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Overlapping Overlapping Brain StatesBrain States
Daniel Erichsen, MD 08/04/2011Daniel Erichsen, MD 08/04/2011
State(s) of the brainState(s) of the brain AwakeAwake Non REM SleepNon REM Sleep REM sleepREM sleep
How do you know?How do you know? AwakeAwake
ResponsiveResponsive TalkTalk Hear/Feel/See/SmellHear/Feel/See/Smell
Purposeful movementsPurposeful movements WalkingWalking
Complex movementsComplex movements EatingEating
Eyes openEyes open
How do you know?How do you know? Asleep (Non REM sleep)Asleep (Non REM sleep)
Unresponsive/Increased sensory threshold.Unresponsive/Increased sensory threshold. Relatively immobileRelatively immobile Absence of purposeful/complex movementsAbsence of purposeful/complex movements Regular respirationRegular respiration PosturePosture Eyes closedEyes closed
Is it possible to fake sleeping?Is it possible to fake sleeping? YesYes
How can we objectively tell if someone is sleeping?How can we objectively tell if someone is sleeping? EEGEEG
WakeWake 13 – 30 oscillations per second (Hz)13 – 30 oscillations per second (Hz) Low amplitude/voltageLow amplitude/voltage = Beta activity= Beta activity
Wake, eyes closed/openWake, eyes closed/open 8 – 13 oscillations per second (Hz)8 – 13 oscillations per second (Hz) Higher amplitude/voltageHigher amplitude/voltage = Alpha activity= Alpha activity
Stage 2 sleepStage 2 sleep 4 – 8 oscillations per second (Hz)4 – 8 oscillations per second (Hz) Sleep spindles, K-complexesSleep spindles, K-complexes Medium amplitude/voltageMedium amplitude/voltage = Theta activity= Theta activity
Stage 3 sleep (Slow wave sleep/Delta sleep)Stage 3 sleep (Slow wave sleep/Delta sleep) <4 oscillations per second (Hz)<4 oscillations per second (Hz) High amplitude (>75 mV)High amplitude (>75 mV) = Delta activity= Delta activity
State(s) of the brainState(s) of the brain AwakeAwake Non REM SleepNon REM Sleep REM sleepREM sleep
REM sleepREM sleep Rapid eye movementsRapid eye movements Paralysis / Loss of muscle toneParalysis / Loss of muscle tone Engorgement of erectile tissueEngorgement of erectile tissue DreamsDreams
REM sleepREM sleep Why paralysis in REM sleep?Why paralysis in REM sleep?
Nocturnal penile tumescence testingNocturnal penile tumescence testing
REM sleepREM sleep Beta activity (13-30 Hz)Beta activity (13-30 Hz)
HypnogramHypnogram
HypnogramHypnogram
HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
HypnogramHypnogram
“Sorry doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Pt in 2B lost his IV…Yes the chubby 3 month old..”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Pt in 2B lost his IV…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamil!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
AAAAAAAAAAHHHHHH!!!!!!AAAAAAAAAAHHHHHH!!!!!!
HypnogramHypnogram
“Doc, he has fever 99.8!What to do??”
“We’re out of Enfamilk!”
“Sorry wrong number…”
“We’ve got and admission.. 16y o with dehydration..”
“Patient 2B lost his IV again…Yes the chubby 3 month old..”
“We’re still out of Enfamilk..”
“We don’t have a Tylenol order for 5A…”
“Patient 2B lost his IV again..”
“Patient 5A says she can’t sleep..”
“Time to sign out!”
HypnogramHypnogram
Ah, finally Morning Report. Zzzzz
Can a person be asleep and awake at the same time?Can a person be asleep and awake at the same time?
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