Sleep

Sleep is defined as unconsciousness from which the person can be aroused by sensory or other
stimuli
It is to be distinguished from coma
Two types of sleep
Slow wave sleep
Most sleep during each night
Is deep and restful
Is associated with decrease in peripheral
vascular tone
Decrease in BP, respiratory rate and basal
metabolic rate
Dreams are not remembered
Consolidation of dreams are not occur


REM
25% of sleep
Bouts of REM lasting 5-30 min appear on
the average every 90 min
Dreams are associated with muscle
activity
The person is more difficult to arouse by
sensory stimuli
People usually awaken spontaneously in
the morning during an episode of REM
sleep
Muscle tone throughout the body is
exceedingly depressed
HR and respiratory are irregular
Despite inhibition of the peripheral
muscles irregular
muscle movements occur
rapid eye movements occur
The brain is highly active
Brain metabolism may be increased as
much as 20%
EEG waves are similar to those that occur
during wakefulness
Paradoxical sleep
The brain activity is not channeled in the
proper
direction for the person to be fully aware
of his surroundings


Basic theories of sleep
Passive theory: the reticular activating system fatigued during the waking day and became inactive
as a result
Active theory: it seems to be some center bellow the midpontile level that is required to cause sleep
by
inhibiting other parts of the brain


Neuronal centers that can cause sleep
Raphe nuclei
When a drug that blocks the formation of serotonin is administered to an animal, it cannot
sleep for the next several days, therefore, serotonin is a transmitter substance associated
with production of sleep.
Some areas in the NTS (nucleus of the tractus solitarius)
Rostral part of the hypothalamus (suprachismatic area)
Occasional area in the diffuse nuclei of the thalamus
Lesions in sleep promoting centers can cause
intense wakefulness
Lesions to the raphe nucleus
Bilateral lesions in the medial rostral suprachiasmal area in the anterior hypothalamus
Excitatory reticular nuclei of mesencephalon and upper pones released from inhibition
Other possible transmitter
1- Muramyl peptide
2- A nanopeptide isolated from the blood of sleeping animals
3- not identified molecularly substance, isolated from the neural tissues of the brain stem of animals
kept awake for days
Possible mechanism of REM
Drugs that mimic action of Ach increase the occurrence of REM
Large Ach releasing neurons in the upper brain stem reticular formation might activate many
portions of the brain
This could cause the excess activity that occurs in certain brain regions in REM sleep
Cycles between sleep and wakefulness
After the brain remain activated for many hours, even neurons in the activating system
become fatigued
Positive feed back between reticular nuclei and cerebral cortex fades
Sleep promoting centers take over
Physiologic effects of sleep
Effects on the nervous system
Restore natural balances among the neuronal centers.


Other functional systems of the body
Prolonged wakefulness is associated with progressive malfunction of the thought processes
and sometimes causes abnormal behavioral activities.
Sleep restores both normal levels of brain activity and normal balance among the different
functions of the CNS.
Brain waves: continuous electrical activity in the brain

Alpha : 8-13 cycles per
second
Awake and in a quiet
resting state
>Origin of alpha waves
Alpha waves will not
occur in the cerebral
cortex without cortical
connections with the
thalamus.
>Conversely,
stimulation in the
nonspecific layer of the
reticular nuclei that
surround the thalamus
or in diffuse
nuclei deep inside the
thalamus sets up
electrical waves
in the thalamocortical
system at a frequency
between 8 and 13 per
second.

>Alpha waves result
from spontaneous
feedback
oscillation in
thalamocortical
system.


cycles per second
Person's attention
directed to some
specific type of mental
activity

Delta : less than 3.5
cycles per second
in very deep sleep, in
infancy, serious brain
organic
disease
> Origin of Delta Waves:
Some synchronizing
mechanism can occur in
the
cortical neuronal
system by itself to
cause the delta
waves.

Theta : 4-7 cycles per
second
1- normally in
children
2- during emotional
stress
3- Brain disorders





