LIFESTYLE

PILLARS
Presentation By- Vinita Sakpal
Nutritionist And Yoga Teacher
 SLEEP
• Sleep is a temporary state of
decreased consciousness
characterized by reduced
wakefulness, inhibition of most
incoming sensory information and
lowered muscle activity.
• Sleep allows the body to regenerate
energy and restore tissues used during
the day on a cognitive level.
• Sleep promotes memory formation by
consolidating recently learned
information.
 CIRCADIAN RHYTHM
• The daily cycle of alternating between periods
of sleep and wakefulness is known as the
circadian rhythm
• The sleep cycle is regulated by the circadian
rhythm, which is driven by the SCN
(suprachiasmatic nucleus).
• This cycle is regulated by the hormone
melatonin which is secreted at night by the
pineal gland in response to low light in the
environment.
• Melatonin decreases wakefulness and promotes
sleep, secretion of melatonin stops in the
morning at which time the hormone cortisol is
at its peak.
• This alternation between melatonin and
cortisol correlates with the feelings of being
awake or sleepy throughout a 24-hour period.
• This internal clock responds to environmental
cues, such as light, to signal when to sleep
and wake. Disruptions in this rhythm can lead
to sleep disorders like insomnia.

• The circadian rhythm also controls the

nocturnal release of adrenocorticotropic
hormone (ACTH), prolactin, melatonin, and
norepinephrine (NE).
• ACTH (Adrenocorticotropic Hormone):
Stimulates cortisol release from the adrenal
glands, helping manage stress and
metabolism.
• Prolactin: Influences immune function and
lactation, with higher nocturnal levels aiding
tissue repair.
• Melatonin: Regulates sleep-wake cycles,
promoting sleep at night.
• Norepinephrine (NE): Influences alertness
and blood pressure regulation, with reduced
levels at night promoting restful sleep.
 SLEEP CYCLE:
• Sleep progresses through five stages: wakefulness, N1,
N2, N3, and REM.
• N1 to N3 are stages of non-rapid eye movement
(NREM) sleep, where sleep gets progressively deeper.
• About 75% of sleep time is in NREM, with most in
N2.
• A typical night has 4-5 sleep cycles, each lasting
90-110 minutes.
• Sleep stages follow this order: N1 → N2 → N3 → N2
→ REM.
• The first REM period is short, but as the night goes on,
REM periods lengthen while deep sleep (N3)
decreases.
• This pattern is crucial for restorative sleep and
dreaming.
 BRAIN WAVES:
During sleep, the brain experiences different types of
waves associated with various stages:
• Beta waves: Present when you're awake and alert.
• Alpha waves: Occur during relaxation, such as when
falling asleep.
• Theta waves: Dominate light sleep (Stages 1 and 2),
associated with drowsiness.
• Delta waves: Seen in deep sleep (Stage 3), associated
with physical restoration.
• Sleep spindles and K-complexes: Appear in Stage 2,
marking the transition between light and deeper sleep.
• REM (Rapid Eye Movement): Brain activity is
similar to wakefulness, but the body remains immobile
for dreaming.
 WAKE/ALERT STAGE:

• EEG recording: beta waves - highest

frequency, lowest amplitude (alpha
waves are seen during quiet/relaxed
wakefulness)
• The first stage is the wake stage or
stage W, which further depends on
whether the eyes are open or closed.
• During eye-open wakefulness, beta
waves predominate.
• Alpha waves become the
predominant pattern as individuals
become drowsy and close their eyes.
 N1 (Stage 1) - Light Sleep (5%)
• EEG recording: theta waves - low
voltage
• This is the lightest stage of sleep and
begins when more than 50% of the alpha
waves are replaced with low-amplitude
mixed-frequency (LAMF) activity.
• Easily awaken by various stimuli like the
sound of the television in the other room.
• Muscle tone is generally reduced
although sudden muscle twitches known
as hypnic jerks can occur.
 N2 (Stage 2) - Deeper Sleep (45%)

