SLEEP DISORDERS Andrzej Kokoszka II Klinika Psychiatryczna AM w Warszawie
<ul><li>Dyssomnias – problems with the timing, quality or amount of sleep </li></ul><ul><li>Parasomnias - abnormalities in...
<ul><li>Insomnia  </li></ul><ul><li>difficulty falling asleep or staying asleep that  </li></ul><ul><ul><li>occurs   three...
<ul><li>Causes of insomnia: </li></ul><ul><li>Major depressive disorder </li></ul><ul><li>- normal sleep onset </li></ul><...
<ul><li>Causes of insomnia: </li></ul><ul><li>Mani a  or hypomani a -  trouble falling asleep and sleep fewer hours. </li>...
<ul><li>Causes of insomnia: </li></ul><ul><li>Use of CNS stimulants (e.g., caffeine)  -  the most common cause of insomnia...
<ul><li>•  Avoidance of caffeine, especially before bedtime </li></ul><ul><li>•  Development of a series of behaviors asso...
<ul><li>•  Relaxation techniques </li></ul><ul><li>•  Psychoactive agents (i.e., limited use of sleep agents to establish ...
<ul><li>stop  of  breathing for brief intervals.  </li></ul><ul><li>l ow oxygen or high carbon dioxide level in the blood ...
<ul><li>central sleep apnea (more common in the elderly), little or no respiratory effort occurs, resulting in less air re...
<ul><li>obstructive  sleep apnea occurs most often in people 40-60 years of age, and is more common in men (8 x)  and in t...
<ul><li>Treatment: </li></ul><ul><li>•  Weight loss (if overweight) </li></ul><ul><li>•  Continuous positive airway pressu...
<ul><li>sleep attacks (i.e., fall asleep suddenly during the day) despite having a normal amount of sleep at night.  </li>...
<ul><li>sleep paralysis -  the inability to move the body for a few seconds after waking. </li></ul><ul><li>is uncommon </...
<ul><li>cataplexy - a sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus (e....
<ul><li>Treatment: </li></ul><ul><li>Stimulant agents (e.g., methylphenidate [Ritalin], modafinil [Provigil] if cata­plexy...
<ul><li>Circadian rhythm sleep disorder </li></ul><ul><li>Inability to sleep at appropriate times </li></ul><ul><li>Delaye...
<ul><li>Nocturnal myoclonus </li></ul><ul><li>Repetitive, abrupt muscular contractions in the legs from toes to hips </li>...
<ul><li>Restless leg syndrome </li></ul><ul><li>Uncomfortable sensation in the legs necessitating frequent motion </li></u...
<ul><li>Primary hypersomnias [Kleine-Levin syndrome and menstrual-associated syndrome (symptoms only in the premenstrum)] ...
<ul><li>Sleep drunkenness </li></ul><ul><li>Difficulty awakening fully after adequate sleep </li></ul><ul><li>Rare, must b...
<ul><li>Bruxism </li></ul><ul><li>Tooth grinding during sleep (stage 2) </li></ul><ul><li>Can lead to tooth damage and jaw...
<ul><li>Sleepwalking disorder </li></ul><ul><li>Repetitive walking around during sleep </li></ul><ul><li>No memory of the ...
<ul><li>Sleep terror disorder </li></ul><ul><li>Repetitive experiences of fright in which a person (usually a child) screa...
<ul><li>Nightmare disorder </li></ul><ul><li>Repetitive, frightening dreams that cause nighttime awakenings </li></ul><ul>...
<ul><li>REM sleep behavior disorder </li></ul><ul><li>REM sleep without skeletal muscle paralysis </li></ul><ul><li>Patien...
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Sleep disorders (PPT 83 kB)

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Sleep disorders (PPT 83 kB)

  1. 1. SLEEP DISORDERS Andrzej Kokoszka II Klinika Psychiatryczna AM w Warszawie
  2. 2. <ul><li>Dyssomnias – problems with the timing, quality or amount of sleep </li></ul><ul><li>Parasomnias - abnormalities in physiology or in behavior associated with sleep </li></ul> Sleep disorders General information
  3. 3. <ul><li>Insomnia </li></ul><ul><li>difficulty falling asleep or staying asleep that </li></ul><ul><ul><li>occurs three times per week for at least 1 month and leads to sleepiness during the day </li></ul></ul><ul><ul><li>or causes problems fulfilling social or occupational obligations. </li></ul></ul><ul><li>- is present in at least 30% of the population. </li></ul> Dyssomnias General information
  4. 4. <ul><li>Causes of insomnia: </li></ul><ul><li>Major depressive disorder </li></ul><ul><li>- normal sleep onset </li></ul><ul><li>- repeated nighttime awakenings </li></ul><ul><li>- waking too early </li></ul> Dyssomnias General information
  5. 5. <ul><li>Causes of insomnia: </li></ul><ul><li>Mani a or hypomani a - trouble falling asleep and sleep fewer hours. </li></ul><ul><li>Anxious patients trouble falling asleep </li></ul> Dyssomnias General information
  6. 6. <ul><li>Causes of insomnia: </li></ul><ul><li>Use of CNS stimulants (e.g., caffeine) - the most common cause of insomnia. </li></ul><ul><li>Withdrawal of agents with sedating action (e.g., alcohol, benzodiazepines, and opiates). </li></ul><ul><li>Medical conditions causing pain and endocrine and metabolic disorders. </li></ul> Dyssomnias General information
