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Speaker 1: Welcome back, everybody. We're gonna be talking about sleep today,

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and we'll also be looking at the neurobiology of sleep. Really,

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that's kind of what we're going to be focusing on.

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So sleep cycles through what they call nr EM stages

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N one through N three, that's ends and nancy and

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rem in ninety minute intervals. That's the way the cycle

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happens for sleep. Some of the neurotransmitters and hormones involved

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are serotonin, melotonin identity, and or rexin. They regulate sleep onset,

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depth and timing. Insomnia has the most common sleep disorder.

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Narcolepsy involves orxen deficiencies were you just fall asleep Everywhere

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sleep disturbances worsen and maintain conditions like depression, anxiety, PTSD,

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and bipolar disorder. I'll tell you sleep is one of

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the biggest things that can help replying quite a bit.

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They've even shown it drops one hour of extra sleep

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can drop six to seven points on the Hamilton Depression Inventory.

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It's pretty powerful stuff. Treating sleep problems biologically and behaviorally

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improves the psychological outcomes of these people, of the people

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with psychiatric issues, and for everybody. Really, it repairs tissues,

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consolidates memory. When we get to memory soon, you'll see

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how that operates. It recalibrates emotion and supports executive function

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back there in the pre final cortex. So let's look

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at some of a little bit more deep dive into

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the ends. So each night, sleep repeats, as we mentioned,

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a ninety minute cycle through non rapid eye movement. That's

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what n RAM stands for, and RM is rapid eye movement.

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So they just kind of abbreviate it to end one

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and one is light sleep. But stage number one and

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you transition kind of between wake and sleep. You got

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different brain waves, and you're going to be in here

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in the theta wave, so you have gamma and beta,

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which usually your alert alpha, Theta and delta deltas are

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completely out, so it's easily disrupted in the theta wave

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and accounts for about five percent of total sleep. Is

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a light sleep, the deeper light sleep stage n two.

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You'll see on the EGS sleep spindles and k complexes

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and temperature drops, heart rate slows. It makes up about

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forty five to fifty five percent of your total sleep.

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So I threw a couple of words in there. Sleep spindles,

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which are brief bursts of high frequency brain activity. The

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last about a half a second to two seconds. Again,

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they're in stage two and they're linked to memory consolidation,

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so sensory processing suppression as well and maintaining sleep stability

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by blocking out external stimuli. The K complex is. These

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are a sudden, sharp, high amplitude waves, often followed by

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a slow wave lasting about a half half a second

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to a second. They occur spontaneously in response to external

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stimuli like noise. Their job is to protect sleep by

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suppressing arousal while while assessing whether it's stimulus requires waking up,

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but it's almost like your personal security. Both are hardmarks of

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light sleep, aiding and transitioning to deeper sleep stages and

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supporting cognitive functions like memory and learning. Now we go

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to stage three, which is and three and this was

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when you didn't get into the delta wave, so you're

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pretty hard. You're knocked out. This is hard to wake from.

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The stage is physically restorative. It supports immune function, growth,

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hormone release, and memory consolidation. Unfortunately, it does decline with age,

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so immune function here is why a lot of times

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if you're not getting enough sleep, you're more susceptible to

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getting sick. The fourth and final stage is what everybody

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hears about rem sleep right. This is where you dream fast,

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low voltage brainwaigh, but with muscle paralysis, which they call atonia.

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Ato Nia is muscle paralysis. This stage is emotionally and

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cognitively restorative, associated processing emotional memories, problem solving, and creativity.

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We're not necessarily going to get into analyzing dreams here.

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We will be doing that and some other podcasts that

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I have. You can check those out at Circle of

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Insight podcast or Psychology Tidbits. I have done some dream

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analysis work over there. Now look at the newer chemistry

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of the sleep wake cycles. They're regulated by homeostatic and

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circadian processes. Think of them as pressure and timing. A

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dentistine builds up during wakefulness. It's the body's sleep debt signal.

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It promotes drowsiness and gets cleared during sleep, and then

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it starts building back up. Cause Caffeine blocks the dentistine receptors,

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which is why it keeps you alert. On a side note,

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a lot of paramedics will use a dentistine to calm

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down the patient at the time Melatonin is released by

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the pineal gland, the pineal p I N E A

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L and its response to diminishing light levels, So you

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get both of these working together, a dentisine and melatonin

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in a way. So when the light levels starts decreasing,

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melatonin starts increasing in the pineal gland. At the same time.

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Throughout the day, you're a dentisine is building up to

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a certain level till you fall asleep, So both of

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these are setting up your circadian timing. Note that exposure

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to blue light from screens in the evening can suppress

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melatonin release and disrupt sleep timing. Serotonin plays dual roles.

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It helps initiate sleep and supports RAM regulation. SSRIs can

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alter rem sleep patterns, often reducing RAM density. Orexin or

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hypocretin orexin is ori E xi N producing the hypothalmus

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keeps you awake and alert, and narcoleps orexin producing neurons

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are deficient or absent, leading to sudden, uncontrollable sleep attacks.

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Let's hurry over to your body's internal clock, which they

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call the circadian rhythm. They're roughly twenty four hour cycles

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regulated by the super chiasmatic nucleus the SCN in the hypothalmus.

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The SCN responds to light input from the retina, sinking

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the body clock to environmental cues like light meals social interaction.

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When circadian rhythms are misaligned, think about overnight midnight shifts.

