Normal sleep and sleep disorders

  • 3,707 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
3,707
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
191
Comments
0
Likes
3

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Electrophysiology of Sleep
    STAGES OF SLEEP
    A. NON-REM – 75%
    Stage 1 -( 5%) 3 to 7 cps theta waves, vertex sharp wave
    Stage 2 - (45%) 12 to 14 cps with sleep spindles and K complex
    Stage 3 - (12%) ½ to 2 cps delta waves Stage 4 – (13%)
    ANTERIOR HYPOTHALAMUS, PRE-OPTIC AREA, DORSAL MEDULLARY RETICULAR FORMATION & NUCLEUS OF THE TRACTUS SOLITARIUS
  • 2. Stages of Sleep
    Stage 3 and 4- arousal characteristics
    when awakened – disorganized thinking, disoriented, brief arousals associated with amnesia for events occurring during the arousal
    Problems : enuresis, somnambulism, nightmares and sleep terror
  • 3. STAGES OF SLEEP
    B. REM SLEEP – 25%
    Low voltage, mixed frequency(theta and slow alpha) SAW TOOTH WAVES
    REM- ON CELLS – DORSOLATERAL PONTINE RETICULAR FORMATION AND THE NEURONS VENTRAL AND LATERAL TO THE LOCUS CERULEUS (cholinergic)
    REM-OFF CELLS- LOCUS CERULEUS & DORSAL RAPHE NUCLEI ( Noradrenergic)
  • 4. EVENTS DURING STAGES OF SLEEP
    NON- REM SLEEP
    SLOW EYE MOVEMENT
    MUSCLES RELAXED
    SOME TONE IN POSTURAL
    MUSCLE GROUPS
    VITAL SIGNS STABLE
    RARE PENILE ERECTION
    RARE DREAMS
    INC. AFTER EXERCISE AND STARVATION
    REM SLEEP
    RAPID EYE MOVEMENT
    FREQUENT MUSCLE TWITCHING
    DECREASED MUSCLE TONE
    ABSENT BODY MOVEMENT
    VS FLUCTUATING
    COMMON DREAMS & PENILE ERECTION
    Inc. brain 02 use, dec. ventilatory response to inc. C02, poikilothermic condition
  • 5. SLEEP REGULATION & FUNCTION
    SEROTONIN- INCREASE SLEEP
    MELATONIN- circadian pacemaker
    DOPAMINE- INCREASE AROUSAL
    increase need with physical work, exercise, illness, pregnancy, mental stress and inc. mental activity
    SLEEP- RESTORATIVE FUNCTION
    NORMAL THERMOREGULATION AND ENERGY CONSERVATION
    NON REM – inc. after exercise and starvation
    ?metabolic need
  • 6. Sleep and Depression, AD
    Marked shortened REM latency (< 60 min.)
    >% of REM sleep
    Shift in REM distribution
    Supersensitivity to acetylcholine
    Transient improvement of depression during sleep deprivation
    Reserpine- increase REM cause depression
    AD decreased REM and Stage 3 and 4
  • 7. Sleep deprivation and requirement
    REM DEPRIVED PATIENTS ARE IRRITABLE AND LETHARGIC WITH SUBSEQUENT INCREASE IN NUMBER AND AMOUNT OF REM SLEEP
    SLEEP REQUIREMENTS
    A. SHORT SLEEPERS- REQUIRE LESS THAN 6 HOURS SLEEP(EFFICIENT, AMBITIOUS, SOCIALLY ADEPT
    B. LONG SLEEPERS- REQUIRE MORE THAN 9 HRS. OF SLEEP; MORE REM PERIODS AND MORE RAPID EYE MOVEMENTS(mildly depressed, anxious, socially withdrawn)
  • 8. SLEEP DISORDER-DYSSOMNIA
    DISORDER OF QUANTITY OR TIMING OF SLEEP
  • 9. Dyssomnia
    1. Primary Insomnia
    2. Psychophysiological Insomnia
    3. Primary Hypersomnia
    4. Narcolepsy
    5. Breathing related sleep disorder
    6. restless leg syndrome
  • 10. DYSSOMNIADiagnostic Criteria for Primary Insomnia
    A.THE PREDOMINANT COMPLAINT IS DIFFICULTY INITIATING OR MAINTAINING SLEEP,OR NONRESTORATIVE SLEEP FOR AT LEAST ONE MONTH
    b. the sleep disturbance (or asso. daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other areas of functioning
    c. no other sleep disorder, such as narcolepsy
    no other mental disturbance
    d. not due to substance or general medical condition
  • 11. Psychophysiological Insomnia
    AKA conditioned insomnia
    Work and relationships are satisfying
    Other characteristics:
    1. excessive worry of not being able to sleep
    2. trying too hard to sleep
    3. rumination
    4. inc. muscle tension when attempting to sleep
    5. able to sleep away from the bedroom, being able to sleep when not trying
    SLEEP STATE MISPERCEPTION
  • 12. SLEEP HYGIENE
    ARISE AT THE SAME TIME DAILY
