Sleep

Divided into

Regulated by
Light

Non-rapid eye
movement (NREM)

Rapid eye
movement (NREM)

Sleep-wake
Homeostasis

Circadian Rhythm

Focused on
ReEna

Eme awake,
sleep pressure,
likelihood of
falling asleep

Is subdivided into

Stage 1

Stage 2

Stage 3

Stage 4

Controlled by

Signal to
SuprachiasmaEc
nucleus
Sends signal to
Pineal gland

REM

Which secretes
Stage 2

Stage 3

Melatonin

Sleep is regulated by two body system

Sleep-wake Homeostasis
Aka homeostatic
process
Internal timer
Creates homeostatic
sleep drive or
pressure for sleep

Sleep-wake Homeostasis
Mechanism is poorly understood despite
years of research
Endogenous ("built-in", self-sustained)
Sleep-regulating substances (e.g.
adenosine)

Sleep-wake Homeostasis
Sleep-wake homeostatic mechanism
Non-REM sleep
Slow wave sleep

Homeostatic & Circadian Rhythm

Circadian Rhythm
Cycle of physiological and biological processes
that fluctuate on a roughly 24-hour timetable

Circadian Rhythms vs. Biological Clock

Endogenous
Entrained (adjusted to the local
environment by external cues [i.e. sunlight]
Rhythm can be reset by exposure to
external stimuli.

Circadian Rhythm & Master Clock

Suprachiasmatic nucleus (SCN)
Located in the hypothalamus
Controls melatonin production
How does light reset the biological clock?
Rods and cones?
Melanopsin

Melatonin & Cortisol

Internal Desynchronization (Jet Lag)

Adenosine

Caffeine (Adenosine Receptor Antagonist)

Winter Blues?
Seasonal Affective
Disorder (SAD)
Depressive symptoms in
the winter or summer
Possible factors:
Circadian rhythm
Serotonin levels
Melatonin levels

Other Neurotransmitters

Sleep-Wake Cycle Neurotransmitters

Stages of Sleep
Non-REM

REM

Non-REM
Non-Rapid Eye Movement
5-15 minutes per stage
Body repairs
Regenerates tissues
Builds bone and muscle
Strengthen Immune System

Non-REM Stage 1
Transition period between wakefulness and sleep
Brain produces high amplitude of theta waves
Eyes closed
5-10 minutes
Can be awakened without difficulty
Feeling of falling

Non-REM Stage 2
Period of light sleep
20 minutes
Brain begins to produce bursts of rapid, rhythmic brain
wave activity: sleep spindles
Heart rate slows
Body temperature decreases
Body enters deep sleep

Non-REM Stage 3
People become less responsive
The delta sleep
Deep, slow brain waves (delta waves)
Noises/activity in the environment may fail to
generate response
Bedwetting and sleepwalking

Stage 4: REM
Eye movement
Increased respiration rate
Increased brain activity
Paradoxical sleep

Muscle relaxed
Brain is active

Dreaming: increased brain activity, voluntary muscles

paralyzed

Why Sleep Matters

Survival
Allow body to repair itself
Cells show increased production of proteins
Cell growth and repair damage from stress and UV rays
Biochemical and Psychological Processes
Physiological and cognitive functions
Memory, attention, complex thought, motor response,
emotional control

Sleep loss
Grumpy, groggy
Harmful consequences
for immune and endocrine
systems
Contribute to obesity,
diabetes and
hypertension
Mood: irritability, anger,
anxiety, sadness

Sleep Duration Vs. Problems

Problems
Obesity
Diabetes
Hypertension
Depression
Problems faced in society
100,000 car crashes
1,500 deaths

Studies
Sleep deprivation vs. test scores
Judgment
Reaction time
Explicit recall
Inverse word reading
Daytime alertness
memory

Hormones and Metabolism

Cortisol
Growth hormone
Follicle Stimulating hormone
Luteinizing hormone
Hormones influencing appetite and weight
Immune system
Cardiovascular disease

Sleep Apnea
Disorder characterized by episodes of
interrupted breathing
3 types
Obstructive Sleep Apnea
Central Sleep Apnea
Complex

