Presentation on different types Sleep Disorder

1. SLEEP DISORDERS

2. INTRODUCION TO SLEEP DISORDERS (KUSHIDA,
2009)
 Sleep disorders can affect the quality and quantity of
sleep or can cause difficulty maintaining normal
wakefulness
 Both of which can cause impaired daytime functioning
and a host of medical, psychiatric and psychosocial
problems. There are more than 80 different types of sleep
disorders that afflict about 70 million Americans.

3. FUNCTIONS OF SLEEP (MORIN & ESPIE, 2012)
 What is Microsleep? (3-15 sec)
 Sleep restores our body tissues and facilitates body
growth
 Sleep increases our immunity to disease
 Sleep keeps our mind alert
 Sleep helps us to process memories
 Sleep enhances our mood

4. HOW MUCH SLEEP DO WE NEED?
Age
 Baby (16-18 hours)
 Preschoolers (10-12)
 Teenagers & young adults (8-10)
 33-45 years (6-8)
 50-70 years (4-6)
 Life style
 Genetics

5. CIRCADIAN RHYTHUM(CHOKROVERTY, 2010)
 Circadian Rhythum: Changes in bodily
processes that occur repeatedly on approximately
a 25-hour cycle
 Suprachiasmatic nucleus SCN : A group of
brain cells in hypothalamus that signal other brain
areas when to be aroused and when to shut down.
 Melatonin: hormone in the body that facilitate
the sleep

6. CONTI….
 Our biological clock that is genetically programmed to
regulate physiological responses within a 24 – 25 hour
period.
 They operate without normal night and day cues
 The circadian rhythm does not control our sleep cycle;
the environment and the 24 hour period does. (i.e.. Jet
lag)

7. STAGES OF SLEEP (AMBROGETTI HENSLEY & OLSON,
2006)
 About every 90 or 100 minutes we pass through 5
stages of sleep.
 Throughout the five stages, our brain waves
continually fluctuate, thus defining each
distinctive stage.

9. LIGHT SLEEP- STAGE 1(WALKER & STICKGOLD,
2005)
 Body movement decreases
 Spontaneous Waking may occur (when you feel
like you are falling out of bed)

10. INTERMEDIATE SLEPP-STAGE 2
 Officially asleep
 Your brain waves slow down with some bursts of
brain activity called ‘Sleep Spindles’
 half of your sleep in this stage.
 Helps refresh body

11. DEEP SLEEP-3 & 4 STAGE
 Deep sleep sets in – hard to wake up
 brain waves become large and slow
 Your breathing becomes rhythmic, and your muscles
remain relaxed.
 Most Restorative stage (reparative hormones released)
 30-40 min first and shorter later
 Towards the end of stage 4, children may wet beds, adults
may sleep walk, etc…
 Interestingly, even though you are in deep sleep, your brain
will still process the meaning of certain stimuli!!

12. RAPID EYE MOVEMENT (REM)
 Nearly an hour after you fall asleep, you begin to descend back
through the stages of sleep.
 During sleep you go stages 1,2,3,4,3,2 then…
 You then enter what is known as REM Sleep!
REM –This stage only lasts about 10 minutes. (20 – 30 minutes
later in night)
 Heart rate rises
 Breathing becomes rapid
 Every 30 seconds or so, your eyes rapidly move around

13. REM (CONT…)
 Motor cortex is still active, but your brainstem blocks any
messages.
 This leaves your muscles so relaxed that you are
essentially paralyzed.
Thus, you are not easily awakened.
The cycle repeats itself every 90 minutes or so.
As the night progresses, we spend less and less
time in stage 4 and more in REM.
By the time we wake-up, we have spent 20 – 25%
of the night in REM Sleep.

