Sleep and Chronobiology

Semmelweis University, Faculty of Medicine

Name of the managing institute (and any contributing institutes): Institute of Behavioural Sciences, Department of Physiology, Department of Pulmonology, Department of Neurology, 1st Department of Paediatrics

Name of the subject: Alvás és kronobiológia

in English: Sleep and Chronobiology

in German: Schlaf und Chronobiologie

Credit value:

Number of lessons per week:   2     lecture:       2         practical course:          seminar:

Subject type:      compulsory course       elective course         optional course

Name of the course leader: Dr. habil. Róbert Bódizs

His/her workplace, e-mail address: Institute of Behavioural Sciences, Semmelweis University, bodizs.robert@med.semmelweis-univ.hu

Position: Senior Research Fellow

Date and registration number of their habilitation: 30. 06. 2014., 01/2014 (Semmelweis University) 

Objectives of the subject, its place in the medical curriculum:  

Aim of the course: providing up-to-date, scientifically grounded knowledge on the physiological, behavioural, psychological and clinical aspects of sleep-waking states and related chronobiological phenomena. Multidisciplinarity, integrative approaches and the emphasis of rhythmic processes are the defining features of the course. Theoretical lectures are always completed with clinical corners, exemplifying the biomedical relevance of the mechanisms and processes detailed in the presentation. In turn, clinical topics are accompanied by sections termed theoretical relevance, unravelling the modelling consequences of the respective disorders.

Successful completion of the subject results in the acquisition of the following competencies:

Understanding the core features of biological rhythms and sleep, ability of using chronobiological concepts in understanding medical and behavioural phenomena, knowledge on the defining EEG features of different sleep-waking states, recognizing the main sleep and circadian rhythm disorders, getting involved in sleep and chronobiology research studies

Detailed curriculum:

(Theoretical and practical lessons shall be given separately by numbering the lessons (by weeks).

Sleep and chronobiology – elective course

Fridays at 4.00 p.m. in seminar room 6 (NET-SZ.06)

February 16.

What is sleep? The definition of sleep, rest and sleep, chronobiology, circadian rhythms, nocturnality-diurnality, chronopathology, chronomedicine, chronotherapy. Clinical corner: sleepwalking, subjective (paradoxical) insomnia, sleep paralysis (Róbert Bódizs)

February 23.

How and why we sleep? Circadian, homeostatic and permissive factors in sleep regulation. Ultradian sleep cycles. Sleep phases and sleep stages, sleep regulatory networks in the brain. Clinical corner: sleep homeostasis, neural plasticity and depression (Róbert Bódizs)

Március 1.

Zoom in on sleep: sleep EEG microstructure and oscillations. Infra(slow), delta, theta, alpha, sigma, beta, gamma and ripple oscillations. EEG spectral profiles of sleep waking states. Thalamocortical system and conscious awareness. Clinical corner: measuring consciousness by EEG analysis, sleep EEG oscillations, cognitive abilities and dementia (Róbert Bódizs).

March 8.

When do we sleep? The circadian molecular clock, clock genes and proteins, biological days and nights, social jetlag, central and peripheral oscillators. Clinical corner: clock gene polymorphisms, chronotypes and circadian rhythm disorders (Krisztina Káldi)

March 15 – National holiday

What is wakefulness? Wakefulness, arousal, and attention, ARAS, alpha, beta and gamma oscillations and their role in vigilance. The default Mode Network of the brain. Sleepiness and its measurement (pupillometry, alpha attenuation, etc). Clinical corner: ADHD, sleep and sleepiness (Róbert Bódizs)

March 22.

State dissociation and other peculiarities during sleep. Parasomnias: NREM parasomnias and REM sleep behaviour disorder, nocturnal frontal lobe epilepsy, aggressive behaviour during sleep, sexsomnia, somniloquy. Theoretical consequences: local sleep, sleepwalking and consciousness (Anna Szűcs)

March 29 – Good Friday (Easter holiday)

What is the role of sleep? The function(s) of sleep. Ecological, restorative, detoxification, memory consolidation, network reorganization and immunological functions. Clinical corner: vaccination and sleep, from circadian desynchronization through sleep loss to weight gain (Róbert Bódizs)

April 5

Breathing space. Sleep-related breathing disorders Obstructive and central sleep apnoea disorders, hypoventilation, hypoxemia. Sleep depth, time-of-day and breathing during sleep. Theoretical consequences: sleep fragmentation vs sleep loss: the detrimental effects of sleep fragmentation (Gábor Horváth)

April 12

On the inability to get sleep. Insomnia and its treatment. Chronic and short-term insomnia, secondary insomnia, insomnia and circadian rhythm disorder, insomnia as insufficient sleep homeostasis, insomnia and hyperarousal. Pharmacotherapy and cognitive behavioural therapy of insomnia, sleep hygiene. Theoretical consequences: learning-dependent and emotional regulation of sleep (György Purebl).

April 19.

Sleeping at the wrong time. Circadian rhythm disorders. Delayed and advanced sleep phase disorder, non-24-hour sleep phase disorder, irregular sleep phase disorder, shift work. Chronotherapy: jet-lag, light therapy, exogenous melatonin. Theoretical consequences: inclusion of external light and physical activity in sleep-wake modelling (György Purebl, Róbert Bódizs)

April 26.

