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  • 1. Sleep Disorders
  • 2. Sleep
    • - Sleep is unconsciousness from which the person can be aroused by sensory or other stimuli
    • - Coma is unconsciousness from which the person cannot be aroused
  • 3. Sleep
    • 1. Slow-wave sleep (non REM sleep)
    • 2. Rapid eye movement sleep (REM sleep)
  • 4. Slow-wave deep (non-REM)
    • -Most sleep during night (75%).
    • -Exceedingly restful.
    • -Dec. peripheral vascular tone.
    • -10-30% dec. in blood pressure, resp. rate and basal metabolic rate.
    • -dreams are usually not remembered.
  • 5. Rapid Eye Movement (REM)
    • -Occurs in normal night sleeps.
    • -Last for 5-30 min. and occur every 90 min.
    • -Rapid movement of the eyes.
    • -Usually ass. With active dreaming and active bodily muscle movement.
    • -The heart rate and resp. rate become irregular (dream).
    • -The brain is highly active.
  • 6. Theories of sleep
    • passive theory of sle ep: excitatory areas of (RAS) in the upper brain stem fatigued and became inactive.
    • active inhibitory process:
    • Stimulation of center located below the midpontile level of the brain stem inhibiting excitatory areas of (RAS) in the upper brain stem leading to sleep.
  • 7. Sleep Disorders
    • -1/3 of U.S. people suffer from sleep disorders.
    • -It is classified into:
    • 1. Primary ( Dyssomnias and Parasomnias )
    • 2. Secondary
  • 8. Causes of 2ry sleep disorders
    • -Medical conditions (pain, met dis, endo dis)
    • -Physical conditions (obesity)
    • -Sedative withdrawal
    • -Use of stimulants
    • -Major depression
    • -Mania or anxiety
    • -Neurotransmitter abnormalities ( dopamine or norepinephrine, ACH, serotonin).
  • 9. Dyssomnias (1ry sleep dis.)
    • It is disturbance in the amount , quality or timing of sleep. It is subdivided into:
    • 1.Primary Insomnia
    • 2.Primary hypersomnia
    • 3.Narcolepsy
    • 4.Breathing-Related Disorder
    • 5.Circadian Rhythm Sleep Disorder
  • 10. 1. Primary Insomnia
    • -Difficulty in initiating or maintaining sleep .
    • -Occurs 3x or more per week for at least 1 month.
    • -Affects 30% of the population.
    • -Often exacerbated by anxiety and preoccupation with getting enough sleep.
  • 11. Primary Insomnia (cont.)
    • Treatment:
    • 1. Sleep hygiene measures (1 st line)
    • 2. Pharmacotherapy (for short term use):
    • -Benadryl
    • -Ambien (zolpidem)
    • -Sonata (zaleplon)
    • -Desyrel (trazodone)
  • 12. 2. Primary Hypersomnia
    • -At least 1 month of excessive daytime sleepiness not due to any medical or other condition.
    • - Treatment:
    • 1. Stimulant drugs as amphetamine (1 st line)
    • 2. SSRI may be useful in some patients.
  • 13. 3. Narcolepsy
    • -Repeated, sudden attacks of sleep during the day for at least 3 months , ass. With:
    • 1. Cataplexy (collapse due to sudden loss of muscle tone).
    • 2. Short REM latency.
    • 3. Sleep paralysis ( brief paralysis upon awakening).
    • 4. Hypnagogic, hypnopompic hallucinations.
  • 14. Narcolepsy (cont.)
    • -Occur in 0.02-0.16% of population.
    • - Equal incidence in males and females.
    • -Onset most commonly in childhood and adolescence.
    • -May have genetic component.
    • -Patients usually have poor nighttime sleep.
  • 15. Narcolepsy (cont.)
    • - Treatment:
    • 1. Timed daily naps.
    • 2. Stimulant drugs (amphetamines and methylphenidate).
    • 3. SSRI or oxalate for patients with cataplexy.
  • 16. 4. Breathing-Related dis.
    • -Sleep disruption and excessive daytime sleepiness caused by abnormal sleep ventilation from either:
    • 1. Obstructive Sleep Apnea [OSA] which is correlated to snoring or
    • 2. Central Sleep Apnea [SPA] which is correlated to heart failure .
  • 17. OSA risk factors:
    • -Male gender.
    • -Obesity
    • -male shirt collar size >17
    • -Previous upper airway surgeries.
    • -Deviated nasal septum.
    • - retrognathia
    • Large uvula
  • 18. Breathing-Related dis. (cont.)
    • - Treatment:
    • 1. OSA:
    • Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery or uvulopalatoplasty.
    • 2. CSA :
    • Mechanical ventillation with a backup rate.
  • 19. Parasomnias
    • -Abnormal events in behavior or physiology during sleep. It is subdivided into:
    • 1. Nightmare disorder.
    • 2. Night Terror disorder.
    • 3. Sleep Walking disorder (somnambulism).
  • 20. 1. Nightmare dis.
    • -Repeated awakenings with recall of extremely frightening dreams.
    • -Occurs during REM sleep.
    • -Onset most often starts at childhood .
    • -Occur more frequently during time of stress.
    • - NO SPECIFIC TREATMENT but tricyclics could be used.
  • 21. 2. Night Terror disorder
    • -Repeated episodes of fearfulness during sleep.
    • -Episodes usually occur during the slow-wave deep stage of sleep.
    • -Patients usually don ’ t remember the episodes.
    • -It usually begins with a scream and ass. With intense anxiety.
  • 22. Night Terror dis. (cont.)
    • -Usually occur in children .
    • -More common in boys .
    • -Tend to run in families.
    • -High ass. With comorbid sleepwalking dis.
    • - No specific treatment but giving diazepam before bedtime might be effective.
  • 23. 3. Sleepwalking dis. (Somnambulism)
    • -Repeated episodes of getting out of bed and walking.
    • -Ass. With blank stare and difficulty in being awakened .
    • -Onset bet. Age 4-8 yrs.
    • run in family to tends boy - More common in
    • -The best treatment is to prevent injury in surrounding environment.
  • 24. Thank you