Help them sleepUsing Osteopathy and Ayurveda to shift

paradigms and help patients sleep

Heather Ferrill DO MS

AAO Convocation 2016

Goals

The brief synopsis of the physiology of sleep

The physiology of sleep debt

Sleep disorders a shift in paradigms Using Ayurvedic doshas to gain a different persective

Treating sleep disorders An Ayurvedic approach to sleep hygiene

An Osteopathic approach to treatment

Marma for sleep

Yoga as a tool to help sleep

Purpose of sleep

Three major theories Repair and restoration

Time for the brain to metabolically and chemically repair

Evolutionary (adaptive) theory

Sleep evolved as a means of conserving energy

Information consolidation

Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory

Consolidation during sleep promotes both quantitative and qualitative changes in memory representations

Stages of sleepStage 1 light sleep

Easy to wake jumpiness

Stage 2 eye movement stops and brain waves slow marked

by sleep spindles

Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory

(newly encoded memories with pre-existing long-term)

Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)

Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-

declarative (short term to long term) memory (emotional and procedural)

Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)

Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)

The glymphaticsystem

A macroscopic waste clearance system for the brain

Architecture An intricate network of perivascular tunnels

formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system

CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system

Dramatic changes in brain architecture and fluid flow during sleep

60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states

Lateral recumbent position most efficient (compared to supine or prone)

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Goals

The brief synopsis of the physiology of sleep

The physiology of sleep debt

Sleep disorders a shift in paradigms Using Ayurvedic doshas to gain a different persective

Treating sleep disorders An Ayurvedic approach to sleep hygiene

An Osteopathic approach to treatment

Marma for sleep

Yoga as a tool to help sleep

Purpose of sleep

Three major theories Repair and restoration

Time for the brain to metabolically and chemically repair

Evolutionary (adaptive) theory

Sleep evolved as a means of conserving energy

Information consolidation

Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory

Consolidation during sleep promotes both quantitative and qualitative changes in memory representations

Stages of sleepStage 1 light sleep

Easy to wake jumpiness

Stage 2 eye movement stops and brain waves slow marked

by sleep spindles

Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory

(newly encoded memories with pre-existing long-term)

Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)

Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-

declarative (short term to long term) memory (emotional and procedural)

Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)

Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)

The glymphaticsystem

A macroscopic waste clearance system for the brain

Architecture An intricate network of perivascular tunnels

formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system

CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system

Dramatic changes in brain architecture and fluid flow during sleep

60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states

Lateral recumbent position most efficient (compared to supine or prone)

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Purpose of sleep

Three major theories Repair and restoration

Time for the brain to metabolically and chemically repair

Evolutionary (adaptive) theory

Sleep evolved as a means of conserving energy

Information consolidation

Based on cognitive research that suggests that sleep is necessary for processing events of the day preparing for the day to come and cement events and information into long term memory

Consolidation during sleep promotes both quantitative and qualitative changes in memory representations

Stages of sleepStage 1 light sleep

Easy to wake jumpiness

Stage 2 eye movement stops and brain waves slow marked

by sleep spindles

Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory

(newly encoded memories with pre-existing long-term)

Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)

Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-

declarative (short term to long term) memory (emotional and procedural)

Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)

Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)

The glymphaticsystem

A macroscopic waste clearance system for the brain

Architecture An intricate network of perivascular tunnels

formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system

CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system

Dramatic changes in brain architecture and fluid flow during sleep

60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states

Lateral recumbent position most efficient (compared to supine or prone)

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Stages of sleepStage 1 light sleep

Easy to wake jumpiness

Stage 2 eye movement stops and brain waves slow marked

by sleep spindles

Stage 3 amp 4 (NREM) Slow wave sleep Predominates in early sleep Benefits consolidation of declarative memory

(newly encoded memories with pre-existing long-term)

Conserves energy restores CNS cools body and brain promotes immune function (Bryant et al 2004)

Stage 4 REM Theta sleep Predominates in late sleep Preferentially benefits the consolidation non-

declarative (short term to long term) memory (emotional and procedural)

