睡眠 Sleep. Professor Tung-Ping Su Department of Psychiatry National Yang-Ming University Taipei Veterans General Hospital Dec. 24, 2007 Lecture for the 4th class of Dept of Medicine National Yang-Ming University. Sleep disturbances. 正視失眠問題. 從流行病學角度來看，保守估計全台灣大約有 150~200 萬 的人飽受失眠之苦
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睡眠Sleep Professor Tung-Ping Su Department of Psychiatry National Yang-Ming University Taipei Veterans General Hospital Dec. 24, 2007 Lecture for the 4th class of Dept of Medicine National Yang-Ming University
How Common Is Insomnia? • Overall prevalence • Symptomatic with consequences • Actually diagnosed • Insomnia symptoms • Overall prevalence 35% Insomnia symptoms with Daytime consequences10%-12% Insomnia diagnosis 6% Adapted from Buysse DJ et al. Primary Psychiatry. 2005;12:37-44.
Prevalence of Insomnia 33% 10% Insomnia Symptoms With Daytime Symptoms Sleep Dissatisfaction 15% Insomnia Diagnosis 6 to 9% Ohayon MM. Sleep Med Rev. 2002;6:97-111.
A Telephone Survey in 2006 Unit: % 30.0% 24.8% 25.0% 20.2% 20.0% 14.6% 13.5% 13.3% 15.0% 10.0% 5.0% 0.0% TOTAL Interrupted Sleep Difficulty in Initiation Nonrestorative Sleep Early Morning Awakening 【n=4,011】 Taiwan society of sleep medicine, 2006
Effect of Sex on the Prevalence of Insomnia by Age 25% 20% 15% 10% 5% 0% Lifetime Prevalence Male Female 40-44 45-54 55-64 65-74 >=75 p < 0.1 6.60% 6.20% 6.90% 10.30% 6.60% 9.20% 9.90% 12.60% + 40-44 45-54 55-64 65-74 >=75 5.50% 5.30% 7% 8.65% 8.40% 5.20% 6.70% 12% 16% 16% 40-44 45-54 55-64 65-74 >=75 Years 30% 25% 20% 15% 10% 5% 0% One-month Prevalence Male Female p < 0.001 ** * * 40-44 45-54 55-64 65-74 >=75 Years
Insomnia Is a 24-hour Problem • Daytime fatigue, lack of energy • Cognitive impairments (attention, memory, concentration) • Mood disturbances (irritability, dysphoria)
Sleep Switch: rapid transition From arousal to asleep & vice versa • VLPO: ventrolateral preoptic nuclei • - Inhibitory on arousal system and active during • sleep • - Damage on VLPO---chronic insomnia • - Suppress VLPO --- awakening • - receiving inputs from monoaminergic neurons • - LC, TMN & Raphe nuclei, inhibit VLPO, are • stabilized by orexin in the awake • - Sleep switch has mutually inhibitory elements • - In that, one side shut down the other side and • diminish its own actions and result in abrupt change • from awake to asleep • In the sleep state: • - VLPO inhibit orexin neurons • and LC, TMN & Raphe nuclei • Narcoolepsy • -a problem with such a switch: rapid unwanted • transitions from one state to the another can occur • when it is unstable • - Narcolepsy (2000) had few orexin neurons in the • hypothalamus • - Orexin neurons (hypocretin): active during wakeful- • ness and reinforce the arousal system • - Lost the stabilizing influence on the orexin neurons
NarcolepsyThree - stage pathway for control of sleepGreater integration of multiple factors and greater flexibility in behavioral response 3rd system Dorsomedial nu. of hypothalamus (DMH) SCN many physiological Functions: eating, temp & Cortisol cycle are affected. Few direct projections VLPO Orexin neurons
EKG Airflow Thoracic effort Abd. effort SAO2 Obstructive Apnea: A complete blockage of the airway despite efforts to breath. Notice the effort gradually increasing ending in airway opening.