15. SLEEP DISORDERS
Dyssomnia
(problems with
amount, quality and
timing of sleep)
Parasomnia
(abnormal behaviors
that are associated
with sleep)
Primary
Sleep
disorders
Sleep disorder
related to another
mental disorder
Sleep disorder
related to general
medical condition
Substance induced
sleep disorder
Secondary
Sleep
Disorders

16. Dyssomni
a
Insomnia
Circadian
rhythm sleep
disorder
Breathing
related
sleep
disorder
Narcolepsy
Hypersomnia

17. INSOMNIA (ESPIE, 2002)
 Difficulty falling asleep at night or getting back to
sleep after waking during the night
 Waking up frequently during the night
 Your sleep feels light, fragmented, or exhausting
 You need to take something (sleeping pills, nightcap,
supplements) in order to get to sleep
 Sleepiness and low energy during the day
 30-40% population suffered from it
 Mostly in old age
 More prevalent in females

18. INSOMNIA (EXPLANATION)
 Excessive level of neurological activity
 Reticular activity system carrying too much
activity from the brain stem to cortex

19. INSOMNIA (TREATMENT)
 Physiological approach/drug therapy
 Hypnotics (Greek word means to “put to sleep”)
 (benzodiazepines): these increase the activity of
inhibitory neurons, reduces the general arousal and
thus facilitate sleep
 Commonly used hypnotics include
1. Halcion (trizolam)
2. Dalamine (flurazepam)
3. Restoril (temazepam)

20. TREATMENT FOR INSOMNIA
Sleep hygiene
Sleep education
Stimulus control
Relaxation
CBT
Exercise and utilizing energy in daily chores
Pharmaceutical

21. DRUG THERAPY
 In some cases antidepressants are also used such
as
 Elavil (amitriptyline)
 Antipsychotics are also used such as
 Haldol (haloperidol)

22. COGNITIVE BEHAVIORAL THERAPY
 Sleep education
 Cognitive control and psychotherapy
 Sleep restriction therapy (SRT)
 Stimulus control (SC)
 Sleep hygiene
 Progressive muscle relaxation (PMR)
 Deep breathing
 Bio-feed back
 Sleep diary

23. HYPERSOMNIA (CHOKROVERTY, 2009)
 Excessive sleepiness which leads to
1. Long periods of sleep at night
2. Need for nap during day time
3. But these naps not relieve sleepiness
4. Individual drag himself throughout the day
5. Become grouchy and ineffective
Even dangerous when it continuous in different
activities like driving etc.

24. HYPERSOMNIA (EXPLANATION)
 Caused by insufficient neurological activity
due to many factors including lesions in
hypothalamus
 Treatment
 Treat with stimulants like caffeine which
increase alertness
 Ritalin (methylphenidate) and various
amphetamines are also used
 Sleep restriction

25. HABBITS THAT IMPAIR SLEEP
 Day time napping
 Too much rest
 No activities for day time
 Excessive caffeine
 Anxiety and anticipations regarding sleep
 Excessive exposure to media
 Environmental factors such as noisy room
 Too active bed patterns, loud music etc

26. NARCOLEPSY
 Irresistible sleep attacks
 Loss of muscle tone
 REM sleep at the start or end of sleep
 Temporary refreshing
 Insufficient neurological arousal
 Stimulants are used
 Small naps during day time can help
NARCOLEPSY (EXPLANATION AND
TREATMENT)

27. BREATHING RELATED SLEEP DISORDER
 Sleep frequently disrupted because of problems
with breathing
 Sleep apneas fall into two categories

28. OBSTRUCTIVE APNEA
 Obstruction of airway to the lungs that the
individual is briefly deprived of oxygen due to
following three reasons
1. The muscle that keep the airway open cannot
receive enough stimulation
2. Obesity can lead to narrowing of airway
3. Position of sleeping
4. Surgery to increase the airway size

29. TREATMENT FOR OBSTRUCTIVE APNEA
 Behavioral treatment
 Avoidance from sedatives
 Wt. loss
 Sleeping on side or face down
 Drug therapy
 Antidepressants to suppress REM
 Use of mechanical device

30. CENTRALAPNEA
 It stems from the problem in brain that causes a
brief interruption in breathing
 It occurs more often in older individuals