Psychological and emotional adaptation through dreaming facilitates CNS development provides sentinel role to allow for periodic awakening to survey environment (adaptive function) (Bryant et al 2004)

Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010)

The glymphaticsystem

A macroscopic waste clearance system for the brain

Architecture An intricate network of perivascular tunnels

formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system

CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system

Dramatic changes in brain architecture and fluid flow during sleep

60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states

Lateral recumbent position most efficient (compared to supine or prone)

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

The glymphaticsystem

A macroscopic waste clearance system for the brain

Architecture An intricate network of perivascular tunnels

formed by astroglial cells to promote efficient elimination of soluble proteins and metabolites from the nervous system

CSF and intestitial fluid continuously interchange CSF driven into Virchow-Robin space (space surrounding penetrating arterioles at the piabrain interface) into the interstitial space to the perivenous spaces of the large veins and out of the brain parenchyma into the cervical lymphatic system

Dramatic changes in brain architecture and fluid flow during sleep

60 increase in interstitial space with marked increase in CSFinterstitial fluid convective flux in sleep and anesthetized states

Lateral recumbent position most efficient (compared to supine or prone)

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

httpio9gizmodocomthe-real-reason-why-sleep-deprivation-can-destroy-you-1447241194

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep and the endocrine system

Sleep (Deep) inhibits the HPA axis Activation of the HPA axis leads to arousal and sleeplessness

Almost every hormone is influenced by circadian rhythm

24hr cortisol ACTH and pro-inflammatory markers IL-6 and TNF all increase proportional to the level of sleep disruption in a night as well as over time (Chrousos 2016)

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

The good news Naps are goodhellip

Naps after a sleepless night decreases sleepiness improves performance and has a beneficial effect on cortisol and IL-6 secretion (Vgontzas

2007)

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Autonomic regulation of sleepNeuroanatomy

Cell populations that regulate sleep are closely situated to cell populations that help regulate autonomic function Sleep

Sleepiness Thalamus Wakefulness Pons basal forebrain

hypothalamus

Autonomics Hypothalamus heart rate blood pressure

energy metabolism GI motility Medulla baroreceptors chemoreceptors

cardioreceptors respiratory receptors all via Glossopharyngeal and Vagus nerves

httpsleepdisorderssleepfoundationorgchapter-1-normal-sleepneurobiology-of-sleep

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep and the autonomic systemnormal NREM

In normal stage 1-3 NREM sleep we see Increased PNS decreased HR BP and cardiac output

Decreased SNS decreased PVR and BP

HR reaches nadir during stage 3 nREM sleep

Autonomic respiratory control

Breathing slows and gets more regular

During stage transitions there are bursts of vagal tone

Physiologic sinus arrhythmia and sinus pauses

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep and the autonomic system normal REM

Cholinergic discharges lead to muscle atonia and dream enactment

Increased eye movements are accompanied by increased SNS and decreased PNS activity

BP and HR fluctuate quite a bit in REM sleep often reaching levels much higher than waking state

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

The autonomics and sleep deprivationShort term

Short term deprivation and restriction leads to mild and temporary increases in the activity of the major neuroendocrine stress systems autonomic sympatho-adrenal

Hypothalamic-pituitary-adrenal axis

Initial signs of alterations in the way we deal with challenges under the influence of sleep restriction appears to be on the level of emotional perception

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

The autonomics and sleep deprivationLong term

INSUFFICIENT SLEEP SENISITIZES INDIVIDUALS TO STRESS RELATED DISORDERS

Gradually alters the neuroendocrine response system AND

Central mechanisms involved in regulating NEI responses (central sensitization)

Changes brain systems and NEI systems in manners similar to that of depression and other stress related disorders Decreased serotonin receptor activity and altered regulation of the HPA axiS

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep restriction and deprivation by any means is as important a risk factor for a

variety of diseases that are linked to stress including mood disorders and cardiovascular

disease

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

sleep debt and brain changes

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas and in mood and sleepiness These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex) left posterior parietal cortex and right superior frontal gyrus After treatment we observed significant improvements involving memory attention and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structure