• EEG recording: sleep spindles and K complexes

• This stage represents deeper sleep as the heart rate and body
temperature drop.
• Sleep spindles are brief bursts of brain activity in Stage 2
sleep, linked to memory consolidation and synaptic plasticity.
They occur in regions like the thalamus and cortex.
• K-complexes, large delta waves, help maintain sleep and are
also involved in memory consolidation.
• Stage 2 lasts around 25 minutes initially and becomes longer
throughout the night, eventually making up 45% of total
sleep.
• This is also the stage where bruxism (teeth grinding) occurs.
Both spindles and K-complexes are vital for stabilizing sleep
and cognitive functions.
 N3 (Stage 3) - Deepest Non-REM Sleep (25%)

• EEG recording: delta waves - lowest frequency,

highest amplitude
• N3 is also known as slow-wave sleep (SWS).
• This the deepest sleep stage, where it’s hardest to
wake up.
• It plays a crucial role in tissue repair, bone and
muscle growth, and immune system
strengthening.
• Sleepwalking, night terrors, and bedwetting also
occur in this phase.
• As we age, we spend less time in N3 sleep.
• Being awakened from this stage can result in
sleep inertia, a temporary period of mental fog
lasting 30 minutes to an hour.
 REM (25%) - REMember your dreams!/ REMain still!
• EEG recording: beta waves - similar to brain waves during
wakefulness (fast, low-amplitude brain waves)
• This stage is often called paradoxical sleep because while
the brain appears active (similar to being awake), the body
is deeply relaxed.
• Dreaming: REM is the stage where vivid dreaming occurs,
including nightmares. It's not a deep, restful sleep stage.
• Muscle atonia: Most of the body's muscles are paralyzed
(except for the eyes and diaphragm), preventing us from
acting out our dreams.
• Erratic breathing and heart rate: Breathing becomes
irregular, and pulse and blood pressure can vary.
• Cycle length: REM sleep starts about 90 minutes after
falling asleep, with cycles getting longer throughout the
night. The first one is around 10 minutes, and the last one
can last up to an hour.
 REM (25%) - REMember your dreams!/ REMain still!

• Waking during REM: People often wake

up naturally during or right after a REM
cycle.
• Active brain: Brain activity increases, using
more oxygen and energy, which increases
brain metabolism by up to 20%.
• Physical reactions: REM sleep can cause
certain physiological responses like
penile/clitoral tumescence (erection) due to
increased brain activity.
• REM sleep is crucial for emotional
regulation, memory processing, and
cognitive functions.
 COMMON PROBLEMS OF SLEEP
DISORDERS
• Insomnia
• Sleep Apnea
• REM Sleep Disorder
• Narcolepsy
• Somnambulism/ Sleepwalking
• Depression
• Aging
 INSOMNIA
• Insomnia is thought to be a disorder of hyperarousal
experienced throughout the entire day.
• This hyperarousal may exhibit itself as a state of
hypervigilance (extremely alert) during the day and
difficulty initiating and maintaining sleep at night.
• Cognitive model suggests that worry and
rumination about life stresses disrupt sleep, creating
acute episodes of insomnia, especially in initiating
sleep and returning back to sleep after an
awakening. When sleep difficulties arise, worry
shifts from life events to concerns about sleep and
its daytime effects, which worsens with perceived
sleep problems or deficits.
 INSOMNIA
• Physiological arousal in insomnia has been studied through metabolic
rate, heart rate variability, neuroendocrine measures, and
neuroimaging.
• Insomnia patients show higher metabolic rates and increased heart
rates with reduced variability during sleep, compared to healthy
sleepers.
• Insomnia is linked to elevated urinary cortisol and catecholamines,
which correlate with increased wake time and light sleep.
• Plasma cortisol and ACTH levels are higher in insomnia, especially at
night, indicating HPA axis involvement (The hypothalamus, pituitary gland,
and adrenal glands work together to regulate stress, mood, digestion, the immune
system, and energy levels by controlling the release of stress hormones like cortisol).
• PET scans show increased brain metabolism in insomnia, with less
reduction during non-REM sleep, suggesting overactive arousal,
emotional, and cognitive networks.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1978319/#sec4
 TREATMENT
• Healthy Sleep Habits: Create a sleep-friendly environment, maintain a
consistent sleep schedule, avoid caffeine, nicotine, and alcohol, exercise
regularly, manage stress, and limit fluid intake before bed.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): A structured program
to improve sleep, including cognitive therapy, relaxation techniques, and sleep
restriction.
• Medications: Prescription medications may include benzodiazepines,
melatonin receptor agonists, and orexin receptor antagonists. Discuss potential
side effects with a healthcare provider.
• Light Therapy: May help regulate sleep-wake cycles.

