Post on 14-Sep-2019
Help them sleepUsing Osteopathy and Ayurveda to shift
paradigms and help patients sleep
Heather Ferrill DO MS
AAO Convocation 2016
Goals
The brief synopsis of the physiology of sleep
The physiology of sleep debt
Sleep disorders a shift in paradigms Using Ayurvedic doshas to gain a different persective
Treating sleep disorders An Ayurvedic approach to sleep hygiene
An Osteopathic approach to treatment
Marma for sleep
Yoga as a tool to help sleep
Purpose of sleep
Three major theories Repair and restoration
Time for the brain to metabolically and chemically repair
Evolutionary (adaptive) theory
Sleep evolved as a means of conserving energy
Information consolidation
Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory
Consolidation during sleep promotes both quantitative and qualitative changes in memory representations
Stages of sleepStage 1 light sleep
Easy to wake jumpiness
Stage 2 eye movement stops and brain waves slow marked
by sleep spindles
Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory
(newly encoded memories with pre-existing long-term)
Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)
Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-
declarative (short term to long term) memory (emotional and procedural)
Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)
Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)
The glymphaticsystem
A macroscopic waste clearance system for the brain
Architecture An intricate network of perivascular tunnels
formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system
CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system
Dramatic changes in brain architecture and fluid flow during sleep
60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states
Lateral recumbent position most efficient (compared to supine or prone)
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Goals
The brief synopsis of the physiology of sleep
The physiology of sleep debt
Sleep disorders a shift in paradigms Using Ayurvedic doshas to gain a different persective
Treating sleep disorders An Ayurvedic approach to sleep hygiene
An Osteopathic approach to treatment
Marma for sleep
Yoga as a tool to help sleep
Purpose of sleep
Three major theories Repair and restoration
Time for the brain to metabolically and chemically repair
Evolutionary (adaptive) theory
Sleep evolved as a means of conserving energy
Information consolidation
Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory
Consolidation during sleep promotes both quantitative and qualitative changes in memory representations
Stages of sleepStage 1 light sleep
Easy to wake jumpiness
Stage 2 eye movement stops and brain waves slow marked
by sleep spindles
Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory
(newly encoded memories with pre-existing long-term)
Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)
Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-
declarative (short term to long term) memory (emotional and procedural)
Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)
Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)
The glymphaticsystem
A macroscopic waste clearance system for the brain
Architecture An intricate network of perivascular tunnels
formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system
CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system
Dramatic changes in brain architecture and fluid flow during sleep
60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states
Lateral recumbent position most efficient (compared to supine or prone)
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Purpose of sleep
Three major theories Repair and restoration
Time for the brain to metabolically and chemically repair
Evolutionary (adaptive) theory
Sleep evolved as a means of conserving energy
Information consolidation
Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory
Consolidation during sleep promotes both quantitative and qualitative changes in memory representations
Stages of sleepStage 1 light sleep
Easy to wake jumpiness
Stage 2 eye movement stops and brain waves slow marked
by sleep spindles
Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory
(newly encoded memories with pre-existing long-term)
Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)
Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-
declarative (short term to long term) memory (emotional and procedural)
Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)
Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)
The glymphaticsystem
A macroscopic waste clearance system for the brain
Architecture An intricate network of perivascular tunnels
formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system
CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system
Dramatic changes in brain architecture and fluid flow during sleep
60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states
Lateral recumbent position most efficient (compared to supine or prone)
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Stages of sleepStage 1 light sleep
Easy to wake jumpiness
Stage 2 eye movement stops and brain waves slow marked
by sleep spindles
Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory
(newly encoded memories with pre-existing long-term)
Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)
Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-
declarative (short term to long term) memory (emotional and procedural)
Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)
Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)
The glymphaticsystem
A macroscopic waste clearance system for the brain
Architecture An intricate network of perivascular tunnels
formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system
CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system
Dramatic changes in brain architecture and fluid flow during sleep
60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states
Lateral recumbent position most efficient (compared to supine or prone)
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The glymphaticsystem
A macroscopic waste clearance system for the brain
Architecture An intricate network of perivascular tunnels
formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system
CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system
Dramatic changes in brain architecture and fluid flow during sleep
60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states
Lateral recumbent position most efficient (compared to supine or prone)
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep and the endocrine system
Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness
