SLEEP DISODERS

1
SLEEP DISODERS
2
Americans

• 62 have sleep problems once wkly or more
• 40 sleepy enough during the day to interfere
  with activities
• 62 drive while drowsy
• 27 have fallen asleep while driving
• 60 children feel parents are tired during the
  day
• 15 children admit falling asleep at school

3
Women
Males
1/3 of men get less than 6 hours sleep (during
week)

• 79 report sleep disturbance during pregnancy
• 36 peri-menopausal women have disturbed sleep
• 25 suffer from significant daytime sleepiness
• 30 disturbed sleep interferes with daily
  activity, 27 job performance is impaired
• 24 say sleep gets in the way of caring for family

4
COMORBIDITIES

• 40-45 of those with insomnia hypersomnia have
  another Axis I disorder
• Mood Disorders 4x higher
• Anxiety Disorders
• Schizophrenia
• Substance abuse

5
Normal Sleep

• Normal Sleep patterns (cycles)
• Non REM
• REM
• Circadian rhythm
• Drugs influence on sleep
• Genetics of sleep

6
Sleep Disorder

• Physiology of sleep
• Sleep Stages
• NREM Sleep
• REM Sleep
• Sleep-Regulating Processes
• Circadian Rhythm
• Endogenous vs. exogenous factor
• Homeostasis
• Balance o f sleep and awake

7
Influences on Sleep

• Developmental Changes
• Newborns and Infants
• Children
• Adolescents
• Young and Middle Adults
• Older Adults myth
• Amount of sleepF (genetics, preferences,
  lifestyle, environment)

8
Influences on Sleep (Contd)

• Medical Disorders and Treatments i.e.. Asthma,
  hyperthyroidism, COPD
• Drugs and Chemical Substances i.e. alcohol,
  lithium, cocaine-gt CNS was affected
• Jet lag

9
Sleep Disorders

• Etiology
• Signs and Symptoms/Diagnostic Criteria
• Dyssomnias abnormalities in the amount, quality,
  or timing of sleep
• Narcolepsy
• breathing-related sleep disorders
• periodic limb movement disorder
• insomnia
• Parasomnias abnormal behavioral or physiological
  events associated with sleep
• sleepwalking
• tooth grinding

10
DYSSOMNIAS
11
PRIMARY INSOMNIA

• difficulty initiating and maintaining sleep
• awakenings that occur much earlier than desired
• sleep that is non-restorative and of poor quality
  
• result in impairment in daytime function.

12

• Prevalence rates are higher in women and increase
  with age.
• Associated with reduced quality of life, mood
  disorders and increased health services usage
• Represents a significant economic burden in the
  US, with estimated direct costs of 13.9 billion
  annually.

13
Causes of Insomnia

• Change in sleep environments
• Jet lag
• Changes in work shift
• Excessive noise
• Unpleasant room temperature
• Stressful life events
• Medical condition
• Medications
• Poor sleep hygiene

14
Behavioral Model of Insomnia

• Insomnia occurs acutely in relation to both
  predisposing and precipitating factors
• The chronic form of the disorder is maintained by
  maladaptive coping behaviors.
• A state of conditioned arousal may develop in
  which situations associated with sleep become
  alerting rather than relaxing- further impairing
  sleep.

15
Insomnia Cycle
16
Cognitive Behavioral Therapy for Insomnia

• change poor sleep habits and faulty beliefs about
  sleep
• promote good sleep hygiene
• THROUGH.
• sleep restriction, stimulus control, relaxation
  techniques, education and good sleep practices.

17

• CBT is as successful as medications in the acute
  treatment (4-8 weeks) of insomnia.
• It is more effective than medications in the long
  term.
• Average of 50-60 improvement
• Long term studies reveal a sustained improvement
  in sleep quality and duration.
• Patients continued to experience improvement over
  follow-up periods of gt1year.

18
Other Treatments

• Pharmacologic therapy
• Benzodiazepines / related hypnotics
• Antidepressants
• Antihistamines
• Melatonin
• Light

19
BREATHING-RELATED SLEEP DISORDER

• Unlike people with insomnia, this is a
  structural/ anatomical problem with physiological
  consequences
• Treatment with oral appliance or surgery is
  needed
• Sleep maintenance, sleep walking, or other
  consequences are generally relieved after
  treatment but..
• Co-occurring sleep disorders may need
  psychological treatment.

20
Sleep Apnea

• Obstructive sleep apnea
• Clinical manifestations
• Central sleep apnea
• Restrictive lung disease
• Neuromuscular disease
• Cardiac
• Neurological

21
Other sleep disorders

• Narcolepsy
• Genetic Aspects of narcolepsy
• Irresistible attacks of refreshing sleep daily
  for 3 months
• Diagnosis
• Cataplexy- brief periods of loss of muscle tone
• REM disordered transitions- can report
  hallucinations, sleep paralysis at transitions
  between wakefulness and sleep
• Treatment of narcolepsy
• Stimulants, REM suppressants
• Behavioral adjustments

22
Circadian Rhythm Sleep Disorder

• Causes insomnia because of a lack of
  synchronization between an individuals internal
  clock and the external schedule
• Treatment is best accomplished with chronotherapy
  and/ or phototherapy

23
(No Transcript)
24
Specifiers

• Delayed Sleep Type- late sleep onset late
  awakening
• Shift Work Type
• Unspecified Type
• Jet Lag Type

25
Jet Lag Type

• Use activities (eating, exercise, sightseeing)
  and exposure to light to try to synchronize body
  rhythms with those of the new environment
• Melatonin 3 mg about 30 minutes before bedtime on
  the day of travel and for up to four days after
  arrival is appropriate
• A dose of 0.5 mg has less effect on sleep, but
  otherwise helps adaptation similarly
• Adult travelers crossing five or more time zones
  are likely to benefit from melatonin

26

• DYSSOMNIA NOS
• Environmental Issues
• Restless Legs Syndrome
• Periodic Limb Movements

27
PARASOMNIAS
28
Parasomnias

• Sleep disorders characterized by abnormal
  behavioral or physiological events which occur
  during sleep or during sleep-wake transitions.
• Parasomnias typically do not cause insomnia or
  excessive sleepiness

29

• Sleep Terror- awakening with fear, dream amnesia
  and unresponsiveness VS.
• Nightmare- awakening with detailed threatening
  dream recall with rapid alertness
• Sleepwalking- activities without responsiveness
  and difficulty awakening
• NOS

30
GMC and Sleep

• Parkinsonism
• Neuromuscular disease
• Respiratory disease
• Dementia
• Epileptic seizures
• Cardiovascular disease