https://www.nhlbi.nih.gov/health/insomnia/treatment
 SLEEP APNEA
• Individuals with sleep apnea experience airway
collapse in deeper sleep states, causing them to
experience reduced time in stage N3 and REM sleep.
• This leads to excessive daytime drowsiness as proper,
efficient sleep is not obtained throughout the night.
• There are two types of sleep apnea: central and
obstructive.
• Central sleep apnea occurs when the brain fails to
signal respiratory muscles during sleep.
• Obstructive sleep apnea is a mechanical problem in
which there is a partial or complete blockage of the
upper airway.
https://www.ncbi.nlm.nih.gov/books/NBK526132/#:~:text=Approximately%2075%2
5%20of%20sleep%20is,roughly%2090%20to%20110%20minutes.
 TREATMENT:
• Healthy lifestyle:
✔ Regular physical activities
✔ Maintaining healthy sleeping habits
✔ Healthy weight
✔ Limiting alcohol and caffeine intake, and quitting
smoking.
✔ Sleep on your side and not on your back as this can help
keep your airway open while you sleep.
• Breathing devices:
A breathing device, such as a continuous positive airway
pressure (CPAP) machine, provides constant air pressure
throughout your upper airways to keep them open and help
you breathe while you sleep.
 TREATMENT:

• Oral devices
• Surgical implant
• Exercises for your mouth and facial muscles, called orofacial
therapy
• Surgical procedures
✔ Adenotonsillectomy to remove your tonsils and adenoids
✔ Surgery to remove some tissue from your mouth and throat,
to help make your upper airway bigger
✔ Upper or lower jaw advancement to move your upper jaw
(maxilla) and lower jaw (mandible) forward, to help make
your upper airway bigger

https://www.nhlbi.nih.gov/health/sleep-apnea/treatment
QUIZ TIME!
QUIZ TIME!
 REM SLEEP DISORDER
• During REM, we are typically atonic, meaning we do not move due to temporary muscle
paralysis.
• If the temporary atonia of REM sleep is disturbed, it may be possible to physically act out
(often unpleasant) dreams with vocalizations and sudden limb movements. This is called
rapid eye movement (REM) sleep disorder.
• The cause of this disorder is not entirely known but may be associated with degenerative
neurological conditions such as Parkinson disease or Lewy body dementia.
• Antidepressant use has also been shown to cause REM sleep disorder.

RBD can be divided into three categories:

Idiopathic RBD
Drug-induced RBD
Secondary RBD due to medical condition
•
 Idiopathic REM Sleep Behavior Disorder (RBD)

• Idiopathic REM Sleep Behavior Disorder (RBD) is often linked to brain diseases known as
synucleinopathies, which include conditions like Lewy body dementia, Parkinson's disease, and
multiple system atrophy. These are disorders where abnormal proteins build up in the brain, affecting
movement and thinking.
• Research suggests that RBD happens when there are disruptions in the brainstem, which normally
controls muscle relaxation during sleep.
• When these signals are faulty, the brain doesn't properly shut off muscle activity during REM sleep,
causing people to physically act out their dreams.
• Other factors that might contribute to RBD include traumatic brain injuries (TBI), post-traumatic
stress disorder (PTSD), and certain developmental disorders. These conditions can also interfere with
normal sleep patterns and may lead to similar sleep disturbances.
 Drug-induced REM Sleep Behavior Disorder (RBD)
• Drug-induced REM Sleep Behavior Disorder (RBD) is common in people taking certain
antidepressants.
• The medications most likely to trigger an RBD episode include:
Selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac). [OCD/ Panic
disorder/ Bulimia/ PTSD]
Tricyclic antidepressants (TCAs), such as mirtazapine, amitriptyline, nortriptyline, and others.
[Anxiety/ Maigraine/ Depression]
Monoamine oxidase inhibitors (MAOIs), like phenelzine and selegiline [Depression/ Bipolar]