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive intermittent nocturnal hypoxemia

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

The best bridge between despair and hope is a good nights sleep

~E Joseph Cossman

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep deprivation and emotional disorders Multiple studies link sleep deprivation

with affective disorders such as depression and anxiety 73 of adolescents with depressive

disorders also suffer sleep disorders (Lui et al 2007)

Bidirectional relationship between sleep disturbance and mental health (Cortese 2013)

Sleep disturbance is a precursor to the development of depressive symptoms in adolescents (Lovato 2014)

Sleep restriction to 65 hours () for 5 days resulted in increased reports of tension anxiety fatigue poorer emotional regulation and opposition with parents in adolescents 12-17 yo (Baum et al 2014)

wwwbrooklynartprojectcom

Sleep deprivation and emotional stabilityNearly all psychiatric and neurological sleep disorder display some degree of affective imbalance

Lack of sleep inappropriately modulates the human emotional brain in response to negative aversion sleep deprivation leads to a hyper-limbic response by the amygdala to negative emotional stimuli with loss of functional connectivity to the MPFC suggesting a loss of pre-frontal control

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala

disconnect Current Biology Vol 17 No 20 R878

Amygdala activity +

Pre-frontal control=

Decreased emotional stability

Get off the devices Smartphone ownership in adolescents

Less than 3 of adolescents without smartphone

Later bedtimes Increased nighttime usage (TV

movies texting internet surfing etc)

There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)

Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)

Predictive role of nighttime media use with the development of depression (Primacket al 2009)

MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)

Keep it out of the bedroom

Blue light from electronic media inhibits melatonin release delaying sleep onset

National sleep foundation recommends getting it OUT of the bedroom

If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes

And NO exposure in the last hour before bedtime

In college students both daytime and nighttime media usage has been found to

Impact sleep quality as well as quantity

Increase ldquonomophobiardquo

Increase anxiety

Negatively impact executive functioning (attention concentration train of thought)

Negatively impact impulse control (Rosen et al 2016)

Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Get off the devices Smartphone ownership in adolescents

Less than 3 of adolescents without smartphone

Later bedtimes Increased nighttime usage (TV

movies texting internet surfing etc)

There is an interrelationship between electronic media usage before bedtime sleep disturbance and depressive symptoms in all age groups (Lemola 2015)

Increasing evidence that electronic device usage is related to and may cause sleep disturbance (Cain amp Gradisar 2010)

Predictive role of nighttime media use with the development of depression (Primacket al 2009)

MOST correlative media usage with depression is spending time surfing online (Facebook chat rooms etc) (Lemola 2011)

Keep it out of the bedroom

Blue light from electronic media inhibits melatonin release delaying sleep onset

National sleep foundation recommends getting it OUT of the bedroom

If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes

And NO exposure in the last hour before bedtime

In college students both daytime and nighttime media usage has been found to

Impact sleep quality as well as quantity

Increase ldquonomophobiardquo

Increase anxiety

Negatively impact executive functioning (attention concentration train of thought)

Negatively impact impulse control (Rosen et al 2016)

Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Keep it out of the bedroom

Blue light from electronic media inhibits melatonin release delaying sleep onset

National sleep foundation recommends getting it OUT of the bedroom

If not able dim to lowest setting and keep 14 inches away from head to reduce the amount of blue light entering the eyes

And NO exposure in the last hour before bedtime

In college students both daytime and nighttime media usage has been found to

Impact sleep quality as well as quantity

Increase ldquonomophobiardquo

Increase anxiety

Negatively impact executive functioning (attention concentration train of thought)

Negatively impact impulse control (Rosen et al 2016)

Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

In college students both daytime and nighttime media usage has been found to

Impact sleep quality as well as quantity

Increase ldquonomophobiardquo

Increase anxiety

Negatively impact executive functioning (attention concentration train of thought)

Negatively impact impulse control (Rosen et al 2016)

Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Without sleep we all become like tall two year olds~JoJo Jensen Dirt Farmer Wisdom 2002

