Arousal, from sleep

The etiology of enuresis is poorly understood, but there is a clear genetic link. The incidence in children from families in whom there are no members with enuresis, where one parent had enuresis as a child, and where both parents had enuresis as children are 14%, 44%, and 77%, respectively. Loci for enuresis have been located on chromosomes 12,13, and 22. Sleep disorders are not considered major contributors with the exception of sleep apnea. Enuresis occurs in all sleep stages in proportion to the time spent in each stage. However, a small proportion of individuals are not aroused from sleep by bladder distention and have uninhibited bladder contractions preceding enuresis. 

A 36-year-old male heroin addict is seen in the ED because he cannot be aroused from sleep On examination, he has shallow breathing and pinpoint pupils. Naloxone is administered, and the patient wakes up. Which of the opiate receptor subtypes that binds naloxone is responsible for reversing the respiratory depression and miosis ... 

Because of these apneic events, a sleep apnea sufferer never really enters the deep, restorative stages of sleep. In fact, the person is aroused from sleep numerous times per hour and. 

Hypnopompic hallucinations clearly illustrate the continuation of REM sleep dreaming into subsequent waking. That is, instead of arising out of the blue (out of thin air, as we say), they simply continue an ongoing—and perfectly normal—sleep-related hallucinatory process across the line into waking. Practically everyone has had some experience with uncoordinated state transitions on arousal from sleep. Sleep walking, being unable to move, and persistent anxiety after arousal from a chase dream are some common examples. 

Sleep-related eating disorder consists of partial arousal from sleep followed by rapid ingestion of food, commonly with at least partial amnesia for the episode on the next day this disorder has been reported, purportedly for the first time, in association with an atypical neuroleptic drug (132). 

Extreme Caution History of sleep apnea, young children, family history of sudden infant death syndrome (SIDS), those difficult to arouse from sleep... 

Emotions are sometimes said to be physiologically arousing, but sleep is an exception. It is a true motivated behavior because drowsy animals will seek a suitable place to sleep rather than simply collapsing on the spot. Drowsiness can be distinguished from fatigue by its overt behavior. Drowsiness prompts sleep fatigue prompts rest. But the function of sleep seems to be rest also. 

Dantendorfer K, Frey R, Maierhofer D, Saletu B (1996) Sudden arousals from slow wave sleep and panic disorder successful treatment with anticonvulsants-a case report. Sleep 19 744-746... 

Non-REM sleep is divided into 4 stages. Stage 1 represents very light sleep and the person can be easily aroused from this stage. Polysomnographically, this stage is... 

Night terrors are pure emotional experiences that occur on awakening from sleep. Typically, they are associated with non-rapid eye movement (NREM) sleep, as are the recurrent dreams of post-traumatic stress. Together with the arousal from NREM sleep, there is intense activation of the heart, the breathing rate increases, and the blood pressure may rise to extremely high levels the person awakens drenched in sweat and terrified, and often has little dream recall whatsoever from these awakenings. 

Parasomnias are adverse events that either occur during sleep or are exaggerated by sleep. Many of these disorders are considered to be disorders of partial arousal from various sleep stages. Examples of parasomnias are sleepwalking disorder, sleep terror disorder, and nightmare disorder. 

Stones, M. J. (1977). Memory performance after arousal from different sleep stages. Psychophysiology, 6, 177-181. 

Johnston RV Grant DA, Wilkinson MH, Walker AM. Repetitive hypoxia rapidly depresses arousal from active sleep in newborn lambs. J Physiol (Lond) 1998 510 651-659. 

As a therapeutic class, hypnotics are nonselective CNS depressants that eflcit drowsiness and a natural sleep state from which the individual can be aroused. The effects of hypnotics are generally dose-dependent. 

From time to time it has been suggested that histamine has some role in a number of behaviours and motor activity while the established and marked sedative effect of Hi receptor antagonists, mentioned at the start of this section, has consistently been considered to indicate a role for histamine in arousal and the sleep-waking cycle (see Chapter 22). 

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