• In addition to antidepressants, other short-term (acute) episodes of RBD can occur due to toxic
metabolic encephalopathy, which is a brain dysfunction caused by things like alcohol (ethanol) use
or other toxic substances affecting the brain temporarily.
 Secondary RBD due to medical condition
• RBD (REM Sleep Behavior Disorder) that occurs alongside narcolepsy may represent a distinct
type of RBD.
This version is characterized by:
Less violent or complex behaviors during REM sleep compared to typical RBD.
Earlier onset, meaning it starts at a younger age.
Equal occurrence in males and females, unlike typical RBD which is more common in males.
A deficiency in hypocretin (orexin), a brain chemical that helps regulate wakefulness, which is
a specific marker for narcolepsy type 1.

• This form of RBD is often tied to the sleep disruptions seen in narcolepsy, a disorder that causes
excessive daytime sleepiness and sudden sleep attacks.
 TREATMENT
• Precautions:
Mitigating fall risk by lowering the bed closer to the floor
Safe-guarding any firearms, knives, and other weapons
Cushioning or padding the floor or sharp furniture surfaces.
Placing patients in restraining clothes or sleeping bags
Separating the sleeping partner from the patient to reduce the risk of injury

• Pharmacological treatment of isolated RBD in adults is immediate-release melatonin

• Although the mechanism of action is unclear, 3 to 12 mg of melatonin at bedtime is recommended
and appears effective in reducing RBD symptoms.
• Clonazepam can significantly reduce periodic limb movement syndrome but not normalize REM
sleep atonia

https://www.ncbi.nlm.nih.gov/books/NBK555928/
 NARCOLEPSY
• Narcolepsy is a sleep disorder where people experience excessive daytime sleepiness (EDS) and
uncontrollable sleep attacks.
• It often disrupts night sleep and can involve cataplexy (sudden muscle weakness), sleep paralysis,
and vivid dreams or hallucinations just as they're falling asleep or waking up.
There are two types:
• Type 1: Includes cataplexy (muscle weakness).
• Type 2: No cataplexy.

• Narcolepsy is often under-diagnosed, with delays of 5-10 years before it's identified. Many
patients develop symptoms in their teenage years, which can impact school and social life, but the
condition can be managed with treatment.
Narcolepsy Type 1: Caused by the loss of brain cells that produce orexin (hypocretin). Likely an
autoimmune disorder. Linked to cataplexy(sudden muscle weakness).
Narcolepsy Type 2: Less severe loss of orexin. No cataplexy, but it may develop over time.
- Narcolepsy causes excessive daytime sleepiness and sudden REM sleep.
- Autoimmune causes suspected, triggered by infections or vaccines (like the H1N1 flu vaccine
in 2009).
- The exact cause of type 2 is less clear but thought to involve orexin as well.

Both types disrupt the brain’s ability to control the sleep-wake cycle.
• Orexin (hypocretin) is a brain chemical that keeps you awake by activating the Reticular
Activating System (RAS), which boosts wake-promoting neurotransmitters (like dopamine,
serotonin, and norepinephrine).
• Normally, orexin levels drop during REM sleep, allowing muscle relaxation (atonia) and sleep
to occur.

• In narcolepsy type 1, a lack of orexin causes an unstable balance between wakefulness and
REM sleep, leading to sudden sleep-wake transitions and REM phenomena (like vivid dreams)
during the day.

• In narcolepsy type 2, the exact mechanism isn’t well understood, but orexin may still play a
role, though in a less severe way.

