had no more feeling than a drowned corpse. My very existence, my life in the world, seemed like a hallucination. A strong wind would make me think my body was about to be blown to the end of the earth, to some land I had never seen or heard of, where my mind and body would separate forever.” —From Sleep, by Haruki Murakami, 1989 PHYSIOLOGY turn off—your mind remains hypervigi- Sleeping While Awake lant. You toss and turn but can’t find the blessed relief of sleep. The reasons for During microsleep, the entire brain nods off so briefly that we often don’t notice it. sleeplessness may be many, but the con- ) Now research shows that individual neurons in the brain can slumber, too, sequences are always the same: You are Koch fatigued the following day, you feel especially when we are sleep-deprived E ( sleepy, you nap. Attention wanders, your B CA We’ve all been there. You go to bed, reaction time slows, you have less cogni- C close your eyes, blanket your mind and tive-emotional control. Fortunately, BY CHRISTOF KOCH wait for consciousness to fade. A timeless fatigue is reversible and disappears after ); SEAN M Christof Koch is president interval later, you wake up, refreshed a night or two of solid sleep. and chief scientific officer at and ready to face the challenges of a new We spend about one third of our lives the Allen Institute for Brain day (note how you can never catch your- in a state of repose, defined by relative illustration Science in Seattle.
    [Show full text]
  • Cognitive and Neuropsychiatric Profiles in Idiopathic Rapid Eye
    Journal of Personalized Medicine Article Cognitive and Neuropsychiatric Profiles in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease Francesca Assogna 1, Claudio Liguori 2,3, Luca Cravello 4, Lucia Macchiusi 1, Claudia Belli 5 , Fabio Placidi 2,3 , Mariangela Pierantozzi 2, Alessandro Stefani 2, Bruno Mercuri 6, Francesca Izzi 3 , Carlo Caltagirone 1, Nicola B. Mercuri 1,2,3, Francesco E. Pontieri 1,7, Gianfranco Spalletta 1,† and Clelia Pellicano 1,*,† 1 Fondazione Santa Lucia, IRCCS, 00179 Rome, Italy; [email protected] (F.A.); [email protected] (L.M.); [email protected] (C.C.); [email protected] (N.B.M.); [email protected] or [email protected] (F.E.P.); [email protected] (G.S.) 2 Dipartimento di Medicina dei Sistemi, Università “Tor Vergata”, 00133 Rome, Italy; [email protected] (C.L.); [email protected] (F.P.); [email protected] (M.P.); [email protected] (A.S.) 3 Centro di Medicina del Sonno, Unità di Neurologia, Università “Tor Vergata”, 00133 Rome, Italy; [email protected] 4 Centro Regionale Alzheimer, ASST Rhodense, 20017 Rho, Italy; [email protected] 5 Dipartimento di Psicologia, Facoltà di Medicina e Psicologia, “Sapienza” Università di Roma, 00185 Rome, Italy; [email protected] 6 UOC Neurologia, Azienda Ospedaliera “San Giovanni Addolorata”, 00184 Rome, Italy; [email protected] 7 Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, “Sapienza” Università di Roma, 00189 Rome, Italy * Correspondence: [email protected]; Tel./Fax: +39-06-51501185 † These authors contributed equally and share senior authorship. Citation: Assogna, F.; Liguori, C.; Cravello, L.; Macchiusi, L.; Belli, C.; Abstract: Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for developing Placidi, F.; Pierantozzi, M.; Stefani, A.; Parkinson’s disease (PD) and may represent its prodromal state.
    [Show full text]
  • Parasomnias and Antidepressant Therapy: a Review of the Literature
    REVIEW ARTICLE published: 12 December 2011 PSYCHIATRY doi: 10.3389/fpsyt.2011.00071 Parasomnias and antidepressant therapy: a review of the literature Lara Kierlin1,2 and Michael R. Littner 1,2* 1 David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA 2 Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Edited by: There exists a varying level of evidence linking the use of antidepressant medication to Ruth Benca, University of the parasomnias, ranging from larger, more comprehensive studies in the area of REM Wisconsin – Madison School of Medicine, USA sleep behavior disorder to primarily case reports in the NREM parasomnias. As such, prac- Reviewed by: tice guidelines are lacking regarding specific direction to the clinician who may be faced Ruth Benca, University of with a patient who has developed a parasomnia that appears to be temporally related to Wisconsin – Madison School of use of an antidepressant. In general, knowledge of the mechanisms of action of the med- Medicine, USA ications, particularly with regard to the impact on sleep architecture, can provide some David Plante, University of Wisconsin, USA guidance. There is a potential for selective serotonin reuptake inhibitors, tricyclic antide- *Correspondence: pressants, and serotonin–norepinephrine reuptake inhibitors to suppress REM, as well Michael R. Littner, 10736 Des Moines as the anticholinergic properties of the individual drugs to further disturb normal sleep Avenue, Porter Ranch, Los Angeles, architecture. CA 91326, USA. e-mail: [email protected] Keywords: parasomnias, REM sleep behavior disorder, non-REM parasomnias, selective serotonin reuptake inhibitors, depression INTRODUCTION and night terrors (Ohayon et al., 1999; Yeh et al., 2009).