Epilepsy
Epilepsy (seizures) is characterized by uncontrolled excessive activity of either part or all of the
central
nervous system.
Types of Epilepsy
Grand Mal
Petit Mal
Focal
Grand Mal:
Grand mal epilepsy is characterized by extreme neuronal discharges in all areas of the brain
in the cerebral cortex, cerebellum and even in the brain stem.
Discharges transmitted all the way into the spinal cord cause generalized tonic seizures of
the entire body, followed toward the end of the attack by alternating tonic and spasmodic
muscle contractions called tonicclonic seizures.
The person bites or swallows his or her tongue and may have difficulty breathing.
Signals transmitted from the brain to the viscera frequently cause urination and defecation.
The usual grand mal seizures lasts from a few seconds to 3-4 minutes.
It is also characterized by postseizure depression of the entire nervous system; the person
remains in stupor for 1 to many minutes after the seizure attack is over, and then remains
severely fatigued and asleep for hours thereafter.
Stimuli
1) strong emotional stimuli
2) Alkalosis caused by overbreathing
3) drugs
4) fever
5) loud noises or flashing lights
Stopage
Neuronal fatigue
Active inhibition by inhibitory neurons that have been activated by the attack
Petit Mal Epilepsy
Involves the thalamocortical brain activating system
It is characterized by 3 to 30s of unconsciousness (or diminished consciousness) during
which time the person has twitch-like contractions of muscles usually in the head region,
especially blinking of the eyes; this is followed by return of consciousness and resumption of
previous activities.
This total sequence is called the absence syndrome or absence epilepsy.
Involve almost any part of the brain, either localized regions of the cerebral cortex or deeper
structures of both the cerebrum and brain stem.
Focal Epilepsy
> This seizure results from oscilation of
1) inhibitory thalamic reticular neurons (GABAergic neurons)
2) excitatory thalamocortical and corticothalamic neurons.
> Most often, it results from some localized organic lesion or functional abnormality, such as
1) scar tissue in the brain that pulls on the adjacent neuronal tissue,
2) a tumor that compresses an area of the brain,
3) a destroyed area of brain tissue, or
4) congenitally deranged local circuitry.
Jacksonian epilepsy:
When a wave of excitation spreads over the motor cortex, it causes progressive march of muscle
contractions throughout the opposite side of the body, beginning most characteristically in the
mouth region and marching progressively downward to the legs but at other times marching in the
oposite direction.
Psychomotor seizure
it may cause
1) a short period of amnesia
2) an attack of unnormal rage
3) sudden anxiety, discomfort, or fear; and/or
4) a moment of incoherent speech or mumbling of some trite phrase.
> Attacks of this type frequently involve part of the limbic portion of the brain (hippocampus,
amygdala, septum, and/or portions of the temporal cortex.

Treatment :
Surgical Excision of Epileptic Foci Can Often Prevent Seizures.The EEG can be used to localize
abnormal spiking waves originating in areas of organic brain disease that predispose to focal
epileptic attacks. Once such a focal point is found,surgical excision of the focus frequently prevents
future attacks.


Depression:
Abnormality of Nor adrenaline and Serotonin
NTS
Due to reserpine that blocks NTs
Decrease in
Anger
Sex drive
Hunger
Anxiety
Depressed mood
Insomnia
Abnormal Behavious
Agitation when proved
Changed Social Habits
Person become Stubborn and refractory
May try to attempt suicide
Treatment :
MAO inhibitors : L-deprenyl will prevent
the destruction of Nor adrenaline
And serotonin
Tricyclic Anti depressant : They decrease
reuptake of NTS (imipramine and
amitptyline)
Electric shock therapy

Mania:

Reverse to depression
Increase Nor adrenaline and Serotonin activity
Abnormal increased activity

Treatment :
Lithium Drugs > Decrease NTS





MANIC DEPRESSION PSYCOSIS
Alternate depression and mania
Mani + Depression : Bipolar Disorder


Schizophrenia :
Prefrontal Cortex abnormality
Decreased Glutamate
Increase Dopamine Release from the areas
around Substantia Niagra
Meolimbic Dopminergic System
Excess dopamine is secreted by a group of
dopamine-secreting neurons whose cell
bodies lie in the ventral tegmentum of the
mesencephalon, medial and superior to the
substantia nigra. These neurons give rise to
the so-called mesolimbic dopaminergic
system that projects nerve fibers and
dopamine secretion into the medial and
anterior portions of the limbic system,
especially into the hippocampus, amygdala,
anterior caudate nucleus, and portions of
the prefrontal lobes. All
of these are powerful behavioral control
centers.
Features
Hallucinations
Fear
Abnormal visuo spatial signals
Speech Disorders
Abnormal Gate
Disorders of sequences and patterns of
movement
L-dopamine will cause aggravation
Treatment :
Heloperidol
Amyltryptylene
Alzheimers Disease :
Aging of neurons
1 % in 60 yrs
30 % 85 Yrs

Features :
Dementia
Abnormal Gait /posture
Muscle Rigidity
Decrease mental faculty
Cause :
Genetic
B-Amyloid Precipitate in Cerebrum,
Cerebelleum,Basal ganglia, Thalamus
,Hippocampus
Downs Syndrome
Metabolic Disease :
Apolopoprotein E is increase which will
increase in cholesterol transport in
blood