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Bidirectional relationship of sleep disorders and pain sensitivity

Schuh-Hofer s et al 2013

Total sleep deprivation for one night

Increased sleepiness

Increased anxiety

Increased sensitivity to heat cold pinprick generalized hyperalgesia

Okifuji amp Hare 2011

Sleep disturbance greater in children with sever headache v mild

Self-reported poor sleep not objective correlative with increased next day pain

Self reported poor sleep correlated to hyper-analgesia and decreased distraction analgesia

Sleep disturbance may decrease the effectiveness of analgesic medications

MOST IMPORTANT improved sleep is correlated with improved pain scores

fin

din

gm

yin

ner

cou

rag

ew

ord

pre

ssc

om

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Sleep amp Pain mechanisms Multifactorial amp controversial

Reduced sleep may reduce opioid binding to mu-opioid receptors thus reducing opioid effect 5HT system

Some 5HT subtype antagonists administered intrathecally to both REM deprived and non-REM deprived rats (others showed analgesic effect)

REM deprived rats showed a significantly higher rate of pain behavior

Cognitive behavioral Sleep deprivation leads to negative

cognition and mood

Negative cognition and mood leads to increased pain perception

(Lautenbacher et al 2006)

Va

len

tin

a K

alli

asldquoD

amaged

rdquo

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Sleep deprivation and memory

12 hours of sleep deprivation in mice affected hippocampal function at the behavioral and cellular levels Inability to perform new task

based on old patterns Reduction in hippocampal

neuronal function

Stress hormones played little to no role in these changes as both control and deprived mice had no statistical difference in cortisol levels

Hagewood et al 2010

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Sleep deprivation and memory Learning new tasks particularly emotionally charged or involved affects REM sleep

in the hours and days after learning the task Duration Amount

REM Sleep deprivation during this REM sleep windows impairs the short term retention

Slow wave sleep deprivation leads to impairment of short-term to long-term memory

httpmashablecom20140107memory-appsWmasj6cs0uqQ

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Sleep Immune system

Chronic insomnia associated with significant decreases in certain T cells and NK-cell responses (Inwim et al 2003) (Savard J et al 2003)

OSA patients have elevated levels of TNF and IL-6 with lower IL-10 supporting theory that OSA activates pro-inflammatory state (Bryant 2004)

Sleep deprivation in the ICU led to an increased risk of hospital acquired infections (Weatherstone 2003)

Sleep deprivation impacts immune function increasing pro-inflammatory indices by activating responses similar to acute injury (Okifuji amp Hare 2011)

Sleep A poor substitute for caffeine

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

The upshot allostatic load Sleep deprivation over time elevates the allostatic load

Increase appetite and energy expenditure Increase proinflammatory sytokines Decrease parasympathetic and increase sympathetic tone Increase blood pressure Increase evening cortisol insulin and blood glucose levels

Affects functional AND structural brain activity in the Hippocampus Amygdala and Prefrontal cortex

Resulting in increased affective disorders such as depression and anxiety Cognitive functioning Long term health problems such as Diabetes and cardiovascular disease

McEwen 2006

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

sleep disorders

Three big categories Those who cant get to sleep

Those who wake during sleep

Those who oversleep or sleep too much

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Ayurvedic paradigm The Doshas

Vata The force of movement inspiration and excitement

Lightness dryness

When disordered anxiety flighty unable to focus

Pitta The force of transmutation and transformation

Sharp direct focused

When disordered anger physical heatmdashreflux ulcers

Kapha The force of groundedness and cohesiveness

Heavy slow sense of safety

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

seeing the sleep disorders from a different perspective Pitta sleep disorders

Cant fall asleep 10pm-2am second wind

Vivid fiery dreams will wake them but they can get back to sleep

Vata sleep disorders Usually wakes during the night and cant fall back to sleep

2-6 am wakers

Kapha sleep disorders Heavy sleepers who tend to oversleep and wake sluggish in the morning

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Lifestyle changes

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

For everyone Adequate fluid intake throughout the day

(preferably water)

