.

4. ‫النوم‬...‫هللا‬ ‫آيات‬‫من‬ ‫آية‬!

8. 1. What is it? What Does It Look Like?
2. Do other animals sleep?
3. Why Is Sleep Important?
4. What causes sleep?
5. How does it develop?
6. What happens when we sleep? How
did it evolve?
7. How does it function?
8. How does it change with age and
with each culture?

9. •Personal awareness of mental activities, internal
sensations, and the external environment
•Consciousness (an organism’s awareness of its own
self and surroundings)
Understanding Consciousness

10. ©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
• Alternate States of
Consciousness
(ASCs): Mental states,
other than ordinary
waking
consciousness, found
during sleep,
dreaming,
psychoactive drug
use, hypnosis, etc.

11. -Sleep is unconsciousness from which the
person can be aroused by sensory or
other stimuli
-Coma is unconsciousness from which the
person cannot be aroused by any
external stimuli

12. What is sleep?
• Sleep is a dynamic and regulated set of
behavioral and physiological states
during which many processes vital to
health and well-being take place.
• Unlike coma: physiologic, recurrent,
and reversible.

13. • “Sleep is a dynamic behavior. Not simply
the absence of waking ”
• “ Sleep is a special activity of the brain,
controlled by elaborate and precise
mechanisms”
Hobson, Sleep.

14. What is Sleep?
• A state of (1) sustained immobility or quiescence
in a (2) characteristic posture accompanied by (3)
reduced responsivity to external stimuli
• Immobility need not be absolute as dolphins, seals
and whales may float or swim while asleep…most
sleep with eyes closed but not all
• Cattle may sleep with eyes open..horses and
elephants sleep while standing…

15. Recognizing sleep: behavioral
criteria
1. Behavioral inactivity
2. A characteristic sleep posture
3. Decreased responsiveness to stimulation
4. A rapid return to waking with moderate
stimulation

16. Sleep Academic Award 16
Sleep is NOT the absence of
wakefulness
• Sleep is a dynamic behavior AND an
altered state of consciousness
• Active
• Complex
• Highly Regulated
• Involves different areas in the brain
• Essential to life
• We all do it

17. • Each of us will spend about 27 years of our
lifetime sleeping…..
• We spend about a third of our lives in sleep
…..And 1/3 part of the population has sleep
disorder
About the Sleep…

18. 1/3 of life is spent sleeping!
Sleep

19. Sleep and its Function
• Sleep is an essential, life sustaining
activity.
• Sleep may play a role in:
1. Restoration and Recovery
2. Energy conservation
3. learning and memory consolidation
4. Brain maturation , development
5. Mood and emotional stability
6. Recent studies suggest that sleep
may strengthen our immune
defenses

20. About Sleep
 We spend 1/3 of our lives asleep
 Sleep is an active process
 No organ or regulatory system “shuts down”
o Slight decrease in metabolic rate
 Some brain activity increases during sleep
o Delta Waves
o Many parts of the brain are as active as awake
periods
 Specific hormones increase during Sleep
o Growth hormone is only released during SWS.
o Melatonin

21. Why is sleep important?
• Inadequate sleep time and poor
quality sleep interfere with quality of
life and can be hazardous to health

44. Bat sleeping upside down

49. ©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Average Daily Hours of Sleep for
Different Mammals

50. Animal Sleep
Animals, like humans also
have a required certain
amount of sleep:
SPECIES
Average total sleep
time per day
Python 18 hours
Tiger 15.8 hours
Cat 12.1 hours
Chimpanzee 9.7 hours
Sheep 3.8 hours
African Elephant 3.3 hours
Giraffe 1.9 hours

