1. Santa Fe, New MexicoJuly 29- August 2, 2013

2. Sleep: An analysis ofthis entity and its influence on the development ofmankind in areas ofreligion, medicine, scien ce, arts, and literature 3. Sleep and Yesterday?Dream and Yesterday?(Show of hands) 4. Yesterday - Sir Paul McCartneyhttp://www.youtube.com/watch?v=Ms65JQTBCcQ 5. Dr. Indal M. SeudealAreas of practiceInternal medicinePulmonary medicineCritical care medicineEmergency room medicineSleep medicineABIM Board certified sleep specialist 6. OutlineHistorical perspective of ParasomniassleepREM behavior disorder Night terrors/nightmaresSleep and religious views Catathenia Christianity Sleepwalking Buddhism Sleep swimming Islam Sudden unexplained Hinduismnocturnal death syndrome Judaism Sleep sex Sleep crimesCurrent concepts Narcolepsy Architecture of sleep States of sleepBrilliant dreams 7. Historical Perspectivesof Sleep 8. 800-600 B.C., HomersOdyssey Epic Greek poem In his first sleep, call up your hardiest cheer. Segmented sleep 2 shifts awake/2 shifts sleep per 24 hourshttp://healthysleep.med.harvard.edu/healthy/matters/history 9. 350 B.C., AristotleSleep isa seizure of theprimary sense organSeat of consciousness:heartSleep onset warm gastricvapors (digestion)http://healthysleep.med.harvard.edu/healthy/matters/history 10. ~1490, Leonardo daVinci Polyphasic sleep: daVinci sleep (15 mins./2 hours) Anatomical paintings explain complexity of human nervous systemhttp://healthysleep.med.harvard.edu/healthy/matters/history 11. 1598, WilliamShakespeareHenry IV (1598): obstructive sleepapnea, Cheyne-Stokes respirationHamlet: To be, or not to be, that is thequestion:Whether tis nobler in themind to sufferThe slings and arrows ofoutrageous fortune,Or to take armsagainst a sea of troublesAnd byopposing end them. To dietosleep,No more; and by a sleep to saywe endThe heart-ache and thethousand natural shocksThat flesh isheir to: tis a consummationDevoutlyto be wishd. To die, to sleep;Tosleep, perchance to dreamay, theresthe rub:For in that sleep of death whatdreams may come,When we haveshuffled off this mortal coil,Must giveus pausetheres the respectThatmakes calamity of so long life.http://healthysleep.med.harvard.edu/healthy/matters/history 12. 1737-1798, Luigi Galvani Italian physician Discovers natural electrical activity in nervous system and muscles This discovery led to measurement of brain activity during sleephttp://healthysleep.med.harvard.edu/healthy/matters/history 13. 1769-1821, NapoleonBonaparte Sleep prescription Sleep habits: possible obstructive sleep apneahttp://healthysleep.med.harvard.edu/healthy/matters/history 14. 1903, First sleeping pill Barbital (Veronal) German chemists Emil Fischer and Joseph von Meringhttp://healthysleep.med.harvard.edu/healthy/matters/history 15. 1916, The hypothalamusand sleepConstantin von Economostudied patients with viralencephalitisDiscovered sleep and wakeregions of the brain(hypothalamus)http://healthysleep.med.harvard.edu/healthy/matters/history 16. 1935, Biological clock German biologist Erwin Bunning describes the biological clock Worked with common green bean plants Conclusion: circadian rhythms are inheritedhttp://healthysleep.med.harvard.edu/healthy/matters/history 17. 1953, Discovery of REM sleephttp://healthysleep.med.harvard.edu/healthy/matters/history 18. http://healthysleep.med.harvard.edu/healthy/matters/history 19. 1997, Mammalian clockgenes Joseph Takahashi (Northwestern University) Identify and clone mammalian circadian gene (Clock gene)http://healthysleep.med.harvard.edu/healthy/matters/history 20. 