Getting too much sleep. Hypersomnia: narcolepsy and its forms, idiopathic hypersomnia, Kleine-Levin syndrome, hypersomnia caused by other disorders. Theoretical consequences: orexin and flip-flop regulation of sleep (Anna Szűcs)

May 3

Why and how we dream? Dreams, and dream disorders. The neurobiology and psychology of dreaming, overall formal and content features of dreams, chronobiological features of dreaming, dreaming and mind wandering. Sleep paralysis, nightmares and nightmare disorder, nightmares and psychopathology. Theoretical consequences: lucid dreaming and consciousness (Péter Simor)

May 10

Sleep like a baby. Sleep-related phenomena and sleep disorders in infants, toddlers, and children. Solitary sleeping and co-sleeping. The slow emergence of the diurnal activity profile, maturation of circadian rhythms, limit setting issues, sudden infant death, other sleep disorders in infancy and childhood. Theoretical consequences: on the anthropology of sleep in infants (Zsófia Lendvai).

May 17

Moving while you sleep. Sleep-related movement disorders. Restless leg syndrome, periodic leg movements during sleep, sleep bruxism, rhythmic movements during sleep, leg cramps during sleep, benign sleep myoclonus in infants. Theoretical consequences: movements during wakefulness and sleep (Anna Szűcs)

Other subjects concerning the border issues of the given subject (both compulsory and optional courses!). Possible overlaps of themes:

Physiology (circadian rhythms, neural oscillations and EEG patterns, the thalamocortical system)

Medical Psychology (sleep disorders, especially insomnia, consciousness and sleep-waking states)

Neurology (hypersomnias of central origin, parasomnia)

Psychiatry (insomnia, depression and sleep)

Special study work required to successfully complete the course:

(E.g. field exercises, medical case analysis, test preparation, etc.)

Field exercises in sleep research for at least 8 hours in total (students have to participate in one of the activities detailed below):

–          sleep research by using mobile devices (polysomnography headbands, actigraphy)

–          sleep research or sleep medicine in a laboratory setting

–          data analysis/digital signal processing in the field of chronobiology and/or sleep research

–          cognitive testing of alertness by using specific tools

Requirements for participation in classes and the possibility to make up for absences:

75% of the classes have to be attended (minimum requirement). The made up for absences up to the 50% of the classes: increasing the time spent in sleep/chronobiology research activities by an equivalent amount of time.

Methods to assess knowledge acquisition during term time:

(E.g. homework, reports, mid-term test, end-term test, etc., the possibility of replacement and improvement of test results)

There will be no tests of knowledge acquisition during term time. Improvement of test results can be done upon request of an oral examination.

Requirements for signature: Participation in field exercises

Type of examination: Written exam (single- and multiple-choice questions)

Requirements of the examination:

(In case of a theoretical examination, please provide the topic list; in case of a practical exam, specify the topics and the method of the exam)

1. The definition of sleep and chronobiology
2. The circadian molecular clock
3. Circadian, ultradian, homeostatic and permissive factors of sleep regulation
4. Sleep EEG microstructure and oscillations
5. Wakefulness, arousal, attention
6. The functions of sleep
7. Insomnia and its treatment
8. Sleep-related breathing disorders
9. Hypersomnia
10. Circadian rhythm disorders
11. Parasomnia
12. Dreaming and its disorders
13. Sleep-related movement disorders
14. Sleep and its disorders in infants, toddlers and children

Method and type of evaluation:

(Method of calculating the final mark based on the theoretical and practical examination. How the mid-term test results are taken into account in the final mark.)

There will be no mid-term tests. The evaluation will be based on the written exam as follows:

–          the maximal test score will be 50 points

–          grade 5: 40–50 points

–          grade 4: 30–40 points

–          grade 3: 20–30 points

–          grade 2: 10–20 points

–          grade 1: 0–10 points

Possibilities for exam retake: In case of failure, the student will be given a one-time opportunity to improve his/her performance.

Printed, electronic and online notes, textbooks, guides and literature (URL address for online material) to aid the acquisition of the material:

Allada R, Bass J. Circadian Mechanisms in Medicine. N Engl J Med 2021;384:550-61. http://dx.doi.org/10.1056/NEJMra1802337

Samson DR. Taking the sleep lab to the field: Biometric techniques for quantifying sleep and circadian rhythms in humans. Am J Hum Biol. 2020;e23541. https://doi.org/10.1002/ajhb.23541

Koukkari WL, Sothern RB. Introducing Biological Rhythms: A Primer on the Temporal Organization of Life, with Implications for Health, Society, Reproduction and the Natural Environment. New York: Springer, 2006. http://dx.doi.org/10.1007/978-1-4020-4701-5

Refinetti R. Circadian Physiology. 3^rd ed. CRC Press, 2016.

Bassetti C, McNicholas W, Paunio T (eds). European Sleep Medicine Textbook, 2^nd ed. European Sleep Research Society, 2021.

Chokroverty S, Thomas RJ (eds). Atlas of Sleep Medicine. 2nd ed. Elsevier, Saunders. 2013. https://www.elsevier.com/books/atlas-of-sleep-medicine/unknown/978-1-4557-1267-0