sleep wake heatillness

8/20/2019 Sleep Wake HeatIllness

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Sleep is regulated by two body system


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Sleep-wake Homeostasis

Aka homeostaticprocess

“Internal timer”

Creates homeostatic

sleep drive orpressure for sleep


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Mechanism is poorly understood despiteyears of research

Endogenous ("built-in", self-sustained)

Sleep-regulating substances (e.g.adenosine)


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Sleep-wake homeostatic mechanism

Non-REM sleep

Slow wave sleep


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Homeostatic & Circadian Rhythm


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Circadian Rhythm

Cycle of physiological and biological processesthat fluctuate on a roughly 24-hour timetable


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Circadian Rhythms vs. Biological Clock

Endogenous

Entrained (adjusted to the localenvironment by external cues [i.e. sunlight]

Rhythm can be reset by exposure toexternal stimuli.


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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


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Melatonin & Cortisol


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Internal Desynchronization (Jet Lag)


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Adenosine


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Caff eine (Adenosine Receptor Antagonist)


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Winter Blues?

Seasonal Aff ectiveDisorder (SAD)

Depressive symptoms in

the winter or summer

Possible factors:

Circadian rhythm

Serotonin levels

Melatonin levels


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Other Neurotransmitters


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Sleep-Wake Cycle Neurotransmitters


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Stages of Sleep

Non-REM REM


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Non-REM

Non-Rapid Eye Movement

5-15 minutes per stage

Body repairs

Regenerates tissues

Builds bone and muscle

Strengthen Immune System


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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


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Non-REM Stage 2

Period of light sleep

20 minutes

Brain begins to produce bursts of rapid, rhythmic brainwave activity: sleep spindles

Heart rate slows

Body temperature decreases

Body enters deep sleep


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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


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Stage 4: REM

Eye movement

Increased respiration rate

Increased brain activity

Paradoxical sleep – Muscle relaxed –

Brain is active

Dreaming: increased brain activity, voluntary musclesparalyzed


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Why Sleep Matters

Survival

Allow body to repair itself

Cells show increased production of proteinsCell growth and repair damage from stress and UV rays

Biochemical and Psychological Processes

Physiological and cognitive functionsMemory, attention, complex thought, motor response,emotional control


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Sleep loss

Grumpy, groggy

Harmful consequencesfor immune and endocrine

systems

Contribute to obesity,diabetes andhypertension

Mood: irritability, anger,anxiety, sadness


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Sleep Duration Vs. Problems

ProblemsObesityDiabetes

HypertensionDepression

Problems faced in society

100,000 car crashes1,500 deaths


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Studies

Sleep deprivation vs. test scores

Judgment

Reaction timeExplicit recall

Inverse word reading

Daytime alertnessmemory


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Hormones and Metabolism

Cortisol

Growth hormone

Follicle Stimulating hormone

Luteinizing hormone

Hormones influencing appetite and weightImmune system

Cardiovascular disease


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Sleep Apnea

Disorder characterized by episodes ofinterrupted breathing

3 types

Obstructive Sleep Apnea

Central Sleep ApneaComplex


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Symptoms

Sleepiness during the day

Problems with daytime concentration and performance

Depression

Irritability

Sexual dysfunction

Learning and memory difficulties

Falling asleep while at work


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Treatment


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Risks

High blood pressure

Heart attack

Irregular heartbeat

Stroke


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Narcolepsy

Chronic neurological disorder that causesthe person to fall asleep at times when he/she wants to be awake

Lack of hypocretin


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Symptoms

Extreme daytime sleepiness

Cataplexy

Hallucinations

Sleep paralysis


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Treatment


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Parasomnias

Bizarre and complex behaviors whichhappen when the transition state toanother doesn’t progress in an orderly

fashion or a person is aroused from sleep,bizarre


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Parasomnias

Sleepwalking

Night Terrors

Agitation, large pupils, sweating, increasedblood pressure

Bedwetting


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REM sleep behavior disorderVigorous or violent behaviors that occurlater in the night

Sleep-related eating disorder

A person eats food during the night while

he or she appears to be asleep

Parasomnias


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Insomnia

Complaint of difficulty:

Initiating or maintaining sleep

Waking too early and not being able to getback to sleep

Waking feeling unrefreshed and lethargic


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Eff ects

Daytime fatigue

Impaired mood and judgment

Poor performance

Increase likelihood of accidents


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Treatment


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Philippines


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St. Luke’s Medical Center

Lung Center of the Philippines

Philippines


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Journal &'9B:99',*

Main JournalPathophysiology of Health Illness:

Thermoregulation, risk factors, and

indicators of aggravationMiyake, Yasufumi (2013)


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Body Temperature Control

Deep body temperatureOptimal temperature for efficient enzymaticactivity for maintaining life 37.5 OC