2003, Sleep and memory Sleep: important role in learning and memory consolidationhttp://healthysleep.med.harvard.edu/healthy/matters/history 21. Yesterday - Sir Paul McCartneyhttp://www.youtube.com/watch?v=Ms65JQTBCcQ 22. Sleep and Religious ViewsChristianityBuddhism Islam HinduismJudaism 23. ChristianityThe term sleep is used symbolically in different senses inthe BibleTo stress certain truths about God He will not allow your foot to slip; he who keeps you willnot slumber. Behold, he who keeps Israel will neitherslumber nor sleep (Psalms 121:3-4)Sometimes sleep is used as the equivalent of being lazy Do not give sleep to your eyes, nor slumber to youreyelids How long will you like down, O sluggard? Whenwill you arise from your sleep? A little sleep, a little slumber,a little folding of the hands to rest. And your poverty willcome in like a vagabond, and your need like an armedman. (Proverbs 6:4-11)Christian Courier Publications. ISSN 1559:2235 24. ChristianityTo portray the utter and final punishment of a wicked power Prophet Jeremiah foretold the complete destruction of the evil Babylonian regime: Babylon shall become heaps, a dwelling-place for jackals, an astonishment, and a hissing, without inhabitant When they are heated, I will make their feast, and I will make them drunken, that they may rejoice, and sleep a perpetual sleep, and not wake, saith Jehovah (Jeremiah 51: 37-39)Sometimes spiritual lethargy is represented as sleep Paul wrote: And this, knowing the season, that already it is time for you to awake out of sleep: for now is salvation nearer to us than when we first believed (Romans 13:11) Awake, you who are sleeping, and arise from the dead, and Christ shall shine on you (Ephesians 5:14)Christian Courier Publications. ISSN 1559:2235 25. Christianity Sleep can suggest the notion of being unprepared to meet the Lord Jesus warned: Watch therefore: for you do not know when the lord of the house is cominglest he come suddenly and find you sleeping (Mark 13:35-56) Commonly used as a designation for death in both Old and New Testement David petitioned the Creator: Consider and answer me, O Jehovah my God: Lighten my eyes, lest I sleep the sleep of death (Psalms 13:3)Christian Courier Publications. ISSN 1559:2235 26. Christianity Sometimes sleep implies the future resurrection of the human body But now Christ is risen from the dead, and has become the firstfruits of those who have fallen asleep. (1 Corinthians 15:30)Christian Courier Publications. ISSN 1559:2235 27. BuddhismBuddha Gautama Insight into cause of suffering and steps necessary to eliminate it Sat under the bodhi tree, where he vowed never to arise until he found the truth 49 days of meditation at age 35 Attained enlightenment Bodhi tree 28. BuddhismDalai Lama: Sleep is the best meditation (People Magazine, 1979)AH: So you go to bed at 8:30 at night and you wake up at 3:30. You clearly put a lot ofemphasis on sleep, which we love, because at The Huffington Post we have dedicatedsections on sleep. So whats the secret of sound sleep, and why is it so important?HHDL: For me, very important. The other day, in Delhi, of course my car alwaysprovided by government. This one driver, one new driver come, then I ask him, Howmany hours you sleep? He says, Four hours. Then I told him, Four hours notadequate. So you must sleep six hours. Then next day, I met, How many hours?Then he told me, Six hours. So I believe, you see, sleep, complete restful, and also Ithink important is daytime your mind calm, relaxed. Then dream, during night, itssleep, also then, happy dream. Too much anxiety in daytime, then even in dream, somekind of nightmare, or these things happen. So, and anyway, for me, sleep, sound sleepusually eight hours, sometimes, last night, nine hours. Very sound sleep. And thenalso, when I handed over all my political responsibility to a person, politicalleadership, formally, that night, very unusual sound sleep. 