Disorders Of sleep

Disorders of sleep affect when and also how we sleep

looking at two main disorders, these are ; Narcolepsy and Insomnia

Symptom's - cataplexy ( loss of muscle movement)

- sudden sleep at innapropriate times

There are three primary explanations as to the cause of narcolepsy

These are REM, The HLA eplanation, The hypocretin explanation

During REM sleep, muscle paralysis takes place.

narcolepsy is just this paraysis (caused by the medula) at the wrong time

activity in the medula (INCREASES) muscle tone (DECREASES) = cataplexy

Siegel et al - looked at the activity in the medula in dogs during cataplexy. Activity was high.

this shows that there is a link between the lack of muscle tone in cataplaxy + the medula as in REM sleep

Schenkel + siegal - then destroyed the medulla in cats + they moved during REM as if awake.

This shows that muscle paralysis doesn't happen without the medulla making it the cause of cataplexy.

However not all people with narcolepsy have cataplexy!

Your immune system is attacking cells nside your body which is causing narcolepsy

Honda et al - found an unusual version of the HLA complex and showed 100% of a sample of narcoleptics in Japan had this unusual complex!

This can't just be coincedence!

Other studies, however have not shown this high concordance rate so what about those people?

Not enough Hypocretin causes narcolepsy

Thannickal et al - when post mortems on narcoleptics, 90% had below average hypocretin producing nueron's.

this estalishes a strong link between hypocretin and narcolepsy however it may be a result of narcolepsy not the other way round.

all explanations appear weak at first glance although there is clearly a link between all thee, one explantion is not the answer.

Nishino et al - showed that (DECREASE) in Hypocretin = (INCREASE) in medulla = (DECREASE) in muscle tone

This establishes a link between the REM explanation + hypocretin

if the HLA explanation can be linked to attacking hypocretin producing neurones then this is genetic form of the HLA complex causes Low hypocretin which leads to low muscle tone!

three types on insomnia;

1.) fatal familial insomnia - We know the genetic cause

2.) Secondary insomnia - Everyone has stresses and colds

3.) Primary insomnia - We don't know the Cause

What can cause it;

age

genetics

stress (diathesis)

AGE

Geriatics Insomnia - Garfinkel - gave geriatrics more melatonin + sleep inproves showing a possible cause for this insomnia is low melatonin production.

GENETICS

We inherit Genes from out parents that give us the gene for insomnia

Watson et al - studied MZ + DZ twins and found a 47% concordance in MZ and 15% in DZ

STRESS - (DIATHESIS)

Suggests we have a predisposition from genes to be an insomniac but this is shaped by enviromental factors. e.g. Bed times as a child

This has now been developed by Spielma + Glovinsky

there is; predisposed, precepitation, perpetuation

This is the best explanation