Adequate rest

Meditation approaching the day with a restful state of mind

7 hours sleep minimum associated with decreased morbidity and mortality (Brant et

al 2004)

Stress management strategies

Journaling meditation nature

Decreased stimulants

Appropriate before bed activity

Eliminate screen time

Decrease reading in the hour before bed

Earlier lighter dinners Make bedtime a ritual

Oil massage bath meditation quiet activity connection time

Restful Waves Dornberghttpklimagekindcomartstunningrestfuloil_paintingfine-art-prints

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Vata has the quality of lightness and mobility the opposite of those qualities that support sleep

Need grounding depth heaviness

Exercise Timing and type matter

Daytime exercise avoid overstimulation especially in the evenings

walking hiking gentle cycling yoga or chi gong

Lifestyle Thrive with routine though they resist it and they love

change

3 meals per day at regular times warm oily and spiced

Increased oils and grounding foods (roots grains etc)

Lots of fermented foods

Oil massage regularly especially at night

Images heymonicabcom

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Pitta is hot fiery and intense

Exercise Make sure that exercise is not

overly intense but do it with relaxed effort instead

Enjoy activities like walking hiking light jogging swimming cycling or yoga in the morning or evening (when it is coolest) and try to breathe through your nose the entire time

Lifestyle Steady intake of dark leafy greens sweet

fruits non-oily foods

Need a lot more focus on rest and ease to counterbalance the tendency to be so very intense

Images heymonicabcom

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Kapha is dense cohesive and slow moving

Routine is important Wake before 6 am

Kapha is highest from 6-10am increasing the likelihood of waking tired

To bed soon after 10

More vigorous exercise Best in the evenings and first thing in

the morning

brisk walking jogging biking hiking martial arts and other forms of strength-building aerobic exercise

Images heymonicabcom

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Nature has no apology to offer It does the work if you know how to line up the parts then food and rest that is required

~AT Still Osteopathy Research and Practice

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

[The] processes of Life must be kept in motionmdashAT Still Philosophy of Osteopathy

My mentors taught me to always be sure to treat the sacrum and to get the neck moving in all sleep disorders

bull Vedic anatomy

Throat area is the place of physical mentalemotional and spiritual purification

Inefficient processing leads to energetic and thus physical manifestations of blockage (somatic dysfunction)

bull Sacrum

Grounding

Autonomic balancing

bull Cranial base and OA

Lymphatic flow

Mid-brain motion

Autonomics

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Balancing the autonomics

The autonomic model of OMT targets balancing of the SNS and PNS drive MFR of the following areas can affect autonomic influences of sleep

Case study of sleep disorder and anhidrosis following trauma revealed resolution after one treatment of the following areas with MFR

Rib raising

Soft tissue

Paraspinal inhibition

Collateral ganglion

Thoracolumbar regionNobles T Bach A Boesler D Case report of osteopathic treatment of insomnia and traumatic anhidrosis IJOM (2016) httpdxdoiorg1-1016jijosm201601006

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

OCMM amp sleep

In a pilot study by Cutler et al CV4 was shown to decrease sleep latency and sympathetic nerve activity as compared to CV4 sham treatment and no treatment

Cutler M et al Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans a pilot study J Altern Complement Med 2005 Feb11(1)103-8

Marma points for sleep disorders

Focus on balancing

bull the Doshas

bull The autonomic system

Yoga to support sleep

Postures (asanas) can stimulate or ameliorate the doshas

bull To support sleep

bull Downward grounding energy

bull Balance the predominant and disturbing dosha

Vajrasana

Bhujangasana (cobra)

Shirshasana (headstand)

Halasana (plow)

Pascimottanasana

VATA postures

Pitta balancing postures

Janu shirshasana

Dhanurasana (bow)

Ardha navasana (half boat)