    [Show full text]
  • The Flower Pot Method of REM Sleep Deprivation Causes Apoptotic Cell Death in The
    bioRxiv preprint doi: https://doi.org/10.1101/375717; this version posted October 18, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. “The flower pot method of REM sleep deprivation causes apoptotic cell death in the hepatocytes of rat” Atul Pandey1, 2*, Devesh Kumar1, 3, Gopesh Ray1, 4, Santosh Kar1, 4* 1School of Biotechnology, Jawaharlal Nehru University, New Delhi-110067, India Present addresses: 2 Department of Ecology, Evolution, and Behavior, The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, 91904, Israel 3 University Hospital Brussels, Brussels, Belgium 4 School of Biotechnology, KIIT University, Bhubaneswar-751024, Odisha, India *Corresponding Authors: [email protected] & [email protected], Ph: +91-9937085111 Short running title: REM sleep deprivation causes liver cell death. Key Words: REM sleep deprivation, Apoptosis, cell-death, Hepatocytes, Sleep recovery, Caspases. bioRxiv preprint doi: https://doi.org/10.1101/375717; this version posted October 18, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Highlights of the study • We observed significant apoptosis in the hepatocytes of REMSD group of rats. • Our expression analysis confirmed altered expression for genes p53, Bcl2, Bax, and Caspase-3 after REMSD. • Protein level analysis supported our gene expression results for p53, Bcl2, Bax, Caspase 3 and Caspase 9 after REMSD. • Sleep recovery improved the respective genes and protein expression levels towards normalcy, signifying the functional role of REM sleep.
    [Show full text]
  • Safe Sleep: Information for Parents
    Safe Sleep: Information for Parents SIDS Crib The term SIDS, or sudden infant death syndrome, A crib can be a crib, bassinet, Pack-N-Play, is used to describe when babies die in their sleep play-yard, or playpen, but it should have a firm without any warning before their first birthday. In mattress and be covered with a well-fitted sheet the early 1990s, parents were told to stop putting only. It is very dangerous for babies to sleep on babies on their tummies to sleep. They were told to a sofa or armchair, because they can wiggle as put them on their backs or sides only. Later, they sleep and get trapped and be smothered. It experts said the side position wasn’t safe either, so is also not safe for them to sleep in a car seat, parents were told to put their babies only on their bouncy seat, swing, baby carrier, or sling, backs. because their neck can bend in ways that makes it hard for them to breathe. Today, we know that just putting babies on their backs to sleep is not enough to keep some of them There are some other very important things that from dying in their sleep. There are many other can help babies sleep safely: easy things parents can do to keep their babies safe Smoking—Keep babies away from people when they sleep. who smoke. We know that babies who are around people who smoke or babies born to Safe Sleep mothers who smoke have a higher risk of “ABC” is an easy way to remember how to make SIDS.
    [Show full text]
  • Rapid Eye Movement Sleep and Significance of Its Deprivation Studies - a Review
    REVIEW ARTICLE Rapid Eye Movement Sleep and Significance of its Deprivation Studies - A Review Seema Gulyani, Ph.D., Sudipta Majumdar, M.Sc., and Birendra N. Mallick, Ph.D. Rapid eye movement (REM) sleep is a unique phenomenon within sleep-wakefulness cycle. It is associated with increased activity in certain group of neurons and decreased activity in certain other group of neurons and dreaming. It is likely to have evolved about 140 million years ago. Although mention of this stage can be traced back to as early as 11 century BC in the Hindu Vedic literature, the Upanishads, it has been defined in its present form in the mid-twentieth century. So far, neurobiology of its genesis, physiology and functional significance are not known satisfactorily and mostly remains hypothetical. Nevertheless, more and more studies have increasingly convinced us to accept that it is an important physiological phenomenon which cannot be ignored as a vestigial pheno- menon. Although there are articles where different aspects of REM sleep have been de- alt with, a review where the knowledge gathered by REM sleep deprivation studies to un- derstand its significance is lacking. There is a need for such a review because a major portion of the knowledge about various aspects of REM sleep, specially its functional sig- nificance, has been acquired mostly from the REM sleep deprivation studies. Hence, in this review the knowledge gathered by REM sleep deprivation studies have been cola- ted along with their importance so that it may be useful and referred to for information as well as while designing future studies.
    [Show full text]
  • Effectiveness of Weighted Blankets As an Intervention for Sleep Problems in Children with Autism”
    EFFECTIVENESS OF WEIGHTED BLANKETS AS AN INTERVENTION FOR SLEEP PROBLEMS IN CHILDREN WITH AUTISM Thesis submitted in partial fulfilment of a Master of Science in Child and Family Psychology at the University of Canterbury by Jane Charleson University of Canterbury 2014 2 Contents List of Tables ................................................................................................................. 6 List of Figures ................................................................................................................ 7 Acknowledgements ........................................................................................................ 8 Abstract .......................................................................................................................... 9 Chapter 1 Introduction ................................................................................................. 10 Definition of autism spectrum disorder ................................................................... 11 Development of sleep in children ............................................................................ 12 Assessment of sleep ................................................................................................. 14 Definition of sleep problems .................................................................................... 16 Prevalence and nature of sleep problems in children with autism ........................... 18 Development and maintenance of sleep problems in children with autism ............
    [Show full text]