51. Fig. 9-17, p. 287

52. Small animals sleep more than large ones, in
correlation with their normal high metabolic rate

53. Sleep Academic Award 53
Sleep
Positions

54. Sleep Across the Life Span

57. Sleep Academic Award 57
Wake / Sleep Pattern Development

58. Total Sleep Requirement

59. ‫مال‬َ‫ج‬‫ال‬ ‫ق‬ْ‫ش‬ِ‫ع‬ ‫ناه‬ْ‫ض‬‫أ‬ ‫قد‬ ُ‫القلب‬
‫قال‬ُ‫ي‬ ‫ال‬ ‫بما‬ َ‫ضاق‬ ‫قد‬ ُ‫در‬َ‫ص‬‫وال‬
‫مأ‬َ‫ظ‬‫ال‬ ‫هذا‬ َ‫ضيك‬ ْ‫ر‬ُ‫ي‬ ‫هل‬ ِ‫ب‬‫ر‬ ‫يا‬
‫الل‬ُ‫الز‬ ‫أمامي‬ ُ‫ساب‬ْ‫ن‬َ‫ي‬ ُ‫ء‬‫والما‬
‫قا‬ِ‫ف‬ْ‫خ‬َ‫ي‬ ‫أن‬ ِ‫ب‬‫القل‬ ‫بهذا‬ ‫أولى‬
‫قا‬ َ‫حر‬ُ‫ي‬ ْ‫أن‬ ِِّ‫ب‬ُ‫ح‬‫ال‬ ِ‫رام‬ ِ‫ض‬ ‫وفي‬
‫بي‬ َّ‫ر‬َ‫م‬ ‫الذي‬ َ‫اليوم‬ َ‫ع‬َ‫ي‬ْ‫ض‬‫أ‬ ‫ما‬
‫َقا‬‫ش‬ْ‫ع‬‫أ‬ ‫وأن‬ ‫وى‬ْ‫ه‬‫أ‬ ‫أن‬ ‫غير‬ ‫من‬
‫ر‬َ‫ح‬َ‫س‬‫ال‬ ‫هذا‬ ِ‫ل‬ِ‫الظ‬ َ‫َفيف‬‫خ‬ ْ‫ق‬ِ‫ف‬‫أ‬
‫َر‬‫ت‬ َ‫الو‬ ِ‫وناغ‬ َ‫النوم‬ ِ‫ع‬َ‫د‬ ‫نادى‬
‫مرأ‬ُ‫ع‬ ُ‫م‬‫النو‬ َ‫ل‬‫أطا‬ ‫فما‬
‫ر‬َ‫ه‬َ‫س‬‫ال‬ ُ‫ل‬‫طو‬ َ‫األعمار‬ ‫في‬ َ‫ر‬َ‫ص‬َ‫ق‬ ‫وال‬

60. Why do we sleep?
• Some believe that sleep gives the body a chance to
gain strength from the day's activities but in reality,
the amount of energy saved by sleeping for even
eight hours is tiny - about 50 kilocalories, the same
amount of energy in a piece of toast!
• We have to sleep because it is needed to sustaining
normal levels of cognitive skills such as speech,
memory, and innovative and flexible thinking. In
other words, sleep plays an important part in brain
development.

61. Sleep Facts
o Research also shows that sleep-deprived
individuals often have difficulty in responding to
rapidly changing situations and making rational
judgments. In real life situations, the consequences
are grave and lack of sleep is said to have been be
a contributory factor to a number of international
disasters such as, Chernobyl,
o Sleep deprivation not only has a major impact on
cognitive functioning but also on emotional and
physical health.
o Research has also suggested that sleep loss may
increase the risk of obesity

63. o The optimal amount of sleep is seven to eight
hours.
o What happens to your body if it's deprived of sleep:
1. You have problems with memory and
concentration.
2. You have problems finding the right word.
3. You get irritable.
4. Neurotransmitters in the brain become altered.
5. Children's growth will be stunted.
6. You become more susceptible to infection.
7. At its extreme, sleep deprivation can lead to death.
o Too much sleep might be as bad for you as not

64. Sleep deprivation
The quality, depth and amount of sleep
influences our mental, emotional and physical
health. Sleep
deprivation has been linked to the following:
1. Shortened life span
2. Inflammation
3. Strained Relationships
4. Heart disease
5. Obesity
6. Chronic irritability
7. Memory loss
8. Depression

65. • A good night's sleep is important on many levels,
from emotional wellbeing and memory
enhancement, to physical health and weight control.
• In a world in which we try to fit more and more into
our busy lifestyle, cutting into our sleep seems to be
the only option.
• Unfortunately cutting into sleep can be likened to
becoming overdrawn at the bank, and will eventually
require repayment with penalties .

66. • Sleep is just as important to good health as a good
diet, hydration, and exercise.
• Studies have shown a connection between sleep
deprivation and weight gain. Essentially these
studies show that people who do not get enough
sleep are at risk for becoming overweight or even
obese.
– The stress of Sleep deprivation causes our
bodies to produce a hormone called cortisol.

67. – Cortisol inhibits muscle building and increases
the production of insulin. Insulin in turn
accelerates fat storage.
– In other words sleep restriction can contribute to
a reduction in muscle size and can increase fat
accumulation.
– Chronic Sleep restriction alters the blood sugar
metabolism and can contribute to diabetes later in
life.