29. Buddhism 30. IslamIslamEmerged as a religion in the 7th century2 sources of Islamic jurisprudence (the Quran andHadith)Allah revealed the Quran to the prophet Muhammadthrough the angel Gabriel from 610-632 C.E. (verse17.106) 31. IslamTypes of sleep:1. Sinah: slumber or dozing off for a very short period No slumber (Sinah) can seize Him nor sleep (verse 2.255) May correspond to stage 1 sleep2. Nuass: short nap Remember when He covered you with a slumber (Nuass) as a security from him (verse 8.11) May correspond to stage 1/stage 2 sleep3. Ruqood: sleep for long period And you would have thought them awake, whereas they were asleep (Ruqood) (verse 18.18) 32. IslamTypes of sleep:4. Hojoo: sleep at night They used to sleep but little by night (Hojoo). And in thehours before dawn, they were (found) asking (Allah) forforgiveness (verse 51. 17-18)5. Subaat: disconnection from the surrounding environment during sleep And we made your sleep (Subaat) as the thing for rest(verse 78.9) 33. IslamProphet MuhammadEncouraged not to be involved in any activity after Ishaprayer (darkness prayer) One should not sleep before night prayer, nor have discussions after it (SB 574)Encouraged to wake up for Fajr prayer (which is about 1hour before sunrise)Sleep on the right side and avoid lying on the stomach Whenever you go to bed, perform ablution like that for the prayer, and lie on your right side (SM 2710) The Prophet told a man who was lying on his stomach, Allah and his Prophet dislike this position 34. IslamThe Quran indicates some resemblance between sleep anddeathThe Quran uses Wafat to describe death It is Allah Who takes away the souls (Wafat) at the time of their death, and those that die not during their sleep. He keeps those (souls) for which He has ordained death and sends the rest for a term appointed. Verily, in this are signs for people who think deeply (verse 39.42) It is He Who takes your souls (Wafat) by night (when you are sleep), and has knowledge of all that you have done by day, then He raises (wakes) you up again that a term appointed (your life period) be fulfilled, then (in the end) to Him will be your return. Then He will inform you of that which you used to do (verse 6.60) 35. HinduismHindu architecture: Vaastu ShastraThe world is a manifestation of the body of God:more precisely, the world IS the body of GodA temple compared to the large universe is aconstructed miniature version (microcosm) of thegreater universe (macrocosm) 36. HinduismAlignment of energiesThe head of the bed is directed towards south, east, or west, butnever northA persons body is a tiny magnet (with north and south poles)Ones head is the north poleThe universe is also a magnet with north and south poles (polaristhe north star is the north pole of the universe)2 like poles will repel each otherConclusion: sleep will be better when the head is placed away fromthe north 37. JudaismJudaism views the gift of sleep as a Godly blessingMaimonides, the great doctor, lists in his halachicwork, Mishna Torah, his recommendation for 8 hoursof sleep per nightShabat was given the blessing of being the day ofrest and leisureSleeping on Shabat afternoon has become a time-honored Jewish custom 38. Judaism: Analysis of sleep in the context ofJudaism by Rabbi Nissan D. Dubov (Director of Chabad Lubavitch in Wimbledon, UK) Sleep is good for digestion Soul searching prior to sleep / let go of baggage before sleep onset / recite prayer Your body belongs to God and is given to you as a deposit Pray at time of awakening While sleeping, soul is elevated to an upper level of consciousness and draws life from the higher world 39. Judaism: Analysis of sleep in the context ofJudaism by Rabbi Nissan D. Dubov (Director of Chabad Lubavitch in Wimbledon, UK) 0:09:30-0:11:20 Soul searching prior to sleep / let go of baggage before sleep onset / recite prayer 40. Judaism: