1. NREM SLEEPAROUSAL DISORDERS
Guided by-
Dr. Nimisha Mishra (M.D.)
Dr. Sunil k. Ahuja (M.D.)
Dr. Ambrish Mishra (M.D.)
Dr. Dheerendra Mishra (M.D.,DNB)
Presented by-
Dr. Jag Mohan Prajapati
JR 1
(Psychiatry)
2. OVERVIEW
INTRODUCTION
ORGANIZATION OF SLEEP
NREM AND REM CHARACTERISTICS
SLEEP DISORDER CLASSIFICATION
TOOLS FOR SLEEP MONITORING
SLEEP WALKING
SLEEP TERROR
CONFUSIONAL AROUSALS
SLEEP RELATED EATING DISORDER
3. INTRODUCTION
Sleep is a state of decreased awareness of environmental
stimuli that is distinguished from states such as coma or
hibernation by its relatively rapid reversibility.
It is also an essential component for good health and
optimal cognitive function.
For peak performance human need 8hrs sleep a day.
5. NREM STAGE BODILY
MOVEMENTS
OCULAR
MOVEMENTS
EMG EEG
N1 Light Persistent face and
limb tone with
repositioning every
15 to 20 minutes
Slow, rolling Continual
activity
Attenuation or
slowing of
alpha
(8-12 Hz
activity )
N2 Intermediate Persistent face and
limb tone with
repositioning every
15 to 20 minutes
Slow, rolling or
none
Further
reduction
Sleep spindles
and or K
complexes
N3 Slow wave,
Deep , Delta
Persistent face and
limb tone with
repositioning every
15 to 20 minutes
Absent Further
reduction
Slow wave(0.5-
2Hz)/Delta
activity
REM STAGE
Activated,
paradoxical
Flaccid, areflexic
conjugate paresis,
except for brief face
and limb movements
Rapid, ocular
movement
Silent with
artifact
Low amplitude,
mixed
frequency
6.
7. CHARACTERISTICS OF NREM AND REM SLEEP
SLEEP ACTIVITY NREM SLEEP REM SLEEP
Eye Movement Slow Rapid
Body Movement Muscle relaxation Muscle twitches
Muscle tone Some tone in postural
muscles
Decreased
Vital signs Stable Fluctuating
Penile erection Rare Common
Dreams Rare Common
EEG Spindles , v-waves,
K-complexes, slow waves
Low voltage
Percentage –Adults 75-80 20-25
Percentage-infants 50 50
9. 5. Circadian Rhythm Sleep-Wake Disorders
a) Delayed sleep phase type
b) Advanced sleep phase type
c) Irregular sleep-wake type
d) Non-24-hour sleep-wake type
e) Shift work type
f) Unspecified type
10. 6. Parasomnias
7. Non-Rapid Eye Movement Sleep Arousal
Disorders:
a. Sleep walking type
b. Sleep terror type
8. Nightmare Disorder
9. Rapid Eye Movement Sleep Behavior Disorder
10. Restless Legs Syndrome
11. Substance/Medication-Induced Sleep Disorder
12. POLYSOMNOGRAPHY
Polysomnography is the continuous, attended, comprehensive recording of
physiological activity during sleep.
A polysomnogram is typically recorded at night and is 6 to 8 hours in
duration.
Brain waves activity, eye movements, submentalis electromyography activity,
nasal–oral airflow , nasal pressure, respiratory effort, oxyhemoglobin
saturation, heart rhythm, and leg movements during sleep are recorded.
13. Body position is usually noted and snoring sounds may
be recorded.
Brain wave activity, eye movements, and submentalis
electromyogram are important for identifying sleep
stages and CNS arousals.
Muscle tension and movements subside with deeper
sleep and can also be useful in the diagnosis of PLMD
and RLS.
14. MULTIPLE SLEEP LATENCY TEST
The patient is instructed to let him- or herself fall asleep; that is, to not resist
falling asleep. Electroencephalographic, electrooculographic , and submentalis
electromyography activity are recorded in order to determine sleep stage.
Every 2 hours, beginning 2 hours after morning awakening, a 20-minute nap
opportunity is provided.
The MSLT is indicated for diagnosing narcolepsy.
15. SLEEP WALKING
Repeated episodes of rising
from bed during sleep and
walking about. While
sleeping , the individual has a
blank staring face , is
relatively unresponsive and
can be awakened with great
difficulty.
Individual can engage in a
complex behaviour of semi
purposeful actions.
17. Very common in children , peak prevalence between 4
to 8 years.
Rare in adults . Familial pattern
“Specialized forms”: Sleep related eating and
Sexsomnia
19. SLEEP TERRORS
Recurrent episodes of
abrupt terror arousals
from sleep , beginning
with a panicky scream.
There is intense fear and
signs of autonomic
hyperactivity-mydriasis ,
tachycardia , rapid
breathing and sweating.
20. Relative
unresponsiveness
to efforts of
others to comfort
the individual
during the
episode.
Recall of event , if
any , is minimal.
Risk of injury
during episode.
Occurs during first
third of nocturnal
sleep , deep
sleep(N3).
21. SLEEP TERRORS COMPARED TO
NIGHTMARES
Sleep Terrors Nightmares
Trigger Partial awakening from
deep sleep
Anxiety, fear; withdrawal
from medicines or drugs
Onset Early in night Anytime during night
Sleep stage N3 (slow-wave sleep) REM
Verbalization Crying, screaming Speaking words, conversing
Autonomic discharge Marked Little
Behavior after episode Returns to deep sleep
without recall
Awakens, recalls dream
content, fearfulness
SOURCE -KAUFMAN
22. CONFUSIONALAROUSALS
It is a milder form of NREM Sleep Parasomnias.
It is common in young children.
The child will typically partially awaken from sleep and
sit up.
The episodes are marked by confusion but usually the
child lies back down and resumes sleep.
23. SLEEP-RELATED EATING DISORDER
1.The patient has recurrent sleep-related eating episodes.
2.The patient consumes peculiar foods, food
combinations, or toxic substances; creates a hazard or is
injured during food preparation (e.g., starting a fire on
the stove); or the patient suffers adverse health
consequences from the sleep-related eating (e.g.,
substantial weight gain).
24. 3.The eating is associated with partial or complete
amnesia and general lowering or loss of conscious
awareness.
4.The eating is associated with partial or complete
amnesia and general lowering or loss of conscious
awareness
