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  • 1. Sleep Disorders Audrea Elliott
  • 2. What is sleep?
    • Sleep is a behavior that follows a circadian rhythm.
    • Sleep is not uniform, but organized into cycles.
    • Sleep is defined behaviorally into four criteria: reduced motor activity, decreased response to activity, stereotypic postures, reversibility.
  • 3. Sleep Cycle
    • There are five stages of sleep; four stages are considered non-REM sleep and one stage of REM sleep
    • Allan & Bacon 2004
  • 4. REM Sleep
    • Accounts for about 25% of sleep.
    • In humans, occurs once every 90 minutes.
    • Brain activity is high during REM.
  • 5. Sleep Deprivation
    • Studies with humans have found that sleep deprivation takes it’s greatest toll on cognitive abilities.
    • When allowed to sleep again, all stages of sleep are not made up evenly.
    • Studies with lab animals have shown that with enough sleep deprivation the animals will become sick and eventually die.
  • 6. Neural Control of Arousal and Sleep Allan & Bacon 2004
  • 7. Sleep Disorders DSM-IV-TR
    • Primary Sleep Disorders-
    • -Dyssomnias
    • - Insomnia
    • - Hypersomnia
    • - Narcolepsy
    • - Breathing-Related Sleeping
    • Disorders
    • - Circadian Rhythm Sleep
    • Disorders
    • - NOS
    • - Parasomnias
    • - Nightmare Disorder
    • - Sleep Terror Disorder
    • - Sleepwalking Disorder
    • - POS
    • Secondary Sleep Disorders-
    • - Sleep Disorder Related to Another Mental Disorder
    • - Sleep Disorder Due to a General Medical Condition
    • - Substance- Induced Sleep Disorder
  • 8. Insomnia
    • Difficulty initiating and maintaining sleep; non restorative sleep.
    • Clinically significant distress/impairment in social, occupational, or other important areas.
    • Disturbance of sleep is not due to another sleep disorder.
    • Disturbance of sleep is not due to another mental disorder
    • Not due to direct effects of substance use or general medical condition.
    • Affects about 60 million Americans have chronic insomnia. About two percent have excessive sleepiness. Most common sleep complaint.
    • Affects 40% of women and 30 % of men.
    • # 1 cause is thought to be sleep medication
    • Acute or Chronic
    • Treatment: medication or behavior modification.
  • 9. Hypersomnia
    • Excessive sleepiness with one month as evidence by either sleep episodes or day time sleep episodes that occur almost daily.
    • Excessive sleepiness caused clinically significant distress/impairment in social, occupational, or other important areas
    • Excessive sleepiness not better accounted for by insomnia, other sleep disorder, or inadequate sleep.
    • Not a result of other mental disorder, physical condition, substance use, or medical condition.
    • Recurrent: 3 days concurrent several times a year for at least two years.
    • 5-10% of sleep clinic patients
    • Lifetime prevalence of at least 16%.
    • Adult population prevalence is 0.5- 5%.
    • Four year prevalence about 8%.
  • 10. Narcolepsy
    • Sleep attack must occur daily over period of one year over a period of at least three months.
    • Must experience either cataplexy or recurrent intrusions of elements of REM sleep.
    • Disturbance not due to physical condition, substance use, or medical condition.
    • A disorder characterized by sudden and uncontrollable, though often brief, attacks of deep sleep.
    • Sometimes is accompanied by paralysis and hallucinations
    • Chronic disease due to brains inability to regulate sleep-wake cycles.
    • Hypocretin system implicated in development.
    • Treatment: keep a regular schedule, take short daytime naps, drug therapy
    • Many people go years before seeking treatment.
  • 11. Cataplexy
    • Neurological condition in which the person experiences sudden bilateral loss of muscle tone and falls, usually experienced right after a strong emotion (anger, fear, or excitement). Can last from seconds to minutes.
    • Can be a symptom of Narcolepsy (60-100%)
    • Treated with antidepressants; imipramine or desipramine
  • 12. Sleep Paralysis
    • A condition either at on set of sleep or at awaking when a person is aware of their surroundings, but not able to move.
    • Often associated with Narcolepsy.
    • Treated with antidepressants and SSRI’s
  • 13. Sleep Apnea
    • Sleep disruption leading to excessive sleepiness or less commonly insomnia due to abnormalities of ventilation during sleep.
    • Sleep disruption not accounted for by another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
    • Physiological disorder in which reduced muscle tone results in blocked air passages.
    • Apnea is the cessation of breath for ten or more seconds. This leads to frequent brief arousals from sleep.