    LIMIT DAILY IN BED TIME TO THE USUAL AMOUNT PRESENT BEFORE THE SLEEP DISTURBANCE
    DISCONTINUE- CAFFEINE, NICOTINE, ALCOHOL, STIMULANTS
    AVOID DAYTIME NAPS
    GRADED EXERCISE EARLY IN THE DAY
  • 13. SLEEP HYGIENE
    AVOID EVENING STIMULATION
    TRY 20 MIN. HOT BATH SOAKS
    EAT REGULAR MEALS AT DAYTIME, AVOID LARGE MEALS NEAR BEDTIME
    PRACTICE EVENING RELAXATION TECHNIQUES
    MAINTAIN COMFORTABLE SLEEPING CONTIONS
  • 14. DYSSOMNIA CRITERIA FOR PRIMARYHYPERSOMNIA
    A. THE PREDOMINANT COMPLAINT IS EXCESSIVE SLEEPINESS FOR AT LEAST ONE MONTH ( OR LESS IF RECURRENT) AS EVIDENCED BY PROLONGED SLEEP EPISODES OR DAYTIME SLEEP EPISODES THAT OCCUR ALMOST DAILY
    B. THE EXCESSIVE SLEEPINESS IS NOT BETTER ACCOUNTED FOR BY INSOMNIA AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF ANOTHER SLEEP DISORDER
  • 15. DIAGNOSTIC CRITERIA FOR NARCOLEPSY (primary hypersomnia)
    A. IRRESISTIBLE ATTACKS OF REFRESHING SLEEP THAT OCCUR DAILY OVER AT LEAST 3 MONTHS
    B. PRESENCE OF ONE OR BOTH OF THE FOLLOWING:
    1. CATAPLEXY- brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion
    2. recurrent intrusions of elements of REM sleep into the transition bet. Sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes
  • 16. DIAGNOSTIC CRITERIA FOR CIRCADIAN RHYTHM SLEEP DISORDER
    A . PERSISTENT OR RECURRENT PATTERN OF SLEEP DISRUPTION LEADING TO EXCESSIVE SLEEPINESS OR INSOMNIA THAT IS DUE TO A MISMATCH BETWEEN THE SLEEP WAKE SCHEDULE REQUIRED BY A PERSON’S ENVIRONMENT AND HIS CIRCADIAN SLEEP WAKE PATTERN
    BCD
  • 17. CIRCADIAN SLEEP DISORDER
    SPECIFY TYPE:
    A. DELAYED SLEEP PHASE TYPE- A PERSISTENT PATTERN OF LATE SLEEP ONSET AND LATE AWKENING TIMES WITH INABILITY TO FALL ASLEEP AND AWAKEN AT A DESIRED EARLIER TIME
    B. JET LAG TYPE
    C. SHIFT WORK TYPE
  • 18. PARASOMNIAS
    ABNORMAL BEHAVIOR DURING SLEEP OR THE TRANSITION BETWEEN SLEEP AND WAKEFULNESS
  • 19. DIAGNOSTIC CRITERIA FOR NIGHTMARE DISORDERS
    A. REPEATED AWAKENINGS FROM THE MAJOR SLEEP PERIOD OR NAPS WITH DETAILED RECALL OF EXTENDED AND EXTREMELY FRIGHTENING DREAMS, USUALLY INVOLVING THREATS TO SURVIVAL, SECURITY OR SELF ESTEEM, THE AWAKENINGS GENERALLY OCCUR DURING THE SECOND HALF OF THE SLEEP PERIOD
  • 20. NIGHTMARE DISORDERS
    B. ON AWAKENING FROM THE FRIGHTENING DREAMS, THE PERSON RAPIDLY BECOMES ORIENTED AND ALERT
    C. THE DREAM EXPERIENCE OR THE SLEEP DISTURBANCE RESULTING FROM THE AWAKENING CAUSES SIGNIFICANT DISTRESS
    D. NO OTHER MENTAL DISORDER, OR INTAKE OF PHYSIOLOGICAL SUBSTANCE
  • 21. DIAGNOSTIC CRITERIA FOR SLEEP TERROR DISORDER
    A. RECURRENT EPISODES OF ABRUPT AWAKENING FROM SLEEP USUALLY OCCURING DURING THE FIRST THIRD OF THE MAJOR SLEEP EPISODE AND BEGINNING WITH A PANICKY SCREAM
    B. INTENSE FEAR AND SIGNS OF AUTONOMIC AROUSAL SUCH AS TACHYCARDIA, RAPID BREATHING, SWEATING DURING EACH EPISODE
    C. RELATIVE UNRESPONSIVENESS TO EFFORTS OF OTHERS TO COMFORT THE PERSON DURING THE EPISODE
    D. NO DETAILED DREAM IS RECALLED AND THERE IS AMNESIA FOR THE EPISODE
    EF
  • 22. DIAGNOSTIC CRITERIA FOR SLEEPWALKING DISORDER
    A. REPEATED EPISODES OF RISING FROM BED DURING SLEEP AND WALKING ABOUT, USUALLY OCCURING DURING THE FIRST THIRD OF THE MAJOR SLEEP EPISODE
    B. WHILE SLEEPWALKING THE PERSON HAS A BLANK STARING FACE IS RELATIVELY UNRESPONSIVE AT EFFORTS TO COMMUNICATE AND CAN BE AWAKENED WITH A GREAT DEAL OF DIFFICULTY
    C. ON AWAKENING THE PATIENT HAS AMNESIA OF THE EPISODE
    D. WITHIN SEVERAL MINUTES AFTER AWKENING FROM THE SLEEPWALKING EPISODE, THERE IS NO IMPAIRMENT OF MENTAL ACTIVITY OR BEHAVIOR
    E. COMMON CRITERIA
  • 23. INSOMNIA RELATED TO ANOTHER PSYCHIATRIC ILLNESS
    Insomnia in depression-normal sleep onset, repeated awakenings
    Insomnia in mania- reduction in need for sleep
    Insomnia in schizophrenia- reduction of total sleep time , slow wave sleep, REM
  • 24. SUBSTANCE INDUCED SLEEP DISORDER
    SOMNOLENCE- AMPHETAMINE, COCAINE, CAFFEINE (WITHDRAWAL)
    SUSTAINED USE OF CNS DEPRESSANT
    INSOMNIA- bzdp, BARBITURATES (WITHDRAWAL)