68. • Another potential source of weight gain is related to
the molecule leptin. Leptin is secreted from fat cells
signaling satiety, “We have had enough to eat.” It
regulates body weight through appetite suppression
and is also linked to having adequate sleep .
• With lack of sleep this signal is inhibited, so that
people crave more food than they need. This in turn
will lead to overeating and additional weight gain.
• Research has suggested that sleep deprivation may
be a novel risk factor for obesity

71. • When you are tired, you are not in the mood to
exercise. When you are tired your willpower may be
compromised and lead to unhealthy eating choices.
• You may drink more caffeine to stay awake
resulting in increased cortisol and insulin production.
• Caffeine may interfere with normal sleep patterns
resulting in a cycle of sleep deprivation and caffeine
consumption.
• A vicious cycle is established, resulting in a
downward spiral.

72. Sleep Deprivation and
Chronic Disease

73. How many hours per night do you usually
sleep?
0
50
1. Less than 5h
2. 6h
3. 7h
4. 8h
5. 9h or more

74. Sleep Deprivation
• A common condition that affects 47
million American adults!
Q.How much sleep do adults need?
A. 7 - 9 hours of sleep per night
A. Different people need different
amounts to feel rested
National Sleep Foundation & Nebraska Rural Health & Safety Coalition

75. Sleep Duration Time Trends in US Adults
9.0
7.5
6.8
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
1910 1975 2005
Hrs per night
National Sleep Foundation. Sleep in America Poll

76. Sleep duration in British Adults
(1967/2003)
Groeger JA et al. J Sleep Res. 2004; 13:359-71
1967
2003

77. What Causes Sleep
Deprivation?
 Not enough time to sleep
 Excessive worry
 Stress, anxiety, depression
 Repeated awakenings
 Working at night
 Travel
 Medical Illness
 Sleep disorders (insomnia)
National Sleep Foundation & Nebraska Rural Health & Safety Coalition

78. What Are The
Consequences?
• Increased risk of accident & injury
• Physical health changes
• Job Performance
National Sleep Foundation & Nebraska Rural Health & Safety Coalition

79. The Silent Killer
Tips Before Driving:
 Get adequate sleep before driving
 Schedule breaks
 Have a travel companion
 Avoid alcohol and/or sedative
medications
National Sleep Foundation

80. Sleep Deprivation and Traffic
Accidents

81. Sleep debt
• Sleep debt or sleep deficit is the cumulative effect of
not getting enough sleep. A large sleep debt may
lead to mental and/or physical fatigue.
• There are two kinds of sleep debt; partial sleep
deprivation and total sleep deprivation. Partial sleep
deprivation occurs when a person or a lab animal
sleeps too little for many days or weeks. Total sleep
deprivation means being kept awake for days or
weeks
• Sleep debt is the difference between the amount of
sleep you should be getting and the amount you
actually get.

82. Sleep debt
Calculating your Sleep Debt
Take your nightly sleep need, and subtract it by the
amount of sleep you actually got. The number that
remains is your sleep debt:
Sleep debt = Hours of sleep you need per night –
Hours of sleep you actually get

83. Sleep debt
• Sarah and Ashley both need eight hours of sleep
per night. Sarah gets 6 hours of sleep on week
nights, and 8 hours of sleep on the weekend. Ashley
gets 8 hours of sleep per night, except for Thursday
night, when she pulls an all-nighter:
• At the end of the week, Sarah has 10 hours of sleep
debt (56 – 46); Ashley has 8 hours of sleep debt (56
– 48). So both women have similar levels of
sleep debt, even though one accumulated the debt
all over Thursday night. Their similar levels of sleep
debt will give them similar negative symptoms of

84. Paying back sleep debt
• You cannot replace lost sleep all at once.
• If you lose two nights of sleep you will not sleep for
fourteen or sixteen additional hours on the third
night.
• When you sleep longer to catch up, try to do so by
going to bed earlier than usual. Otherwise your
normal waking time will be shifted. This is likely to
make it difficult to get to sleep at the usual time the
following night.

85. Paying back sleep debt
• you should pay back your sleep debt by going to
bed earlier than usual. This way, you can maintain
your normal waking time.
• You can also use a nap to help you pay back your
sleep debt. But make sure you take your nap in
the early afternoon, as late-afternoon napping will
shift your biological clock, making getting up in the
morning a struggle

86. Avoid accumulating new sleep debt
• After factoring how much sleep you need, and
repaying your sleep debt, factor it into your daily
schedule.
• Create a daily ritual of going to bed and getting up at
the same time, each day of the week. This will
ensure you do not accumulate new sleep debt.

87. • Sleep debt is the accumulated amount of sleep
loss from insufficient sleep, regardless of cause.
• If you simply choose to restrict the amount of
sleep that you get, this could be one potential
cause.
• If you have a sleep disorder such as insomnia,
sleep apnea, or circadian rhythm sleep disorders,
this could likewise lead to a sleep debt.