Analysis of sleep in the context ofJudaism by Rabbi Nissan D. Dubov (Director of Chabad Lubavitch in Wimbledon, UK) 28:30-29:45 Pray at time of awakening* 41. Judaism: Analysis of sleep in the context ofJudaism by Rabbi Nissan D. Dubov (Director of Chabad Lubavitch in Wimbledon, UK) 51:10-51:36 While sleeping, soul is elevated to an upper level of consciousness and draws life from the higher world 42. Yesterday - Sir Paul McCartneyhttp://www.youtube.com/watch?v=Ms65JQTBCcQ 43. Current Concepts of Sleep 44. Current Concepts ofSleep: Sleep stages4-5 cycles/nightStage1 Every 90-110 minutesStage 3: slow waveStage sleep (SWS)REM2 REM: rapid eyemovement sleep(predominant in lastStage 1/3 of sleep time)3 45. Current Concepts ofSleep: Sleep Architecture 25%5% Stage 1 5% sleep 45% Stage 2 45% sleep Stage 3 20% sleep REM20% 46. Current Concepts ofSleepStage 1 Light sleep Slowing of heart rate and respiration Brain waves: slowing of brain activity Decreased muscle tonus 47. Current Concepts ofSleepStage 2 Slower brain activity Further decrease in heart rate and respiration Further decrease in muscle tonus 48. Current Concepts ofSleepStage 3 Slow wave sleep Change in brain waves to large slow delta waves Continued decrease in heart rate and respiration Continued decrease in muscle tonus 49. Current Concepts ofSleepStage REMRapid eye movement sleepBrain waves are similar to that of awakeLarge fluctuations in heart rate and respirationAlmost complete paralysis 50. Current Concepts ofSleepTake home pearls1. 3 STATES OF EXISTENCE a) Wake b) Non REM sleep (stages 1, 2, and 3) c) REM sleep2. REM SLEEP IS SIMILARPHYSIOLOGICALLY TO THE WAKE STATE 51. Parasomnias 52. ParasomniasA category of sleep disorders that involve abnormaland unnaturalmovements, behaviors, emotions, perception, anddreams that occur while fallingasleep, sleeping, between sleep stages, or duringarousal from sleep 53. Parasomnia: REMBehavior DisorderThe normal loss of muscle tone during sleep is absentin REM behavior disorderThe patient is able to act out his/her dreams withmovements, vocalizations, etc.Can be very disturbing to the patient and familymembersCan lead to serious physical injury to self and others 54. Parasomnia: REMBehavior Disorderhttp://www.youtube.com/watch?v=z2BgjH_CtIA 55. Parasomnia: REMBehavior Disorderhttp://www.youtube.com/watch?v=IEgvw1Z-0co 56. Parasomnia: REM Behavior Disorderhttp://www.youtube.com/watch?v=rFXYRQ9xPUA 57. Parasomnia: REM Behavior Disorderhttp://www.youtube.com/watch?v=rFXYRQ9xPUA 58. Parasomnia: Night terrors/nightmares Arise from stage 3 sleep and REM sleephttp://www.youtube.com/watch?v=UQXJWzLjzLk 59. Parasomnia:CatathreniaLoud annoying sleep groanhttp://www.youtube.com/watch?v=9aT8vll4fBE 60. Parasomnia:Sleepwalkinghttp://www.youtube.com/watch?v=mlQRiGSy1o4 61. Parasomnia: Sleepswimming 62. Parasomnia: Sleepswimminghttp://bodyodd.nbcnews.com/_news/2012/08/28/13511255-swimming-in-her-sleep-how-the-idaho-woman-did-it?lite 63. Parasomnia: Sudden unexplained nocturnal death syndrome Affects primarily young Hmong men from Laos (median age 33) and northeastern Thailand (where the population are mainly of Laotian descent) Brugada syndrome Mutation of SCN5A on chromosome 3p21 Characterized by ventricular fibrillation and death during sleep 64. Parasomnia: Sudden unexplainednocturnal death syndromehttp://www.youtube.com/watch?v=eNAG4PGKj0c 65. Parasomnia: Sleep sex(sexsomnia)An NREM parasomniaEngage in sexual activity while sleeping (have no memory of actions onceawake)Cause: unknown (may be a genetic component)Males account for 2/3 of casesEffects:AngerConfusionDenialFearTreatment: combination of medication, therapy, and lifestyle changes 66. Sleep Crime Crimes committed in sleep including homicidal somnambulism Steven Steinberg