neurobiology of sleep and wakefulness tom scammell, md neurology, bidmc
TRANSCRIPT
Neurobiology of Sleep and Wakefulness
Tom Scammell, MDNeurology, BIDMC
• Circadian regulation of sleep (Saper)
• The neurobiology of sleep
• Narcolepsy and other sleep disorders
3 Stages of Behavior
• Wakefulness - awareness of self and one’s environment
• Rapid Eye Movement (REM) Sleep - unconscious but cortex active, dreaming, paralysis, saccadic eye movements
• Non-REM Sleep - unconscious with little cortical activity
The electroencephalogram
EEG waves differ across behavioral states
Alpha (8-13 Hz)
Theta (4-7 Hz)
Delta (< 4 Hz)
Stage 1
Stage 2
Stage 3
Stage 4
REM
NREM
The Sleep Cycle
REM
12 1 2 3 4 5 6Clock time
2 major determinants of sleep:
• Homeostatic component- long sleep compensates for prolonged wakefulness
• Circadian component - alertness varies with time of day
Sleep homeostasis: adenosine
• ATP ADP AMP Adenosine• Dependent on glucose, glycogen, and O2
• Brain glycogen falls with sleep deprivation • Adenosine concentration rises during wake and falls during
sleep• Caffeine blocks adenosine receptors
• Other somnogens: PGD2, TNF...
Wake-promoting pathways
periaqueductal grey(dopamine)
Ventral
REM sleep
• Cortical activation
• Dreams are vivid, emotional, and bizarre
• Paralysis
• Rapid eye movements
• Autonomic fluctuations
Mechanisms of REM sleep
See Saper lab Nature 2006
Non-REM sleep
• Cortical synchrony
• Difficult to wake out of deep NREM sleep
• Dreams brief and less vivid
• Increased parasympathetic activity
Mechanisms of non-REM sleep
VLPO lesions produce insomnia
Lu, et al, 2000
Amines and carbachol inhibit the VLPO
Gallopin, et al, 00
The flip-flop and bistability
Saper, et al, 01
What stabilizes wake and sleep?
OrexinHypocretin
Brief bouts of wake and sleep with orexin deficiency
% Wake
% Wake
100
50
0
7 PM7 AM7 PM
100
50
0
Wild-type
Orexinknockout
% Wake
% Wake
%w
ake
%w
ake
Mochizuki, et al, 04
Orexin activates arousal regions
REM-onneurons( )
Orexin excites orexin neurons
Li, et al, 02
Orexin may stabilize sleep/wake behavior
Amines (locus coeruleus, dorsal raphe,tuberomammillary nucleus)
Acetylcholine (LDT/PPT, basal forebr.)
Orexin/Hypocretin
GABA (ventrolateral preoptic nucleus)
Wake Non-REM REM
O
O
O
O
O
Activity of state-regulatory nuclei
Sleep disorders are clinically important
• 15% of adults have chronic insomnia
• 24% of adults have chronic sleepiness
• 25% of motor vehicle accidents with loss of consciousness are due to falling asleep
• 60% of fatal truck accidents are due to sleepiness
• A 23 year old woman is referred for excessive sleepiness after having fallen asleep while driving. She reports that her sleepiness has been present since high school, and she often struggles to remain awake. She occasionally feels weak in the knees when laughing. Once, she fell to the ground while laughing during a party and could not get up for 1-2 minutes. If she is sleepy while driving, she may imagine seeing an animal in the road. Once she was terrified to find herself unable to move for a minute after awakening.
Narcolepsy
Daytime sleepiness
Disrupted nighttime sleep
Fragments of REM sleepCataplexy - sudden, brief episodes of muscular weakness
Hypnagogic hallucinations - vivid, dream-like hallucinations at the beginning or end of sleep
Sleep paralysis - inability to move upon awakening
Polysomnograms in control anduntreated narcolepsy patient
Adapted from Rogers et al. Sleep. 1994;17:590.
Time of day
Co
ntr
ol
Un
trea
ted
nar
cole
psy
Time of day
2000 2400 0400 0800 1200 1600
W
REM
12
3/4
2000 2400 0400 0800 1200 1600
W
REM
12
3/4
MT
MT
Loss of orexin in human narcolepsy
Crocker, et al, 05
Impaired orexin signaling and narcolepsy
Daytime sleepinessFragmented sleepCataplexySleep paralysisHypnagogic hallucinations
Loss of orexin neurons
HumansMice/Rats/Dogs
Lack of orexinLoss of orexin neuronsLack of orexin receptors
Narcolepsy
Cataplexy in orexin knockout mice
Probable mechanisms of narcolepsy
LDT/PPTREM-on cells
motor neurons
LCraphe
noorexin
What causes narcolepsy?
• Most narcoleptics do not have mutations in the genes coding for orexin or its receptors
• Only 1/3 of monozygotic twins will both develop narcolepsy
• 85% of narcoleptics with cataplexy have HLA DQB1* 0602 compared to only about 25% of the general population
What causes narcolepsy?
• Narcoleptics may have gliosis (scarring) in the orexin neuron region
• HLA DQB1* 0602 and other genes may confer a susceptibility for some individuals to develop narcolepsy, possibly through an autoimmune attack on the orexin neurons
Orexin neurons respond to metabolic factors
Yamanaka, et al, 03
Hunger-induced wake requires the orexin neurons
Yamanaka, et al, 03
Narcolepsy and Metabolism
• People with narcolepsy are mildly obese (BMI=28) but eat less than normal
• Thus, metabolic rate may be reduced in narcolepsy
Drugs: tricyclic antidepressants ModafiniltrazedoneAmphetaminesGamma hydroxy butyrate
Orexin/ataxin-3 mice
Orexin/ataxin-3 mice are overweight but eat less than normal
decreased metabolic rate and locomotor activity?less motivation to eat?
Orexin and drug addiction
• Addiction to amphetamines appears to be quite rare in people with narcolepsy
• Orexin neurons activate brain regions implicated in drug-seeking (ventral tegmental area, nucleus accumbens) and makes VTA neurons more excitable
• Mice lacking orexin have almost no conditioned place preference to morphine
• …Maybe orexin provides the impetus to seek rewarding stimuli like food and drugs
VTA
Motivation,drug-seeking
ArcVMH
Feeding
VLM
Increased sympathetic activity
LC
Wakefulness,reduced REM sleep
raphe
orexin
• Waking is due to the coordinated action of neurons producing amines, acetylcholine, and orexin
• Pontine pathways regulate REM sleep, and preoptic nuclei promote non-REM sleep
• Orexin deficiency produces narcolepsy
• Orexin may promote many aspects of arousal
Orexin KO run less but the diurnal pattern is normal
Orexin KO spend less time running
Still, orexin KO mice initiate wheel running as often and run as fast as WT mice
KO fall asleep or have cataplexy soon after running
28% of running bouts are soon followed by cataplexy
Why do orexin KO mice run less?
• Sleepiness• Imminent cataplexy• Less motivated to keep running
(perhaps running is less rewarding)