• The hypocretin system is crucial for regulating stable wakefulness and sleep cycles, and its
deficiency leads to the symptoms of narcolepsy.
 TREATMENT
• Medications
Stimulants: These are often the first line of treatment for excessive daytime sleepiness.
1. Modafinil (Provigil): A wakefulness-promoting agent with fewer side effects than
traditional stimulants.
2. Amphetamines: Such as dextroamphetamine or methamphetamine, may be
prescribed for severe cases.
Antidepressants: These can help with cataplexy and other REM sleep-related symptoms.
3. Sodium oxybate (Xyrem): Approved for treating both excessive daytime sleepiness
and cataplexy. It's a central nervous system depressant that improves nighttime sleep
quality.
Sodium Oxybate: This medication is specifically used to treat cataplexy and excessive
daytime sleepiness in narcolepsy patients.
 TREATMENT
Lifestyle Changes
• Regular Sleep Schedule: Establishing a consistent sleep routine can help regulate
sleep patterns.
• Naps: Short naps throughout the day can reduce sleepiness.
• Healthy Sleep Environment: Creating a comfortable, dark, and quiet sleep
environment can enhance nighttime sleep.

Behavioral Strategies
• Sleep Hygiene: Practicing good sleep hygiene, such as avoiding caffeine or heavy
meals before bedtime and limiting screen time.
• Cognitive Behavioral Therapy (CBT): This can help address any associated
emotional or psychological issues.
 TREATMENT
Support and Education
• Patient Education: Understanding narcolepsy can help patients manage their
symptoms and improve their quality of life.
• Support Groups: Connecting with others who have narcolepsy can provide
emotional support and practical advice.
Consultation with Specialists
• Regular follow-ups with a sleep specialist or neurologist can help monitor the
condition and adjust treatment as necessary.

https://www.ncbi.nlm.nih.gov/books/NBK459236/
 Somnambulism
Somnambulism is the medical term for sleepwalking, which includes undesirable actions such
as walking, occurring during abrupt but limited arousals from deep non-rapid eye movement
(NREM) and slow-wave sleep.
Somnambulism is characterized by:
• Incomplete arousal occurs during NREM sleep, usually during the earlier third of the night
• The ability or inability to recall dream content.
• Simple or complex movements that are in harmony with a dream
• Diminished awareness of the environment
• Impaired decision-making ability, planning, and problem-solving skills[2]
Somnambulism has been associated with various other sleep disorders such as confusional
arousals, rhythmic movement disorders, night terrors in children, somniloquy (sleep talking),
and bruxism (teeth grinding), as well as daytime fatigue, and emotional and behavioral issues
in children.
 Causes:
• Genetic Factors: There is often a family history of sleepwalking, suggesting a
genetic predisposition.
• Sleep Deprivation: Lack of adequate sleep can trigger episodes.
• Stress and Anxiety: Psychological factors, including stress, anxiety, and
emotional turmoil, can contribute to sleepwalking.
• Other Sleep Disorders: Conditions such as sleep apnea, restless legs
syndrome, or periodic limb movement disorder can increase the likelihood
of sleepwalking.
• Substance Use: Alcohol and certain medications can disrupt sleep patterns
and contribute to somnambulism.
 EFFECTS:
• Safety Risks: Sleepwalkers may engage in potentially dangerous activities, such as walking
outside, climbing stairs, or using sharp objects, leading to injuries.
• Disturbed Sleep: Sleepwalking can interrupt the sleep cycle, resulting in less restorative sleep
for the individual.
• Impact on Others: Family members may be disturbed by the sleepwalker’s behavior, leading to
anxiety or concern for safety.
 TREATMENT:
• Ensure Safety: Take measures to create a safe sleeping environment (e.g., removing sharp
objects, locking doors and windows).
• Sleep Hygiene: Establishing a regular sleep routine and ensuring adequate sleep can help
reduce episodes.
• Stress Management: Techniques such as relaxation exercises, mindfulness, or therapy can help
manage stress and anxiety.
• Medications: In severe cases, medications such as benzodiazepines or antidepressants may be
prescribed to help regulate sleep patterns.
• Professional Evaluation: A sleep study (polysomnography) might be recommended to assess
the individual’s sleep patterns and rule out other sleep disorders.

• https://www.ncbi.nlm.nih.gov/books/NBK559001/