case:1981, Scottsdale, AZ: murdered wife by stabbing her 26 timesClaimed crime committed during sleepwalkingHe walked away a free man Kenneth Parks case:1987, Toronto, Canada:Drove 23 km to mother-in-laws home and stabbed her to deathDrove to police station to report crimeVerdict: not guiltyCan sleepwalking be a murderdefense?, LawrenceMartin, M.D., FACP, FCCP 67. Sleep Crime Scott Falater case:1997, Phoenix, AZ: murdered wife by stabbing her 44 timesand holding her head under water in the swimming poolClaimed he was sleepwalking at the time of the murderVerdict: guilty of First Degree Murder; life imprisonmentwithout parole Burgess case:1996, Queensland, Australia: hit woman on the head with abottle and tried to strangle herClaimed sleepwalkingVerdict: not guiltyCan sleepwalking be a murder defense?,Lawrence Martin, M.D., FACP, FCCP 68. Parasomnia: Narcolepsy Intrusion of sleep state into wake state Tetrad:Excessive daytime sleepinessSleep paralysisHallucinationsAt sleep onset (hypnogogic)At sleep offset (hypnopompic)Cataplexy 69. Parasomnia: Narcolepsyhttp://www.youtube.com/watch?v=59evkMq_QcM 70. Parasomnia: Narcolepsyhttp://www.youtube.com/watch?v=HOkckq9pfoE 71. Yesterday - Sir Paul McCartneyhttp://www.youtube.com/watch?v=Ms65JQTBCcQ 72. Brilliant Dreams 73. Mary Shelleys Frankenstein Inspired By a Dream 1816, Lake Geneva, Switzerland at Lord Byrons villa Stormy weather, retired indoors, went to bed. On the morrow I announced that I had thought of a story. I began that day with the words, It was on a dreary night of November 74. Dream leads to Nobel PrizeOtto Loewi (1873-1961), German physiologistNobel prize (medicine, 1936): work on chemicaltransmission of nerve impulseCame up with the idea of chemical transmission, 190317 years later, dreamt again of chemical transmissionI got up immediately, went to the laboratory, andperformed a single experiment on a frogs heartaccording to the nocturnal design. 75. Abraham Lincoln dreamtof his own assassination President Abraham Lincoln recounted the following dream just a few days prior to his assassination: About ten days ago, I retired very late. I soon began to dream. There seemed to be a death-like stillness about me. Then I heard subdued sobs. I thought I left my bed and wondered downstairs. I went from room to room: no living person was in sight, I arrived at the East Room 76. Abraham Lincoln dreamtof his own assassination Before me was a catafalque, on which rested a corpse wrapped in funeral vestments Who is dead in the White House? I demanded of one of the soldiers The President was his answer; he was killed by an assassin! Then came a loud burst of grief from the crowd, which awoke me from my dream 77. Kekul dreams of moleculesand benzene structure Friedrich August Kekul von Stradonitz Discovered tetravalent nature of carbon and the Structural Theory I fell into a reverie, and lo, the atoms were gamboling before my eyes! I had never been able to discern the nature of their motion. I saw how, frequently, two smaller atoms united to form a pair; how a larger one embraced the two smaller ones The cry of the conductor: Clapham Road, awakened me from my dreaming 78. Kekul dreams of moleculesand benzene structure Another dream helped him discover the benzene molecule (circular structure) I was sitting on my textbook I turned my chair to the fire and dozed. Again the atoms were gamboling before my eyes. long rows of atoms sometimes more closely fitted together all twining and twisting in snake-like motion. One of the snakes had seized hold of its own tail, and the form whirled mockingly before my eyes. 79. Madame C.J. Walker FromDream to Millionaire Madame C.J. Walker (1867-1919), first female American self-made millionaire Founded successful African-American cosmetic company Suffered from scalp