Setu banda sarvangasana

Ustrasana

Sarvangasana

Kapha balancing postures

Ardha matsyendrasana

Vrksasana

Tadasana

Parupurna navasana

gomukhasana

htt

p

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ws

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ain

tin

g-S

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it-L

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18

33

61

106

27

6v

iew

A good laugh and a long sleep are the best cures in the doctors book

~ Irish proverb

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

Yoga to support sleep

Postures (asanas) can stimulate or ameliorate the doshas

bull To support sleep

bull Downward grounding energy

bull Balance the predominant and disturbing dosha

Vajrasana

Bhujangasana (cobra)

Shirshasana (headstand)

Halasana (plow)

Pascimottanasana

VATA postures

Pitta balancing postures

Janu shirshasana

Dhanurasana (bow)

Ardha navasana (half boat)

Setu banda sarvangasana

Ustrasana

Sarvangasana

Kapha balancing postures

Ardha matsyendrasana

Vrksasana

Tadasana

Parupurna navasana

gomukhasana

htt

p

ww

ws

aa

tch

iart

co

ma

rtP

ain

tin

g-S

pir

it-L

ife

18

33

61

106

27

6v

iew

A good laugh and a long sleep are the best cures in the doctors book

~ Irish proverb

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

Pitta balancing postures

Janu shirshasana

Dhanurasana (bow)

Ardha navasana (half boat)

Setu banda sarvangasana

Ustrasana

Sarvangasana

Kapha balancing postures

Ardha matsyendrasana

Vrksasana

Tadasana

Parupurna navasana

gomukhasana

htt

p

ww

ws

aa

tch

iart

co

ma

rtP

ain

tin

g-S

pir

it-L

ife

18

33

61

106

27

6v

iew

A good laugh and a long sleep are the best cures in the doctors book

~ Irish proverb

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

Kapha balancing postures

Ardha matsyendrasana

Vrksasana

Tadasana

Parupurna navasana

gomukhasana

htt

p

ww

ws

aa

tch

iart

co

ma

rtP

ain

tin

g-S

pir

it-L

ife

18

33

61

106

27

6v

iew

A good laugh and a long sleep are the best cures in the doctors book

~ Irish proverb

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

htt

p

ww

ws

aa

tch

iart

co

ma

rtP

ain

tin

g-S

pir

it-L

ife

18

33

61

106

27

6v

iew

A good laugh and a long sleep are the best cures in the doctors book

~ Irish proverb

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

resources Diekelmann S Born J The memory function of sleep Nature Reviews Neuroscience 11 114-126 (February 2010) |

doi101038nrn2762

Jessen NA et al The Glymphatic System A beginners Guide Neurochem Res (2015) 402583-2599 DOI 101007s11064-015-1581-6

Tarasoff-Conway J Clearance systems in the brainmdashimplications for Alzheimer disease Nature Reviews Neurology 11 457ndash470 (2015) doi101038nrneurol2015119Published online 21 July 2015

Hedok Lee et al The Effect of Body Posture on Brain Lymphatic Transport The Journal of Neuroscience 5 August 2015 35(31) 11034-11044 doi 101523JNEUROSCI1625-152015

Lulu X et al Sleep Drives Metabolite Clearance from the Adult Brain Science 18 Oct 2013 Vol 342 Issue 6156 pp 373-377DOI 101126science1241224

Miglis MG Autonomic dysfunction in primary sleep disorders Sleep Medicine (2015) httpdxdoiorgdoi 101016jsleep201510001

Meerlo P Sgoifo A Suchecki D Restricted and disrupted sleep effects on autonomic function neuroendocrine stress systems and stress responsivity Sleep Medicine Reviews (2008) 12 197-210

Canessa N et al Obstructive Sleep Apnea Brain Structural Changes and Neurocognitive Function before and after Treatment American Journal of Respiratory and Critical Care Medicine Vol 183 No 10 (2011) pp 1419-1426

Yoo SS et al The human emotional brain without sleep-a prefrontal amygdala disconnect Current Biology Vol 17 No 20 R878

Schuh-Hofer S et al One night of total sleep deprivation promotes a state of generalized hyperalgesia a surrogate pain model to study the relationship of insomnia and pain Pain 2013 Sep154(9)1613-21 doi 101016jpain201304046 Epub 2013 May 11

