Human Sleep and Its Disorders

1 An Introduction to Sleep Studies.- Techniques of Human Sleep Studies.- The Sleep Stages.- Waking.- NonREM Sleep.- Stage 1.- Stage 2.- Stages 3 and 4.- REM Sleep.- The REM-NonREM Cycle.- Sleep Stages and Age.- Effects of Temporal Variables on Sleep.- Physiological Variables Related to the Sleep Stages.- Sleep Deprivation.- Total Sleep Deprivation.- Selective Sleep Stage Deprivation.- Natural Long, Short, and Variable Sleepers.- Regulation of Sleep.- Passive versus Active Regulation.- The Neurotransmitters.- Pharmacologic and Anatomic Approaches.- Neurotransmitters and the REM-NonREM Cycle.- Neurotransmitters and Arousal.- Circulating Humors and Sleep.- Summary.- 2 A Pharmacologic Approach to Sleep Studies.- Serotonergic System.- L-Tryptophan and Sleep.- Effects of Administration on Sleep.- Metabolic Considerations.- 5-Hydroxytryptophan.- Parachlorophenylalanine.- Methysergide.- Lysergic Acid Diethylamide.- Ventricular Fluid 5-HIAA.- Noradrenergic System.- L-Dihydroxyphenylalanine (L-DOPA).- Effects on REM Sleep.- Effects on NonREM Sleep.- Threo-dihydroxyphenylserine (DOPS).- Alpha-Methyl-Paratyrosine (AMPT) and Alpha-Methyl-Phenylalanine (AMPA).- Alpha-Methyl-DOPA.- Pimozide.- Adrenergic Receptor Blockers.- Other Drugs Influencing Amines.- Monoamine Oxidase Inhibitors.- Tricyclic Antidepressants and Blockers of Amine Re-uptake.- Reserpine.- Debrisoquine.- Amphetamines.- Chlorpromazine.- Effect of Diets Deficient in Catecholamine Precursors.- Metabolites of Norepinephrine and Dopamine in the CSF.- Cholinergic System.- Histaminergic System.- Discussion.- Serotonin.- Serotonin or a Metabolite?.- Relation to REM Sleep.- Relation to NonREM Sleep.- Noradrenergic System.- Norepinephrine or a Precursor?.- Effects on REM Sleep.- Cholinergic System.- Histaminergic System.- Interaction between Transmitters.- Summary.- 3 Neuroendocrinology and Sleep.- Basic Concepts in Neuroendocrinology.- Growth Hormone.- Sleep-Related GH Secretion in Disease States.- Effects of Injections of GH on Sleep.- The Pituitary-Adrenal Axis.- Relation to Sleep-Waking Cycle.- Sleep-Related Cortisol Secretion in Disease States.- Effects of ACTH and Cortisol on the Sleep Stages.- Prolactin.- Relation of PRL Secretion to Other Hormones.- Effects of Drugs on Sleep-Related Prolactin Secretion.- Follicle-Stimulating Hormone and Luteinizing Hormone.- Relation of LH and FSH Secretion to Sleep.- Relation of Testosterone Secretion to Sleep.- Effects of Sex Hormones on Sleep.- Sleep-Related Secretion in Disease States.- Thyroid-Stimulating Hormone.- TSH Secretion and Sleep.- Sleep in Hyper- and Hypothyroidism.- CNS Actions of TRH.- Antidiuretic Hormone.- ADH Secretion during Sleep.- Effects of ADH on Sleep.- Melatonin.- Effects of Melatonin on Sleep.- Summary.- 4 Narcolepsy and Diseases of Excessive Sleep.- Definition.- Sleep Attacks.- Cataplexy.- Sleep Paralysis.- Hypnogogic and Hypnopompic Hallucinations.- Natural History.- Epidemiology and Genetics.- Etiology.- Narcolepsy-Cataplexy.- Secondary Narcolepsy.- Other Disorders of Excessive Daytime Sleep.- Independent Narcolepsy or NonREM Narcolepsy.- Obstructive Sleep Apnea Syndrome.- Narcolepsy with Sleep Apnea.- Hypersomnia with Automatic Behavior.- Hypersomnia with Sleep Drunkenness.- Excessive Daytime Sleepiness Associated with Known Organic Disease.- Excessive Daytime Sleepiness in Depression.- Diagnosis.- Pharmacotherapy of Narcolepsy.- Stimulants.- Tricyclic Antidepressants.- Monoamine Oxidase Inhibitors.- Methysergide.- Other Pharmacotherapies.- Summary.- 5 Clinical Studies of Insomnia.- Normal Sleep.- Incidence of Insomnia.- Kinds of Insomnia.- Tentative List of Causes of Insomnia.- Psychogenic.- Situational.- Alterations of Normal Activity—Rest Cycle.- Dream Related.- Sleep Apnea.- Restless Legs Syndrome.- Nocturnal Myoclonus.- Oversleeping.- Drug Related.- Neurological.- Secondary to or Accompanying a Medical Illness.- Sleep Induction.- Alcohol.- Benzodiazepines.- Mebutamate.- Barbiturates.- Chloral Hydrate.- Glutethimide.- Methaqualone.- Diphenhydramine.- L-Tryptophan.- Electrosleep.- An Approach to Patients Who Complain of Insomnia.- 6 Alcohol, Alcoholism, and the Problem of Dependence.- Animal Studies.- Ethanol and the Sleep EEG of Animals.- Ethanol and Behavioral Measures of Sleep.- Ethanol and Possible Neurotransmitters.- Animal Studies of Spontaneous Ethanol Selection.- Ethanol in Normal Human Subjects.- Effects of Ethanol on Chronic Alcoholics.- Sleep in “Dry” Alcoholics.- Response to Ethanol.- Sleep during Acute Withdrawal.- Issues Raised by Observations of the REM Sleep Rebound.- Experimental Therapies.- Summary.- 7 Affective Disorders and Schizophrenia.- Basic Definitions.- Affective Disorders.- Schizophrenia.- Studies of Sleep in Depressed Patients.- Comparative Studies.- Longitudinal Studies of Depressed Patients.- Sleep of Depressed Patients in Remission.- Chemical Correlates of Sleep in Depression.- Further Sleep Studies in Bipolar Illness.- Sleep during the Switch Process in Manic-Depressive Illness.- Experimental Deprivation of Sleep in Depression.- Effects of REM Sleep Deprivation on Depression.- Effects of Antidepressant Medication and Lithium Salts on Human Sleep.- Concluding Comments on Affective Disorders.- Sleep Studies in Schizophrenia.- Cross-Sectional Studies of Schizophrenia.- Longitudinal Studies of Sleep in Schizophrenia.- Experimental REM Deprivation in Schizophrenia.- Experimental Sleep Deprivation in Schizophrenia.- Effects of Neuroleptics on Sleep.- Concluding Remarks about Sleep in Schizophrenia.- Summary.