infection (caused her to lose most of her hair in 1890s) Dreamt A big black man appeared to me and told me what to mix up in my hair. Some of the remedy was grown in Africa, but I sent for it, mixed it, put it on my scalp, and in a few weeks my hair was coming in faster than it had ever fallen out. 80. The Sewing MachineElias Howe, 1845Had idea of a machine with a needle which wouldgo through a piece of cloth: couldnt figure outexactly how it would workHis dream: he was taken prisoner by a group ofnatives; they were dancing around him withspears.As he saw them move around him, he noticed thattheir spears all had holes near their tipsBy locating a hole at the tip of the needle, thethread could be caught after it went through cloththus making his machine operable 81. Jack Nicklaus Finds a NewGolf Swing in a DreamJack Nicklaus, 1964: having a bad slump(high 70s)Wednesday night I had a dream and it wasabout my golf swing.I was hitting them pretty good in thedream and realized I wasnt holding the clubthe way Ive been holding it latelySo when I came to the course yesterdaymorning I tried it the way I did in my dreamand it worked. I shot a sixty-eight yesterdayand a sixty-five today. 82. Srinivasa Ramanujan Mathematical Genius andDreamerInspiration and insight for his work many times cameto him in his dreamsHindu goddess, Namakkal, would appear and presentmathematical formulae which he would verify afterwaking 83. Dreams and the King of HorrorNovelist Stephen King describes how dreams affect his writings in an interview with UKreporter Stan Nicholls:Nicholls: "If the inspiration for Misery didnt come from a real-life incident, where did itcome from?"King: "Like the ideas for some of my other novels, that came to me in a dream. In fact, ithappened when I was on Concord, flying over here, to Browns. I fell asleep on theplane, and dreamt about a woman who held a writer prisoner and killed him, skinnedhim, fed the remains to her pig and bound his novel in human skin. His skin, the writers skin.I said to myself, I have to write this story. Of course, the plot changed quite a bit in thetelling. But I wrote the first forty or fifty pages right on the landing here, between the groundfloor and the first floor of the hotel.""Another time, when I got road-blocked in my novel It, I had a dream about leeches insidediscarded refrigerators. I immediately woke up and thought, That is where this is supposedto go. Dreams are just another part of life. To me, its like seeing something on the street youcan use in your fiction. You take it and plug it right in. Writers are scavengers by nature."Nicholls comments: "This could explain the line in Bag of Bones that goes, Perhaps in dreamseveryone is a novelist." 84. Paul McCartney findsYesterday in a dream1965 filming Help!, McCartney staying in a smallattic room of his familys house on WimpoleStreetDream: I woke up with a lovely tune in my head.I thought, Thats great, I wonder what that is?There was an upright piano next to me, to theright of the bed by the window. I got out of bed,sat at the piano, found G, found F sharp minor7th -- and that leads you through then to B to Eminor, and finally back to E. It all leads forwardlogically. I liked the melody a lot, but because Iddreamed it, I couldnt believe Id written it. Ithought, No, Ive never written anything like thisbefore. But I had the tune, which was the mostmagic thing!" 85. Yesterday - Sir Paul McCartneyhttp://www.youtube.com/watch?v=Ms65JQTBCcQ 86. Conclusions Evolutio n Living Beings Sleep CONCEPTS:Early / Religious / ScientificWhat ifs??? Unihemispheric sleep (dolphins and seals, Canadian geese) Plants (Mimosa pudica) Mark 14:32-42 87. ConclusionsFinal thoughts Sleep: one third of your existence Make it worth it!http://www.youtube.com/watch?v=uNkaeUr3-HU