Hypothalamus

Regulate body temperature


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P

Mechanisms of heat exchange Q Vaporization

Q Dry Heat Exchange

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Radiation Q Accounts for most of heat absorbed from the

environment

P

Conduction

P

Convection Q Gas or liquid absorbs and moves heat away from the

body

Q gains greater importance in preventing heat-relatedillnesses

Body Temperature Control


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Fever and Hyperthermia

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Fever Q reset body temperature setting

Q occurs during infections

P

release of endogenous pyrogensP

Increased metabolic activity

F d H h i


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Hyperthermia Q body temperature setting unchanged,

Q occurs when physiological

thermoregulation mechanisms cannot keepup with increasing body temperature

P

heat input from the environment and bodymetabolism is increased compared with heat

output from the skin


F d H h i


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Thermoregulation Factors

F t L di t H th i


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Factors Leading to Hyperthermia

F t L di t H th i


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P

Environmental factors Q Aff ect how efficiently extra heat can be

released from body

Q

include:P

Environmental temperature, humidity, radiantheat, wind strength, etc.


F t L di t H th i


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F t L di t H th i


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Risk Factors

Environmental factors

Age

Mental illness

Dehydration

Hypertension

Cardiac Disease

H t Ill


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Heat Illnesses

Encompass a spectrum of disorders fromminor syndromes to heat stroke

Characterized by hyperthermia

General term for a condition resulting fromphysical adjustment disorders in hotenvironments

Specific Heat Illnesses


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P

Heat Rash/PricklyHeat Q Skin irritation caused

by sweat that doesnot evaporate fromthe skin

Q Characterized byerythematous

papular rash,

pustules



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Heat Edema Q Swelling of the

extremities due to

vasodilation andvenous stasis

P heat causes bloodvessels to expand, so

body fluid moves intothe hands or legs bygravity




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P

Heat Syncope Q Fainting secondary to insufficient perfusion

during and after exertion in the heat

Q

Characterized by lowering of blood pressure




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Heat Cramps Q Sporadic, often severe muscle spasms

Q Most common in voluntary muscles of

extremities and abdomen Q Usually without complications

Q Arise after vigorous exertional stress




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Heat Exhaustion Q Heat prostration or collapse

Q Mild to moderate form of heat illness

associated with moderate to high bodytemperature

Q can precede heat stroke




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Heat Exhaustion Q Common symptoms

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Light-headedness

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HeadacheP Increased thirst

P Nausea

P Vomiting

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Muscle crams




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Heat Exhaustion Q Types

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Water Depletion (hypernatremic)

P

Salt Depletion (hyponatremic)




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Heat Stroke Q Medical emergency, life threatening

Q Characterized by temperature greater than

106O F (~41 O C) and presence of CNSdysfunction

Q Sweating stops and body can no longer riditself of excess heat

Q

Multisystem disease




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P

Heat Stroke


Implications: Organ Impairment


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Implications: Organ Impairment

Enzyme denaturation

Decrease in mitochondrial function disturbs

oxidative phosphorylation R impairment

Disseminated intravascular coagulation (DIC)


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Condition in which blood clots formthroughout body’s small blood vessels Q Reduce or block blood flow

Q

Can damage body’s organs Q Can cause internal and external bleeding



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Prevention


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Prevention

!

Drink at least 13 glasses of water every day.

! Avoid drinking teas, coff ee, 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 eitherearly morning or after sunset.

! Wear lightweight, light-colored, loose-fitting clothing,

and a wide-brimmed hat.(from DOH)

Outdoor Workers and Landscaping


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“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 )



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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 ofoutdoor workers (2007) = 577 cases

(Based from OHS Status Report - Philippines)

Innovative Solutions


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Japan's "Green Curtain"Program

These green curtains are the

growth of walls/curtainsof plants over buildings,which block out somesunlight and help to keepbuildings cooler.




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Result:

Reduced use ofairconditioning

system→ ReducedGreenhousegases emission and

reducedconsumption of energy→ Innovative way to combatclimate change




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Global Cooling Project (independent fromheat stroke prevention plan), including:1) Energy conservation plans -

decarbonising2) Ecological Vehicle Promotions3) Use of solar energy systems

4) Climate campaigning and education.

First Aid Treatment


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First Aid Treatment

If you suspect heatstroke:

! Move the person out of the sun and into ashady 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 caff eine, if heor she is able.

(from Mayoclinic)


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Philippines


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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


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DOH

@#0"+C 099'9+0*+ 9#B/#+0/1 &/S 5/'B T010


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DOH


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DOH


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United States


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United States

20 cases per 100,000 people240 deaths annually

Mobile app on heat-related illness

sleep wake heatillness

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