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

Lyme Patient at 3 AM

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

Anatomy and Physiology

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

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

Melatonin Release

Histamine Control and Release Histamine Control Center in Hypothalamus

OREXIN

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

Sleep Stages

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

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

Neuropathic Pain

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

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

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

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

Wonderful Sleep