88. • With sleep, you can only pay off a recent debt.
For example, if you have not slept well over the
past year you are not able to pay back the sleep
that you’ve missed over that time. Rather, you
can only get extra sleep to attempt to make up for
the recent time that you lost.
• You might think that with the passage of time,
your debts are completely forgiven and forgotten,
but in the context of sleep debt, this is not so.

89. Sleep debt can cause weight gain
• Sleep loss decreases
leptin levels
– an appetite
depressor hormone
• Sleep loss increases
ghrelin levels
– an appetite
stimulator hormone
– Sleep loss may
equal weight gainhttp://www.obesityonline.org/slides/slideimgs/talk034__s010_f.gif

90. Fragmented Sleep
(Sleep Disruption)
Insufficient Sleep
(Sleep Deprivation)
Excessive Daytime Sleepiness (EDS)
Neurobehavioral deficits
cognitive/executive function
attention/concentration
Cardio-metabolic
appetite regulation
high blood pressure
Increased Morbidity / Mortality
Decreased Quality of Life
Performance
deficits
errors/accuracy

91. Cardio-Metabolic Risk Factors
• Obesity/body fat distribution
• Type 2 Diabetes Mellitus
• Hypertension
Total and Cause-Specific Mortality
Coronary Heart Disease
Short Sleep Duration & Chronic Diseases

92. Sleep Deprivation & Obesity:
Potential Mechanisms
ObesitySleep
Deprivation
Patel SR et al. Obesity; 2008; in press

93. Gale SM et al. J Nutr 2004; 134:295-8
LACK OF SLEEP
less
more

96. • Leptin and ghrelin are two hormones that have been
recognized to have a major influence on energy
balance. Leptin is a mediator of long-term regulation
of energy balance, suppressing food intake and
thereby inducing weight loss. Ghrelin on the other
hand is a fast-acting hormone, seemingly playing a
role in meal initiation
• Ghrelin is considered the counterpart of the
hormone leptin, produced by adipose tissue

97. Sleep Deprivation & Diabetes:
Potential Mechanisms
Spiegel K et al. J Appl Physiol. 2005; 99: 2008-19
Diabetes
Acute sleep
deprivation
Chronic sleep
deprivation

100. Gelfand EV et al, 2006; Vasudevan AR et al, 2005
* working definition
Cardiometabolic risk

101. Short sleep duration Long sleep duration
Low SES/Unhealthy lifestyle/
Poor general health status
Co-Morbidities/Elderly
Appetite dysregulation/
Impaired glucose homeostasis
CVD/Metabolic alterations
Increased morbidity/mortality/
Reduced quality of life
Inflammatory/neurovegatative/
hormonal responses
Depression/
Poor general health status
Putative pathways

102. Negative health consequences
• Cardiac
– Individuals with <6 hours total sleep time have a
higher CV mortality
• Endocrine
– Decreased glucose metabolism
– Decreased leptin; increased ghrelin
– Elevated cortisol in pm
• *Mullington JM et al. Progress in Cardiovascular Diseases 2009

103. Negative health consequences
• Inflammatory
– Visceral adiposity contributes directly to the
production of IL6 which in turn stimulates the
production of C-reactive protein
– Prolonged inflammation is associated with
future development of CV disease
• *Mullington JM et al. Progress in Cardiovascular Diseases 2009

104. Negative health consequences
• Immune
– Elevation of pro-inflammatory cytokines (IL-6,
IL-12) and concomitant reduction in anti-
inflammatory cytokines (IL-10)
• Contributes to sense of fatigue, sleepiness,
body-aches irritability, anxiety, depressed
mood, and diminished concentration
– Decrease in natural T killer cells
• Increase in incidence of colds, flu, illness
• Lange T et al. Annals of the NY Acad of Sci 2010

106. Institute of Medicine Report - 2008

107. Institute of Medicine Report
December 2008
• Working for more than 16 consecutive hours is
unsafe for physicians-in-training and their patients
• (level of alertness drops considerably after 16 hours
of wakefulness)
• After 24 hours without sleep:
– attentional failures double
– physicians’ clinical performance drops to the 7th
percentile of their performance when well rested
– impairment of reaction time is comparable to
being legally drunk

108. Institute of Medicine Report
December 2008
• Residents working 30 hour shifts make 36% more
serious medical errors caring for ICU patients,
including diagnostic and medication errors than
those scheduled to work 16 hours
• Residents are 73% more likely to stab themselves
with a needle/scalpel when performing a procedure
after working 20 hours than during a 12 hour shift
• Residents have double the odds of an MVA coming
home from work following a 24 hour shift (Near-
misses were 5x as likely.)

