3. “To sleep perchance to dream..that’s the rub!” spoken by Hamlet

4. Lyme Patient at 3 AM

5. Importance of Sleep 1. Mood, memory, cognition 2. Endocrine function
3. Immune regulation and repair
4. Insomnia increases risk for other conditions,
such as diabetes, HBP, Dementia,
heart attacks
5. Control of Homeostasis, Circadian rhythms

7. Anatomy and Physiology

8. Circadian Rhythms
Refer to cyclic changes in the body which control sleep, wakefulness,
2. Also called our Biologic clock
Controlled by the suprachiasmic nucleus or SCN in response to ambient light
WE ARE CREATURES OF THE LIGHT

9. SCN 1. Sits above optic chiasm
2. Small area: 20,000 specialized nuclei
3. Neuronal and hormone activities
control sleep/wake cycles
4. Responds to ambient light from retinal
cells thru retinal-hypothalamic tract

10. Melatonin Release

12. Histamine Control and Release
Histamine Control Center in Hypothalamus

13. OREXIN

14. Stages of Sleep 1. REM Rapid eye movement
Active brain in a paralysed body
2. NREM
Non-rapid eye movement
Quiet brain in a active body

15. Sleep Stages

17. Inflammation and Sleep
The production of inflammatory cytokines may trigger onset of poor sleep cycles

18. Cytokines and Sleep
IL1 and TNF promote NREM sleep in non-infected animal.
Injection into human subjects causes
sleep deprivation symptoms and need for sleep
3. These cytokines disturb production of wakefullness neurtransmitters
Control of inflammation improves sleep by attenuating this mechanism

19. Neuropathic Pain

20. Antihistamines that Help Sleep
H1 blockers cause sedation:
Benadryl, Atarax, and many others

21. NEUROPATHIC PAIN BLOCKERS
1. GABAPENTIN
a. Wide therapeutic range.Titrated up to as much as
3600mg
b. Controls sleep and pain thru control of gaba receptors
thus quieting the brain
2. TRILEPTAL or LYRICA
a. Titrated up to max doses for daytime neuropathic
pain management
b. May be used before sleep for neuropathic pain but are not
sleep meds

22. Prescription Meds for Sleep
Sedative-hypnotics: Ambien, Sonata,
Lunesta
2. Tranquilizers:
Trazadone, Seroquel, Klonopin,
Xanax, Valium, Ativan
3. Belsomra is a new agent that suppresses production of Orexin

23. Improving Sleep 1. Take phosphatidyl serine 200-300mg at 8pm
to lower cortisol before sleep. Titrate gabapentin begin at 9pm
to produce stage 3 and 4 deep sleep .
2. Take melatonin 3-10 mg 30 min before sleep
3. Take an antihistamine to suppress wakefullness effects of
histamine
4. Basic sleep hygiene: lose the phone, tablet, turn off TV
don’t exercise late in the evening
5. Control pain: specifically neuropathic pain caused by Lyme
Gabapentin works best at nite, Trileptal or Lyrica during day
6. Control Cytokines by detoxing
7. Ashwagandha 500 mg AM and Noon to simulate cortisol
production by adrenals

24. Wonderful Sleep