    • May be caused by decreased levels of Serotonin in the hypoglossal nucleus.
    • Treatment: Continual Positive Airway Pressure (CPAP), Lifestyle Changes, and Surgery.
    • A new medicine modafinil (Provigil) is some times given to prevent day time sleepiness along with CPAP
  • 14. Circadian Rhythm Sleep Disorder
    • Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia due to mismatch between sleep-wake schedule.
    • Clinically significant distress/impairment in social, occupational, or other important areas.
    • Disturbance of sleep is not due to another sleep disorder.
    • Disturbance of sleep is not due to another mental disorder
    • Not due to direct effects of substance use or general medical condition.
    • Delayed Sleep Phase Type
    • - A persistent pattern of late sleep onset and late awakening times with an inability to fall asleep and awaken at a desired earlier time.
    • Shift Work Type
    • - Night shift or shift changes
    • - Can start in adolescence and last for years or decades without intervention.
    • - shift work: sleep back to normal within 2 weeks after shift change.
    • - Jet Lag: one day per time zone
  • 15. Nightmares
    • Repeated awakening from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats of survival, security, or self-esteem.
    • On awakening from frightening dreams, person rapidly becomes oriented and alert.
    • Dream experience or sleep disturbance resulting from the awakening results in clinically significant distress/impairment in social, occupational, or other important areas.
    • Nightmares not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
    • Dreams that occur in REM sleep, less intense then sleep terrors.
    • Awakening usually occurs in second half of sleep period.
    • Prevalence 10-50% kids 3-5 years old; 3% young adults; 50% adults suffer occasional nightmares.
    • Likely to reoccur in children that are exposed to severe psychosocial stressors
  • 16. Sleep Terrors
    • Recurrent episodes of abrupt awaking from sleep.
    • Intense fear and signs of autonomic arousal such as tachycardia, rapid breathing, & sweating.
    • Relative unresponsiveness to efforts of others to comfort the person during the episode.
    • No detailed dreams are recalled and there is amnesia for the episode.
    • The episode causes clinically significant distress/impairment in social, occupational, or other important areas.
    • Not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
    • Abrupt autonomic arousal in Stage 3-4 sleep that is interpreted as fear.
    • Often occurs between 4-12 years or 20-30 years.
    • Often resolves in adolescence.
    • Chronic sleep terrors waxes and wanes.
    • Psychopathology is likely to be associated with PTSD and general anxiety.
    • Prevalence 1-6% children; less then 1% adults.
    • No treatment in children, usually go away. Can give sleep medication.
  • 17. Sleep Walking (somnambulism)
    • Repeated episodes of rising from bed during sleep and walking about.
    • While sleep walking person has a blank staring face; is relatively unresponsive of others to communicate with him/her, and can be awakened only with great difficulty.
    • On waking the person has amnesia.
    • Within several minutes after awakening from sleep walking episode. There is no impairment, mental activity, or behavior. (May be a period of confusion disorientation.)
    • Sleep walking causes clinically significant distress.
    • Not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
    • Stage 3 and 4 sleep
    • Prevalence 10-30% of children at least once; 2-3% often. Occurs 1-7% of adults and 0.5%-0.7% have weekly or monthly attacks
    • Gender differences occurs more often in females during childhood. Occurs mostly in males in adulthood.
  • 18. REM Behavior Disorder
    • A neurological disorder in which a person does not become paralyzed during REM sleep, and acts out dreams his/her dreams.
    • Degenerative neurological illness in 50% of affected persons.
    • Often give Clonazepam
  • 19. Restless Leg Syndrome
    • Neurological disorder that is characterized by unpleasant sensations of legs and an urge to move them when at the rest.
    • Sleep movements can be so severe that causes chronic sleep disturbances and sleep deprivation
    • Effects about 12 million Americans.
    • Causes: Mostly unknown (idiopathic)
    • Treatment: underlying cause, some meds, and exercise.
  • 20. Reference
    • Abad, V.C. & Guilleminault, C.(2004). Emerging drugs for narcolepsy. Expert Opinion Emerging Drugs, 9(2), 281-291.
    • Erman, M.K. (2005). Therapeutic options in the treatment of insomnia. The journal of clinical psychiatry, 66(9) , 18-23.
    • Lemon, M.D. (2006). New medication choices for the treatment of insomnia. South Dakota journal of medicine, 59(2) , 66-67.
    • Roth, T. (2005). Prevalence, associated risks, and treatment patterns of insomnia. The journal of clinical psychiatry, 66(9) , 10-13.