Symptoms
Sleepiness during the day
Problems with daytime concentration and performance
Depression
Irritability
Sexual dysfunction
Learning and memory difficulties
Falling asleep while at work

Treatment

Risks
High blood pressure
Heart attack
Irregular heartbeat
Stroke

Narcolepsy
Chronic neurological disorder that causes
the person to fall asleep at times when he/
she wants to be awake
Lack of hypocretin

Symptoms
Extreme daytime sleepiness
Cataplexy
Hallucinations
Sleep paralysis

Treatment

Parasomnias
Bizarre and complex behaviors which
happen when the transition state to
another doesnt progress in an orderly
fashion or a person is aroused from sleep,
bizarre

Parasomnias
Sleepwalking
Night Terrors
Agitation, large pupils, sweating, increased
blood pressure
Bedwetting

Parasomnias
REM sleep behavior disorder
Vigorous or violent behaviors that occur
later in the night
Sleep-related eating disorder
A person eats food during the night while
he or she appears to be asleep

Insomnia
Complaint of difficulty:
Initiating or maintaining sleep
Waking too early and not being able to get
back to sleep
Waking feeling unrefreshed and lethargic

Effects
Daytime fatigue
Impaired mood and judgment
Poor performance
Increase likelihood of accidents

Treatment

Philippines

Philippines
St. Lukes Medical Center
Lung Center of the Philippines

Journal Discussion
Main Journal
Pathophysiology of Health Illness:
Thermoregulation, risk factors, and
indicators of aggravation
Miyake, Yasufumi (2013)

Body Temperature Control

Deep body temperature
Optimal temperature for efficient enzymatic
activity for maintaining life
37.5 C
Hypothalamus
Regulate body temperature

Body Temperature Control

Mechanisms of heat exchange
Vaporization
Dry Heat Exchange
Radiation
Accounts for most of heat absorbed from the
environment

Conduction
Convection
Gas or liquid absorbs and moves heat away from the
body
gains greater importance in preventing heat-related
illnesses

Fever and Hyperthermia

Fever
reset body temperature setting
occurs during infections
release of endogenous pyrogens
Increased metabolic activity

Fever and Hyperthermia

Hyperthermia
body temperature setting unchanged,
occurs when physiological
thermoregulation mechanisms cannot keep
up with increasing body temperature
heat input from the environment and body
metabolism is increased compared with heat
output from the skin

Fever and Hyperthermia

Thermoregulation Factors

Factors Leading to Hyperthermia

Factors Leading to Hyperthermia

Environmental factors
Affect how efficiently extra heat can be
released from body
include:
Environmental temperature, humidity, radiant
heat, wind strength, etc.

Factors Leading to Hyperthermia

Factors Leading to Hyperthermia

Risk Factors
Environmental factors

Dehydration

Age

Hypertension

Mental illness

Cardiac Disease

Heat Illnesses
Encompass a spectrum of disorders from
minor syndromes to heat stroke
Characterized by hyperthermia
General term for a condition resulting from
physical adjustment disorders in hot
environments

Specific Heat Illnesses

Heat Rash/Prickly
Heat
Skin irritation caused
by sweat that does
not evaporate from
the skin
Characterized by
erythematous
papular rash,
pustules

Specific Heat Illnesses

Heat Edema
Swelling of the
extremities due to
vasodilation and
venous stasis
heat causes blood
vessels to expand, so
body fluid moves into
the hands or legs by
gravity

Specific Heat Illnesses

Heat Syncope
Fainting secondary to insufficient perfusion
during and after exertion in the heat
Characterized by lowering of blood pressure

Specific Heat Illnesses

Heat Cramps
Sporadic, often severe muscle spasms
Most common in voluntary muscles of
extremities and abdomen
Usually without complications
Arise after vigorous exertional stress

Specific Heat Illnesses

Heat Exhaustion
Heat prostration or collapse
Mild to moderate form of heat illness
associated with moderate to high body
temperature
can precede heat stroke

Specific Heat Illnesses

Heat Exhaustion
Common symptoms
Light-headedness
Headache
Increased thirst
Nausea
Vomiting
Muscle crams

Specific Heat Illnesses

Heat Exhaustion
Types
Water Depletion (hypernatremic)
Salt Depletion (hyponatremic)

