الفهرس 
Normal SleepOnly 14 pages are availabe for public view
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Abstract
In the light of the above mentioned facts, it is proved that
our brains are very active during sleep. Moreover, sleep
affects our daily functioning and our physical and mental
health in many ways that we are just beginning to
understand.
Nerve-signaling chemicals called neurotransmitters
control whether we are asleep or awake by acting on
different groups of nerve cells, or neurons, in the brain.
Neurons in the brainstem, which connects the brain with
the spinal cord, produce neurotransmitters such as serotonin
and norepinephrine that keep some parts of the brain active
while we are awake. Other neurons at the base of the brain
begin signaling when we fall asleep. Human sleep has been
described as a succession of five recurring stages: four non-
Rapid Eye Movement (non REM) stages and REM stage.
Sleep and the circadian system exerts a strong regulatory
influence on immune functions.
Investigations of the normal sleep–wake cycle showed
that immune parameters like numbers of undifferentiated
naïve T cells and the production of pro-inflammatory
cytokines exhibit peaks during early nocturnal sleep
whereas circulating numbers of immune cells with
immediate effector functions, like cytotoxic natural killer
cells, as well as anti-inflammatory cytokine activity peak
during daytime wakefulness. There is an interrelationship
between sleep and autoimmune neurological disorders and
there are multiple sleep disturbances that are noticed in
patients with these disorders. Sleepiness, fatigue, and sleep
fragmentation are among the most frequent symptoms of
acute and chronic inflammatory neurologic autoimmune disorders.In the same sense, patients with multiple sclerosis
report symptoms of insomnia ,sleep disordered breathing,
periodic leg movements and fatigue in addition to
narcolepsy as well .Yawning and napping provided
symptoms relief among MS patients .Fatigue is a highly
prevalent and disabling symptom in immune-mediated
neuropathies which include Guillain–Barre syndrome
(GBS), chronic inflammatory demyelinating
polyneuropathy (CIDP).
Patients with GBS report hallucinations with severely
abnormal REM and NREM sleep structure associated with
lack of atonia during REM sleep. These with CIDP report
symptoms of restless leg syndromes (RLS) but to date the
occurrence of RLS in CIDP has not been studied
specifically. Muscle fatigability has been mentioned in
most myasthenia gravis studies and these studies have
shown that MG patients have more fatigue than healthy
controls.
Patients with MG often report symptoms of nonrestful
sleep, excessive daytime sleepiness and sleep apnea. It was
proven that sleep helped mitigate neuromuscular
fatigability during the day in MG patients. Obstructive
sleep apnea was shown to be increasingly prevalent among
cases of inflammatory myopathies like dermatomyositis
(DM) , polymyositis (PM) , sporadic inclusion body
myositis (sIBM) and rheumatoid arthritis (RA) as well as
juvenile idiopathic arthritis (JIA). Daytime sleepiness ,
restless leg sensations , poor to fair quality sleeping and
insomnia are some of the common symptoms among RA
patients.
There is a need for more research with larger sample
sizes to clarify the issue of sleep deprivation in RA patients. There was a noticeable improvement in
polysomnography parameters in these patients following
anti-TNF-a therapy. Elevated potentially sleep-relevant
cytokines like TNF-a and IL-6 was reported in cases of
acute disseminated encephalomyelitis (ADEM) .Likewise
,hypersomnia , fragmented night sleep and early sleepwake
disturbances have been described in patients with
autoimmune limbic encephalitis in addition to some
reported symptoms of severe sleep apnea. Furthermore,
there is a novel sleep disorder characterized with non-REM
and REM parasomnia and obstructive sleep apnea which is
associated with IgLON5 antibodies