109. • There are serious consequences to chronic
sleep deprivation, including obesity and heart
disease. That's why it's important to meet
your sleep needs every day by following
better sleep guidelines so that you might
preserve your health and well-being.

110. Sleep
Hygiene

111. Better Sleep Guidelines
National Sleep Foundation

112. 1. Get up and go to bed at the same time
every day, even on weekends.
• We are creatures of habit, and our sleep is no
exception. By consistently going to bed and
getting up at the same time, we condition our body
to follow a regular pattern of sleep. This allows our
body’s natural clock, called a circadian rhythm, to
help initiate and maintain our sleep

113. • Studies find that sleeping in a cool environment is
most conducive to sleep. By eliminating excess
noise and light, we can minimize the disruptions
that might wake us up. In addition, the bedroom
should be a relaxing place and not a source of
stress.
2. Make sure your bedroom is quiet, dark,
cool, and comfortable.

114. • Somehow we have managed to make the bedroom
a multipurpose room. All electronics must be
removed! Televisions, gaming systems, computers,
telephones, and various other gadgets are
stimulating and disruptive to sleep. Don’t allow them
in your bedroom and don’t use them in the brief
period before going to bed. Even the small amount
of light from a computer screen in the evening hours
can stimulate your brain into thinking it is time to be
awake
3. Make Bedrooms are for sleeping & sex,
not for watching television or doing
work.

115. • Caffeine can be found in expected places like
coffee, soda pop, or tea, but also in unexpected
foods like chocolate. As a stimulant it will keep you
awake, even if used nearly six hours before bed.
Likewise, nicotine will disrupt your sleep. And
contrary to common practice, an alcoholic “nightcap”
can actually make your sleep worse. Though it may
cause you to become drowsy, alcohol fragments the
stages of your sleep and makes it more disrupted.
4. Avoid caffeine, alcohol, and nicotine 4-6
hours before bedtime.

116. • The period of time that you are awake adds to
something called “sleep drive.” The longer we stay
awake, the more we want to go to sleep.
• By taking a nap we can relieve this desire to sleep,
but it will also make it less likely that we will be able
to easily go to sleep later.
• Adults should have a consolidated period of sleep at
night without additional naps.
• If there is excessive daytime sleepiness and desire
to nap, in spite of adequate sleep time, this might
suggest a sleep disorder warranting further
evaluation.
5. Don’t take naps

117. • Staying active and physically fit is an excellent
way to ensure a good night’s sleep. However,
exercise too close to bedtime may actually cause
difficulties in getting to sleep as your body will still
be revved up.
6. Exercise every day, but avoid doing it
4 hours before bedtime.

118. • Just like we maintain for children, adults need
daily sleep rituals prior to going to bed to allow us
to unwind and mentally prepare for going to sleep.
These rituals should include quiet activities such
as reading, listening to relaxing music, or even
taking a nice bath
7. Develop sleep rituals which include
quiet activities, such as reading, 15
minutes before bedtime.

119. • Individuals who have difficulty initiating sleep often
toss and turn in bed and try to force sleep to come.
As this is repeated, night after night, this sets up a
situation where we associate our bed with the
anxiety of not being able to sleep. If you are unable
to get to sleep within 15 minutes, go to another quiet
place and lie down until you feel ready to fall asleep,
and then return to your bedroom to sleep.
8. If you are having trouble getting to
sleep, don’t struggle in bed or you will
train yourself to have difficulties there..

120. • Discomfort with heartburn or acid reflux as well as
needing to get up multiple times to urinate can be
very disruptive to a good night’s sleep. It is best to
avoid setting up these situations by not eating or
drinking in the few hours just prior to bedtime.
9. Avoid eating or drinking in the few hours
right before going to bed, as these might
lead to disruptions of your sleep.

121. • The most important advice is to respect that your
body needs to sleep. Too often we are likely to allow
our sleep time to be infringed upon when our
daytime obligations take longer than we expect.
Additionally, opportunities to engage in pleasurable
activities—visiting friends, watching television,
playing on the internet, eating out, and any number
of others—quickly cut into our sleep time if we allow
them to. It is important to schedule your sleep time
and keep to that schedule, no matter what might
come up during the day..
10. Make sleep a priority: don’t sacrifice
sleep to do daytime activities.

124. • Establishing healthy sleep practices helps
prevent sleep problems and promotes
optimal sleep.
• Sleep Disorders are treatable!

125. Thank
you