Almost every hormone is influenced by circadian rhythm
24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The good news Naps are goodhellip
Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas
2007)
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Autonomic regulation of sleepNeuroanatomy
Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep
Sleepiness Thalamus Wakefulness Pons basal forebrain
hypothalamus
Autonomics Hypothalamus heart rate blood pressure
energy metabolism GI motility Medulla baroreceptors chemoreceptors
cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves
httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep and the autonomic systemnormal NREM
In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output
Decreased SNS decreased PVR and BP
HR reaches nadir during stage 3 nREM sleep
Autonomic respiratory control
Breathing slows and gets more regular
During stage transitions there are bursts of vagal tone
Physiologic sinus arrhythmia and sinus pauses
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep and the autonomic system normal REM
Cholinergic discharges lead to muscle atonia and dream enactment
Increased eye movements are accompanied by increased SNS and decreased PNS activity
BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The autonomics and sleep deprivationShort term
Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal
Hypothalamic-pituitary-adrenal axis
Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The autonomics and sleep deprivationLong term
INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS
Gradually alters the neuroendocrine response system AND
Central mechanisms involved in regulating NEI responses (central sensitization)
Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep restriction and deprivation by any means is as important a risk factor for a
variety of diseases that are linked to stress including mood disorders and cardiovascular
disease
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
sleep debt and brain changes
Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure
The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The best bridge between despair and hope is a good nights sleep
~E Joseph Cossman
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep deprivation and emotional disorders Multiple studies link sleep deprivation
with affective disorders such as depression and anxiety 73 of adolescents with depressive
disorders also suffer sleep disorders (Lui et al 2007)
Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)
Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)
Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)
wwwbrooklynartprojectcom
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance
Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala
disconnect Current Biology Vol 17 No 20 R878
Amygdala activity +
Pre-frontal control=
Decreased emotional stability
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Get off the devices Smartphone ownership in adolescents
Less than 3 of adolescents without smartphone
Later bedtimes Increased nighttime usage (TV
movies texting internet surfing etc)
There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)
Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)
Predictive role of nighttime media use with the development of depression (Primacket al 2009)
MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Keep it out of the bedroom
Blue light from electronic media inhibits melatonin release delaying sleep onset
National sleep foundation recommends getting it OUT of the bedroom
If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes
And NO exposure in the last hour before bedtime
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
In college students both daytime and nighttime media usage has been found to
Impact sleep quality as well as quantity
Increase ldquonomophobiardquo
Increase anxiety
Negatively impact executive functioning (attention concentration train of thought)
Negatively impact impulse control (Rosen et al 2016)
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Bidirectional relationship of sleep disorders and pain sensitivity
Schuh-Hofer s et al 2013
Total sleep deprivation for one night
Increased sleepiness
Increased anxiety
Increased sensitivity to heat cold pinprick generalized hyperalgesia
Okifuji amp Hare 2011
Sleep disturbance greater in children with sever headache v mild
Self-reported poor sleep not objective correlative with increased next day pain
Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia
Sleep disturbance may decrease the effectiveness of analgesic medications
MOST IMPORTANT improved sleep is correlated with improved pain scores
fin
din
gm
yin
ner
cou
rag
ew
ord
pre
ssc
om
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep amp Pain mechanisms Multifactorial amp controversial
Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system
Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)
REM deprived rats showed a significantly higher rate of pain behavior
Cognitive behavioral Sleep deprivation leads to negative
cognition and mood
Negative cognition and mood leads to increased pain perception
(Lautenbacher et al 2006)
Va
len
tin
a K
alli
asldquoD
amaged
rdquo
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep deprivation and memory
12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task
based on old patterns Reduction in hippocampal
neuronal function
Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels
Hagewood et al 2010
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep
in the hours and days after learning the task Duration Amount
REM Sleep deprivation during this REM sleep windows impairs the short term retention
Slow wave sleep deprivation leads to impairment of short-term to long-term memory
httpmashablecom20140107memory-appsWmasj6cs0uqQ
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Sleep Immune system
Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)
OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)
Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)
Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)
Sleep A poor substitute for caffeine
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
The upshot allostatic load Sleep deprivation over time elevates the allostatic load
Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels
Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex
Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease
McEwen 2006
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
sleep disorders
Three big categories Those who cant get to sleep
