Sleep Disorders.ppt

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Sleep Disorders.ppt

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

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