Hagewoud R et al Sleep deprivation impairs spatial working memory and reduces hippocampal AMPA receptor phosphorylation Journal of Sleep Research Volume 19 Issue 2 pages 280ndash288 June 2010

Smith C The REM sleep window and memory processing in Sleep and brain plasticity (eds Maquet P Smith C amp Stickgold R) 117ndash133 (Oxford)

Gomez-Gonzalez B et al Role of sleep in the regulation of the immune system and the pituitary hormones Ann NY Acad Sci 1261 (2012) 97-106

Resources Lovato N amp Gradisar M A meta analysis and model of the relationship between sleep and depression in adolescents Recommendations for future

research and clinical practice Sleep Medicine Reviews 2014 doi 101016jsmrv201403006

Cortese S et al Assessment and management of sleep problems in youths with ADHD Journal of the American Academy of Child and Adolescent Psychiatry 52 784-796

Rosen L et al Sleeping with technology cognitive affective and technology usage predictors of sleep problems among college students Sleep Health 2 (2016) 49ndash56

Lemola S et al Adolescentsrsquo Electronic Media Use at Night Sleep Disturbance and Depressive Symptoms in the Smartphone Age J YouthAdolescence (2015) 44405ndash418 DOI 101007s10964-014-0176-x

Augner C AssociAtions of subjective sleep quAlity with depression score Anxiety physicAl symptoms And sleep onset lAtency in studentsCent Eur J Public Health 2011 19 (2) 115ndash117

Lad V Durve A Marma points of Ayurveda The Ayurvedic Press Albuquerque NM 2008

Lad V Textbook of Ayurveda Fundamental Principles 5th ed The Ayurvedic Press Albuquerque NM 2002

Lui X et al Insomnia and hypersomnia associated with phenomenology and comorbidity in childhood depression Sleep 30 83-90

Baum KT et al Sleep restriction worsens mood and emotion regulation in adolescents Journal of child and adolescent psychiatry 55 180-190

Cain N Gradisar M (2010) Electronic media use and sleep in school-aged children and adolescents A review Sleep Medicine 11 735-742

Primack BA et al (2009) Association between media use in adolescence and depression in young childhood A longitudinal study Archives of general psychiatry 66 181-188

Rosen et al Sleeping with technology cognitive affective and technology useage as predictors of sleep problems among college studdents Sleep Health 2 (2016) 49-56

Schuh-Hofer s et al One ngiht of total sleep deprivation promotes a state of generalized hyperalgesia A surrogate pain model to stufy the relationship of insomnia and pain Pain vol 154 issue 9 spet 2013 1613-1621

McEwen B Sleep deprivation as a neurologic and physiologic stressor allostasis and allostatic load Metabolisn Clinical and Experimental 55 (Suppl 2) (2006) S20-S23

Resources

Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534

Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69

Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467

Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)

Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)

Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)

Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071

Resources

Okifuji A amp Hare BD Do sleep disorders contribute to pain sensitivity Curr Rheumatol Rep (2011) 13528-534

Lautenbacher S Kundermann B Kreig JC Sleep deprivation and pain perception Sleep med Rev 2006 10(5)357-69

Bryant PA Trinder J Curtis N Sick and tired Does sleep have a vital role in the immune system Nature Reviews (June 2004) vol 4 457-467

Inwim et al Nocturnal catecholemines and immune function in isomniacs depression and control subjects Brain Behav Immun 17 365-372 (2003)

Savard J et al Chronic insomnia and immune functioning Psychosom Med 65 211-221 (2003)

Weatherstone KB Franck LS Klein NJ Are there opportunities to decrease nosocomial infection by choice of analgesic regimen Evidence for immunity and pain interactions Arch Pediatr Adolesc Med 157 1108-1114 (2003)

Chrousos G Vgontzas AN Kritikou I HPA Axis and Sleep [Updated 2016 Jan 18] In De Groot LJ Beck-Peccoz P Chrousos G et al editors Endotext [Internet] South Dartmouth (MA) MDTextcom Inc 2000- Available from httpwwwncbinlmnihgovbooksNBK279071