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sorption of water Parasympathetic out ow is activated periodically in REM sleep; sympathetic activity is suppressed Breathing is C /A more irregular and heart rate and blood pressure uctuate Penile erections appear periO /A odically, usually during REM periods A number of hormonal changes have a regular relationship to the sleep-wake cycle The secretion of cortisol and particularly of ROC/A thyroid-stimulating hormone is diminished at the onset of sleep High concentrations of LOC/A cortisol are characteristically found on awakening Melatonin, elaborated by the pineal gland, is produced at night and ceases upon retinal stimulation by sunlight (see Chap 27) D During the rst 2 h of sleep there is a surge of growth hormone secretion, mainly during sleep stages 3 and 4 This feature persists through middle and late adult life and then C /A disappears Prolactin secretion increases during the night in both men and women, the O /A highest plasma concentrations being found soon after the onset of sleep Also, an increased sleep-associated secretion of luteinROC/A izing hormone occurs in pubertal boys and girls Neurophysiology of Sleep Evidence from LOC/A animal studies suggests that the physiologic mechanisms governing NREM and REM sleep lie in the pontine reticular formation Chin EMG and are in uenced by acetylcholine and by E the two biogenic amines 5-hydroxytryptamine (serotonin) and norepinephrine Serotonergic neurons are located in and near the midline or raphe regions of the pons; the lower groups of raphe cells project to the medulla and spinal cord; the more rostral groups project to the medial temporal (limbic) cortex; and the dorsal raphe nuclei project to the neostriatum, cerebral and cerebellar cortices, and thalamus Norepinephrine-rich neurons are concentrated in the locus ceruleus and related nuclei in the central tegmentum of the caudal mesencephalon as well as in other lateral-ventral tegmental regions These neurons project downward to the lateral horn cells of the spinal cord and upward via cenF Figure 19-2 (Continued) D Upper tracings: Stage 3 sleep Appearance of high-voltage slow (delta) trally located tegmental tracts to speci c thawaves E Middle tracings: Stage 4 deepest stage of sleep, with predominant delta wave activity lamic and hypothalamic nuclei and all of the cerebral cortex, and, via the superior cereoccupying 50 percent of a 30-s tracing F Lower tracings: REM sleep, characterized by episodes of bellar peduncle, to the cerebellar cortex Chorapid eye movement and occasional muscle twitches in an otherwise at chin EMG Technical Note: Four sites from the same montage are illustrated in each recording: C3/A2, left linergic neurons are found in two major loci central to right mastoid; O2/A1, right occipital to left mastoid; ROC/A1, right outer canthus to left in the parabrachial region of the dorsolateral mastoid; LOC/A2, left outer canthus to right mastoid A chin EMG tracing is added to each recording pontine tegmentum in the pedunculopon(Adapted with permission from Butkov N Atlas of Clinical Polysomnography Vol 1 Synapse Media, tine group of nuclei and the lateral dorsal teg1996) mental group The cholinergic cell groups project rostrally, but the precise anatomy of this projection system has not been de ned Cells from these groups Urine excretion decreases during sleep, and the absolute quanmake up parts of the ascending reticular activating system tity of sodium and potassium that is eliminated also decreases; Hobson originally proposed that the basic oscillation of the however, urine speci c gravity and osmolality increase, presumsleep cycle is the result of reciprocal interaction of excitatory and ably because of increased antidiuretic hormone excretion and reab1C 92.

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group of nuclei, Shiromani and colleagues have suggested that interaction between these neurons occurs in the region of the pedunculopontine nuclei rather than in the medial pontine reticular formation, as suggested by Hobson and associates The traditional view that dreaming and REM sleep are obligately or even closely connected has been questioned by Solms, who has presented the main alternative to Hobson s model Among patients with cerebral lesions that eliminate or disrupt REM sleep, he cites several cases in which dreaming was retained Conversely, in nine of his patients with basal forebrain (frontal) lesions, dreaming was lost, at least for a time, while REM periods remained undisturbed through the night This same observation had been made many years ago in patients who had prefrontal leukotomies Solms has proposed that the dopaminergic systems in the basal forebrain areas elicit or modulate dreaming This view is supported by the reports of diminished dreaming in patients being treated with dopaminergic blockers and the enhancement of dreaming reported by patients taking L-dopa (major intracortical dopaminergic pathways originate in the frontal lobes) It is evident from the comprehensive reviews of Culebras and other authors that there is as yet no agreement concerning the integration of all these brainstem mechanisms in the production of sleep and dreams

Figure 19-3 Normal sleep cycles REM sleep (darkened areas) occurs cyclically throughout the night at intervals of approximately 90 min in all age groups REM sleep shows little variation in the different age groups, whereas stage 4 sleep decreases with age (Redrawn by permission from Kales and Kales et al)

inhibitory neurotransmitters Single-cell recordings from the pontine reticular formation have suggested that there are two interconnected neuronal populations whose levels of activity uctuate periodically and reciprocally During wakefulness, according to this conceptualization, the activity of aminergic (inhibitory) neurons is high; because of this inhibition, the activity of the cholinergic neurons is low During NREM sleep, aminergic inhibition gradually declines and cholinergic excitation increases; REM sleep occurs when the shift is complete It is likely that these monoaminergic neuronal circuits are modulated by input from hypocretin-secreting neurons of the hypothalamus, but the details of this control system are not yet known Hypocretin, a peptide that assumes great importance in the pathophysiology of narcolepsy, is discussed further on Despite the undoubted heuristic value of Hobson s reciprocal interaction hypothesis, some of its features remain controversial Although it is generally agreed that cholinergic mechanisms selectively promote REM sleep and its components rapid eye movements, absence of activity in the antigravity muscles (ie, atonia), and desynchronized EEG the role of amines has been more dif cult to establish Thus, lesions of the locus ceruleus and raphe nuclei, which contain neurons rich in norepinephrine, do not greatly alter REM sleep Nevertheless, a considerable body of pharmacologic data suggests that a decrease in monoamines causes an increase in REM activity and vice versa Insofar as the bulk of cholinergic and aminergic neurons are found in the pedunculopontine

This parameter is used to specify for which element the properties dialog is to be called: Web Item Parameters (ITEM_PROPERTIES) Data Provider Properties (DATAPROVIDER_PROPERTIES) Conditions (CONDITIONS_PROPERTIES) Exceptions (EXCEPTIONS_PROPERTIES) Characteristic Properties (CHARACTERISTIC_PROPERTIES) Axis Properties (AXIS_PROPERTIES) Characteristic Properties Input Help (MEMBER_ACCESS_ PROPERTIES) Characteristic Properties Filter Values (FILTER_PRESENTATION_ PROPERTIES) Data Cell Properties (DATA_CELL_PROPERTIES) Structure Element Properties (STRUCTURE_MEMBER_PROPERTIES) Properties of All Data Cells (ALL_DATA_CELL_PROPERTIES) Depending on the properties source you choose, there are a number of additional parameters that you need to set

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