Specific Heat Illnesses

Heat Stroke
Medical emergency, life threatening
Characterized by temperature greater than
106 F (~41 C) and presence of CNS
dysfunction
Sweating stops and body can no longer rid
itself of excess heat
Multisystem disease

Specific Heat Illnesses

Heat Stroke

Implications: Organ Impairment

Enzyme denaturation
Decrease in mitochondrial function disturbs
oxidative phosphorylation impairment

Disseminated intravascular coagulation (DIC)

Condition in which blood clots form

throughout bodys small blood vessels
Reduce or block blood flow
Can damage bodys organs
Can cause internal and external bleeding

Disseminated intravascular coagulation (DIC)

Diagnosis and Tests

It's usually apparent to doctors if you have heatstroke, but laboratory
tests can confirm their diagnosis, rule out other causes for your
symptoms and assess organ damage. These tests include:
A blood test to check blood sodium or potassium and the
content of gases in your blood to see if there's been damage to
your central nervous system
A urine test to check the color of your urine, because it's usually
darker if you have a heat-related condition, and to check your
kidney function, which can be affected by heatstroke
Muscle function tests to check for serious damage to your
muscle tissue (rhabdomyolysis)
X-rays and other imaging tests to check for damage to your
internal organs
(MayoClinic.com)

Prevention
Drink at least 13 glasses of water every day.
Avoid drinking teas, coffee, and alcoholic beverages
that could result to dehydration.
Avoid sun exposure between 9:00 AM to 3:00 PM daily,
where the warmest temperatures are usually
observed.
Stay at home as much as possible.
Do regular exercise and other outdoor activities either
early morning or after sunset.
Wear lightweight, light-colored, loose-fitting clothing,
and a wide-brimmed hat.
(from DOH)

Outdoor Workers and Landscaping

Outdoor laborers compose the largest
percentage of patients with heat-related
illnesses. - JAMES L. GLAZER, 2005
State of California Department of Industrial Relations Policy on
Landscaping for their employees:
Landscaping means providing landscape care and
maintenance services and/or installing trees, shrubs, plants,
lawns, or gardens, or providing these services in conjunction
with the design of landscape plans and/or the construction
(i.e., installation) of walkways, retaining walls, decks, fences,
ponds, and similar structures
(State of California Department of Industrial Relations)

Outdoor Workers and Landscaping

Landscaping Policy Includes Consideration for:
Access to shade
Access to water.
Training of employees for heat illness
prevention.
Application in the Philippine Context:
Why is it needed?
Cases of Heat stroke, cramps, exhaustion of
outdoor workers (2007) = 577 cases
(Based from OHS Status Report - Philippines)

Innovative Solutions
Japan's "Green Curtain"
Program
These green curtains are the
growth of walls/curtains
of plants over buildings,
which block out some
sunlight and help to keep
buildings cooler.

Innovative Solutions
Result:
Reduced use of
airconditioning
system
Reduced
Greenhouse
gases emission and
reduced
consumption of energy
Innovative way to combat
climate change

Innovative Solutions
Global Cooling Project (independent from
heat stroke prevention plan), including:
1) Energy conservation plans decarbonising
2) Ecological Vehicle Promotions
3) Use of solar energy systems
4) Climate campaigning and education.

First Aid Treatment

If you suspect heatstroke:
Move the person out of the sun and into a
shady or air-conditioned space.
Call emergency medical help.
Cool the person by covering with damp sheets
or by spraying with cool water. Direct air onto
the person with a fan or newspaper.
Have the person drink cool water or other
nonalcoholic beverage without caffeine, if he
or she is able.

(from Mayoclinic)

Philippines
Hottest days in 2014: May 21 and 22
Average of 37 celsius
Hottest ever recorded in Manila: May 14, 1987
38.6
Hottest ever recorded in the Philippines: May 11,
1969 (Tuguegarao City)
42.2

DOH
Health assistant secretary Dr. Eric Tayag:

heat stroke could lead to serious health
complica1ons from a mild seizure to death if
not prevented by being aware of its tell-tale
signs.

DOH

DOH

United States
20 cases per 100,000 people
240 deaths annually
Mobile app on heat-related illness