overlapping brain states daniel erichsen, md 08/04/2011
TRANSCRIPT
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Overlapping Overlapping Brain StatesBrain States
Daniel Erichsen, MD 08/04/2011Daniel Erichsen, MD 08/04/2011
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State(s) of the brainState(s) of the brain AwakeAwake Non REM SleepNon REM Sleep REM sleepREM sleep
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How do you know?How do you know? AwakeAwake
ResponsiveResponsive TalkTalk Hear/Feel/See/SmellHear/Feel/See/Smell
Purposeful movementsPurposeful movements WalkingWalking
Complex movementsComplex movements EatingEating
Eyes openEyes open
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How do you know?How do you know? Asleep (Non REM sleep)Asleep (Non REM sleep)
Unresponsive/Increased sensory threshold.Unresponsive/Increased sensory threshold. Relatively immobileRelatively immobile Absence of purposeful/complex movementsAbsence of purposeful/complex movements Regular respirationRegular respiration PosturePosture Eyes closedEyes closed
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Is it possible to fake sleeping?Is it possible to fake sleeping? YesYes
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How can we objectively tell if someone is sleeping?How can we objectively tell if someone is sleeping? EEGEEG
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WakeWake 13 – 30 oscillations per second (Hz)13 – 30 oscillations per second (Hz) Low amplitude/voltageLow amplitude/voltage = Beta activity= Beta activity
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Wake, eyes closed/openWake, eyes closed/open 8 – 13 oscillations per second (Hz)8 – 13 oscillations per second (Hz) Higher amplitude/voltageHigher amplitude/voltage = Alpha activity= Alpha activity
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Stage 2 sleepStage 2 sleep 4 – 8 oscillations per second (Hz)4 – 8 oscillations per second (Hz) Sleep spindles, K-complexesSleep spindles, K-complexes Medium amplitude/voltageMedium amplitude/voltage = Theta activity= Theta activity
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Stage 3 sleep (Slow wave sleep/Delta sleep)Stage 3 sleep (Slow wave sleep/Delta sleep) <4 oscillations per second (Hz)<4 oscillations per second (Hz) High amplitude (>75 mV)High amplitude (>75 mV) = Delta activity= Delta activity
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State(s) of the brainState(s) of the brain AwakeAwake Non REM SleepNon REM Sleep REM sleepREM sleep
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REM sleepREM sleep Rapid eye movementsRapid eye movements Paralysis / Loss of muscle toneParalysis / Loss of muscle tone Engorgement of erectile tissueEngorgement of erectile tissue DreamsDreams
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REM sleepREM sleep Why paralysis in REM sleep?Why paralysis in REM sleep?
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Nocturnal penile tumescence testingNocturnal penile tumescence testing
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REM sleepREM sleep Beta activity (13-30 Hz)Beta activity (13-30 Hz)
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HypnogramHypnogram
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HypnogramHypnogram
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HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
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HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
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HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Pt in 2B lost his IV…Yes the chubby 3 month old..”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Pt in 2B lost his IV…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
AAAAAAAAAAHHHHHH!!!!!!AAAAAAAAAAHHHHHH!!!!!!
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HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
“Time to sign out!”
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HypnogramHypnogram
Ah, finally Morning Report. Zzzzz
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Can a person be asleep and awake at the same time?Can a person be asleep and awake at the same time?