31. CIRCADIAN RHYTHM SLEEP DISORDER
 Mismatch between the timing of an individual’s
natural sleep-wake cycle and the demands made
on the individual by the circumstances in which
he or she lives.
 It can be treated with bright light

33. Parasomnias
Nightmare
disorder
Sleep
terror
disorder
Sleepwalking
disorder

37. Other Types of Sleep disturbances

41. DELAYED SLEEP PHASE DISORDER
 People with delayed sleep phase disorder are unable to get to sleep
earlier than 2 to 6 a.m. no matter how hard they try. They struggle to go
to sleep and get up at socially acceptable times.
 When allowed to keep their own hours (such as during a school break or
holiday), they fall into a regular sleep schedule.
 Delayed sleep phase disorder is most common in teenagers, and many
teens will eventually grow out of it.
 For those who continue to struggle with a biological clock that is out of
sync, treatments such as light therapy and chronotherapy can help. To
learn more, schedule an appointment with a sleep doctor or local sleep
clinic.

42. JET LAG
 Jet lag is a temporary disruption in circadian rhythms
that occurs when you travel across time zones.
 Symptoms include daytime sleepiness, fatigue,
headache, stomach problems, and insomnia. The
symptoms typically appear within a day or two after
flying across two or more time zones.
 The longer the flight, the more pronounced the
symptoms.
 The direction of flight also makes a difference.
Flying east tends to cause worse jet lag than flying
west.

43. JET LAG (CONT….)
 However, jet lag can be worse if individual:
 Lost sleep during travel
 Are under a lot of stress
 Drink too much alcohol or caffeine
 Didn’t move around enough during your flight

44. DSM V CRITERIA
 The most obvious concerns are fatigue and
cognitive focus, but mood can be greatly affected
too.
 Sleep disorder not only is a risk factor for
subsequent development of certain mental
conditions but a potential warning sign for
serious mental or medical issues.

45. CONT…..
 Sleep disorders range from insomnia disorder to
narcolepsy and breathing-related disorders to
restless legs syndrome.
 A prime goal of DSM-5 changes to sleep-wake
disorders is to increase the clinical utility of
definitions and diagnostic criteria, especially for
general medical or mental health clinicians, and
to clarify when referral is appropriate to a sleep
specialist.

46. CHANGES FROM DSM IV TR TO DSM V
 Sleep-wake disorders instead of sleep disorders.
 The diagnosis of primary insomnia has been
renamed insomnia disorder to avoid the
differentiation of primary and secondary
insomnia.
 DSM-5 also distinguishes narcolepsy, which is
now known to be associated with hypocretin
deficiency, from other forms of hypersomnolence.

47. IS IT A SLEEP DISORDER?
 Do you. . .
 Feel irritable or sleepy during the day?
 Have difficulty staying awake when sitting still, watching
television or reading?
 Fall asleep or feel very tired while driving?
 Have difficulty concentrating?
 Often get told by others that you look tired?
 React slowly?
 Have trouble controlling your emotions?
 Feel like you have to take a nap almost every day?
 Require caffeinated beverages to keep yourself going?

48. CONCLUSION
 Bio psycho social model
 Successful management in sleep in adults can
improve quality of life and daily functioning

49. REFERENCES
 Ambrogetti, A., Hensley, M. J., & Olson, L. G. (Eds.).
(2006). Sleep disorders: A clinical textbook. Quay Books.
 Chokroverty, S. (2010). Overview of sleep & sleep disorders.
 Espie, C. A. (2002). Insomnia: conceptual issues in the
development, persistence, and treatment of sleep disorder in
adults. Annual Review of Psychology, 53(1), 215-243.
 Kushida, C. A. (Ed.). (2009). Handbook of sleep disorders.
Informa Healthcare.
 Morin, C. M., & Espie, C. A. (Eds.). (2012). The Oxford handbook
of sleep and sleep disorders. Oxford University Press.
 Walker, M. P., & Stickgold, R. (2014). Sleep, memory and
plasticity.Neuroscience and Psychoanalysis, 1, 93.