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Things of that nature are jet lag, Sleep becomes fragmented,

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and hormonal rhythms shift and mood regulation weakens. So look

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now at some of the disorders associated with sleep. Will

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also look at some treatment strategies. So insomnia disorder difficulty

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falling asleep or staying asleep. Another one is early awakening

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must last at least more than three nights per week

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for three months and cause daytime impairment. The neurobiology associated

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with it as heightened cortisol levels due to hyper arousal.

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You also have an elevated metabolic rate and increase sympathetic activity.

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Remember the fight or flight system kicks in here. First

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line of treatment make sure you know this for the

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exam is CBT. Also sleep hygiene, melotonin, short term sedative hypnotics,

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and load dose trazodone. I've seen trousodon being prescribed a lot.

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Also zopidim so. Again, first line of treatment is CBT

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number two. It was obstructive sleep apney I repeated airway

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collapse during sleep, causing brief arousals and oxygen desaturation. Often

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missed unless the bed partner reports snoring or gasping. It

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can lead to daytime fatigue, increase srutability that's also linked

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to depression and hypertension. Treatment the most common is SEAPAP

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weight loss, avoiding alcohol sedatives. By the way, SEAPAP is

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the continuous positive airway pressure. It's a medical device that

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they use to treat sleep. APNA delivers a steady stream

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of air pressure through a mask worn over the nose

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or mouth, keeping the airway open to prevent breathing in eruptions.

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So what it does with the therapy can improve sleep architecture,

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potentially increasing the frequency or quality of Stage two. This

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is where we talked about sleep spindles and k complexes.

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Better airway pagency reduces arousals, allowing more consistent sleep cycles.

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We move on now to narcolepsy, which we've mentioned a

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little bit earlier. Narcolepsy is characterized by sleep attacks, cataplexy,

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sleep paralysis, and hypnagogic hallucinations. So you're hallucinating just before

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you go to sleep. Cause is usually a resin deficiency

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in the hypothalmus. Treatment is medophinol sodium oxybate structured naps.

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Stimulants can work as well for alertness and SSRIs for

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cattle AMPLEXI in cataplexy if you're wondering, is a sudden

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brief loss of muscle tone triggered by strong emotions, either laughter, surprise,

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or anger, often associated with narcolepsy. Episodes can range from

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mild droopy eyelids to head nodding to severe full body

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collapse lasting minutes I mean seconds to minutes, but preserved consciousness.

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So again, sudden brief loss of muscle tone triggered by

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strong emotions, and it is a symptom of narcolepsy. Sleep

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in psychological disorder is depression, which we talked about earlier.

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Shortened RIM latency, increased RIM density, poor sleep predicts onset

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and relapse. Sleep disturbances are both a symptom and a

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risk factor for depression. Unfortunately, antidepressants can suppress rem initially,

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which may be therapeutic in the beginning. So I'm going

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to take away that Unfortunately I mislooked at my notes.

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Anxiety disorders difficulty initiating or maintaining sleep due to hyper arousal.

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You got worry loops and elevated europe An effort to

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disrupt pre sleep relaxation. Sleep deprivation increases a migular reactivity,

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reducing emotional regulation as well. The increase in the megular reactivity,

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of course, makes you hypervigilant. Third is PTSD also having

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fragmented ram intrusive nightmares. REM rebound after trauma. Rem rebound

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is a phenomenon where rapid eye movements sleep increases in

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duration intensity following a period of rim deprivation or suppression,

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such as from certain medications, stress, things of that nature.

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It reflects the body's attempt to recover lost rem critical

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for memory consolidation as we remember in cognitive function, so

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rebound underscores the the brain's prioritization of rem sleep. In

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addition to get nightmares maintain hypervigilance. For PTSD, prazosis in

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an alpha one blocker can reduce trauma related nightmares, prosis

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and p R A Z O s I N bipolar disorder.

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Sleep deprivation can trigger manic episodes. Many of features decreased

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need for sleep without fatigue sleep regularity is essential to

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stabilizing mood cycles, so mood stabilizers often normalized sleep like valparate, depicoat,

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or lithium. Lastly, it's a treatment strategy, so CBT is

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your first line most effective long term treatment targets maladapted

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beliefs and condition to arousal stimulus controls, sleep restriction, relaxation, training,

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and cognitive restruction are some of the components. Pharmacological treatments

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short term hypnotics so zopiderm, s zola, piclon, zopiclon which

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is e z O p I c l O n

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E which bind gabba, melatonin agonists like raalmaton which is

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non sedating circadian regulators, ramaton is r ame te o

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n E. Rexin antagonists like superoxytin that's s u v

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O r e x A n T promotes sleep onset

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without suppressing rem Antidepressants low dose trazodone common for insomnia

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with comorbid depression or anxiety. And last is sleep hygiene.

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Consistent schedule even on weekends, no screens or stimulating activities

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sixty minutes before bed. I always recommend reading. I think

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that helps a lot of tends to put people's kind

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of get them drowsy just using out benergy in your

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brain right soon much glucose, cool, dark, quiet environment and

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no caffeine after two. Also avoid naff throughout the day

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that are longer than twenty minutes. You don't want to

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get into that mess for sure. We'll go back over

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the importance of REM sleep, memory consolidation and learning, emotional regulation,

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brain development, cognitive function, and neuronal restoration, so really important.

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Also you'll see sleep there too. Remember REM rebound highlights

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REM's importance. After deprivation, the brain prioritizes REM to recover

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its benefits, often at the expense of other sleep stages.

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This could alter into spindle and k complex frequency, but

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underscores REM's role in the cognitive and emotional health of

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an individual. So that's different. Now next time when we

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come back, we move away from sleep and we're heading

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into some of the foundations of human development across the

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last span and how biology plays a role in human development.