Those who wake during sleep
Those who oversleep or sleep too much
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Ayurvedic paradigm The Doshas
Vata The force of movement inspiration and excitement
Lightness dryness
When disordered anxiety flighty unable to focus
Pitta The force of transmutation and transformation
Sharp direct focused
When disordered anger physical heatmdashreflux ulcers
Kapha The force of groundedness and cohesiveness
Heavy slow sense of safety
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
seeing the sleep disorders from a different perspective Pitta sleep disorders
Cant fall asleep 10pm-2am second wind
Vivid fiery dreams will wake them but they can get back to sleep
Vata sleep disorders Usually wakes during the night and cant fall back to sleep
2-6 am wakers
Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Lifestyle changes
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
For everyone Adequate fluid intake throughout the day
(preferably water)
Adequate rest
Meditation approaching the day with a restful state of mind
7 hours sleep minimum associated with decreased morbidity and mortality (Brant et
al 2004)
Stress management strategies
Journaling meditation nature
Decreased stimulants
Appropriate before bed activity
Eliminate screen time
Decrease reading in the hour before bed
Earlier lighter dinners Make bedtime a ritual
Oil massage bath meditation quiet activity connection time
Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Vata has the quality of lightness and mobility the opposite of those qualities that support sleep
Need grounding depth heaviness
Exercise Timing and type matter
Daytime exercise avoid overstimulation especially in the evenings
walking hiking gentle cycling yoga or chi gong
Lifestyle Thrive with routine though they resist it and they love
change
3 meals per day at regular times warm oily and spiced
Increased oils and grounding foods (roots grains etc)
Lots of fermented foods
Oil massage regularly especially at night
Images heymonicabcom
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Pitta is hot fiery and intense
Exercise Make sure that exercise is not
overly intense but do it with relaxed effort instead
Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time
Lifestyle Steady intake of dark leafy greens sweet
fruits non-oily foods
Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense
Images heymonicabcom
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Kapha is dense cohesive and slow moving
Routine is important Wake before 6 am
Kapha is highest from 6-10am increasing the likelihood of waking tired
To bed soon after 10
More vigorous exercise Best in the evenings and first thing in
the morning
brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise
Images heymonicabcom
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required
~AT Still Osteopathy Research and Practice
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy
My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders
bull Vedic anatomy
Throat area is the place of physical mentalemotional and spiritual purification
Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)
bull Sacrum
Grounding
Autonomic balancing
bull Cranial base and OA
Lymphatic flow
Mid-brain motion
Autonomics
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Balancing the autonomics
The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep
Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR
Rib raising
Soft tissue
Paraspinal inhibition
Collateral ganglion
Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
OCMM amp sleep
In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment
Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Marma points for sleep disorders
Focus on balancing
bull the Doshas
bull The autonomic system
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Yoga to support sleep
Postures (asanas) can stimulate or ameliorate the doshas
bull To support sleep
bull Downward grounding energy
bull Balance the predominant and disturbing dosha
Vajrasana
Bhujangasana (cobra)
Shirshasana (headstand)
Halasana (plow)
Pascimottanasana
VATA postures
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Pitta balancing postures
Janu shirshasana
Dhanurasana (bow)
Ardha navasana (half boat)
Setu banda sarvangasana
Ustrasana
Sarvangasana
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Kapha balancing postures
Ardha matsyendrasana
Vrksasana
Tadasana
Parupurna navasana
gomukhasana
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
htt
p
ww
ws
aa
tch
iart
co
ma
rtP
ain
tin
g-S
pir
it-L
ife
18
33
61
106
27
6v
iew
A good laugh and a long sleep are the best cures in the doctors book
~ Irish proverb
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |
doi101038nrn2762
Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6
Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015
Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015
Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224
Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001
Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210
Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426
Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878
Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11
Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010
Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)
Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future
research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006
Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796
Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56
Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x
Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117
Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008
Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002
Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90
Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190
Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742
Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188
Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56
Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621
McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071
Resources
Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534
Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69
Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467
Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)
Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)
Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)
Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071