  7. 7. <ul><li>• Avoidance of caffeine, especially before bedtime </li></ul><ul><li>• Development of a series of behaviors associated with bedtime (i.e., &quot;a sleep ritual&quot; or &quot;sleep hygiene&quot;) </li></ul><ul><li>• Maintaining a fixed sleeping and waking schedule </li></ul><ul><li>• Daily exercise (but not just before sleep) </li></ul> Dyssomnias – treatment of insomnia General information
  8. 8. <ul><li>• Relaxation techniques </li></ul><ul><li>• Psychoactive agents (i.e., limited use of sleep agents to establish an effective sleep pattern and antidepressants or antipsychotics if appropriate) </li></ul> Dyssomnias – treatment of insomnia General information
  9. 9. <ul><li>stop of breathing for brief intervals. </li></ul><ul><li>l ow oxygen or high carbon dioxide level in the blood awakens the patient repeatedly during the night, resulting in daytime sleepiness. </li></ul> Dyssomnias: breathing-related sleep disorder (sleep apnea) General information
  10. 10. <ul><li>central sleep apnea (more common in the elderly), little or no respiratory effort occurs, resulting in less air reaching the lungs. </li></ul><ul><li>obstructive sleep apnea, respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs. </li></ul> Dyssomnias: breathing-related sleep disorder (sleep apnea) General information
  11. 11. <ul><li>obstructive sleep apnea occurs most often in people 40-60 years of age, and is more common in men (8 x) and in the obese. Patients often snore. </li></ul><ul><li>Sleep apnea occurs in 1%-10% of the population and is related to depression, headaches, and pulmonary hypertension. It also may result in sudden death during sleep in the elderly and in infants. </li></ul> Dyssomnias: breathing-related sleep disorder (sleep apnea) General information
  12. 12. <ul><li>Treatment: </li></ul><ul><li>• Weight loss (if overweight) </li></ul><ul><li>• Continuous positive airway pressure (CPAP), a device applied to the face at night to gently move air into the lungs </li></ul><ul><li>• Surgery to enlarge the airway, e.g., </li></ul><ul><li>• Tracheostomy (as a last resort) </li></ul> Dyssomnias: breathing-related sleep disorder (sleep apnea) General information
  13. 13. <ul><li>sleep attacks (i.e., fall asleep suddenly during the day) despite having a normal amount of sleep at night. </li></ul><ul><li>-hypnagogic or hypnopompic hallucinations. These are strange perceptual experiences that occur just as the patient falls asleep or wakes up, respectively, and occur in 20- 40% of patients. </li></ul> Dyssomnias: narcolepsy General information
  14. 14. <ul><li>sleep paralysis - the inability to move the body for a few seconds after waking. </li></ul><ul><li>is uncommon </li></ul><ul><li>decreased sleep latency, very short REM latency (<10 minutes), less total REM, and interrupted REM (sleep fragmentation). </li></ul> Dyssomnias: narcolepsy General information
  15. 15. <ul><li>cataplexy - a sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus (e.g., laughter, fear) and occurs in 30-70% of patients. </li></ul><ul><li>occurs most frequently in adolescents and young adults. </li></ul><ul><li>may have a genetic component. </li></ul> Dyssomnias: narcolepsy General information
  16. 16. <ul><li>Treatment: </li></ul><ul><li>Stimulant agents (e.g., methylphenidate [Ritalin], modafinil [Provigil] if cata­plexy is present, antidepressants may be added) </li></ul><ul><li>Scheduled daytime naps </li></ul> Dyssomnias: narcolepsy General information
  17. 17. <ul><li>Circadian rhythm sleep disorder </li></ul><ul><li>Inability to sleep at appropriate times </li></ul><ul><li>Delayed sleep phase type involves falling asleep and waking later than wanted </li></ul><ul><li>Jet lag type last 2-7 days after a change in time zones </li></ul><ul><li>Shift work type (e.g., in physician training) can result in physician error </li></ul> Dyssomnias General information
  18. 18. <ul><li>Nocturnal myoclonus </li></ul><ul><li>Repetitive, abrupt muscular contractions in the legs from toes to hips </li></ul><ul><li>Causes nighttime awakenings </li></ul><ul><li>More common in the elderly </li></ul> Dyssomnias General information
  19. 19. <ul><li>Restless leg syndrome </li></ul><ul><li>Uncomfortable sensation in the legs necessitating frequent motion </li></ul><ul><li>Repetitive limb jerking during sleep </li></ul><ul><li>Causes difficulty falling asleep and nighttime awakenings </li></ul><ul><li>More common with aging, pregnancy, and kidney disease </li></ul> Dyssomnias General information
  20. 20. <ul><li>Primary hypersomnias [Kleine-Levin syndrome and menstrual-associated syndrome (symptoms only in the premenstrum)] </li></ul><ul><li>Recurrent periods of excessive sleepiness occurring almost daily for at least 1 mont </li></ul><ul><li>Sleepiness is not relieved by daytime na </li></ul><ul><li>Often accompanied by hyperphagia (overeating) </li></ul><ul><li>Kleine-Levin syndrome is more common in adolescent males </li></ul> Dyssomnias General information
  21. 21. <ul><li>Sleep drunkenness </li></ul><ul><li>Difficulty awakening fully after adequate sleep </li></ul><ul><li>Rare, must be differentiated from substance abuse or other sleep disorder </li></ul><ul><li>Associated with genetic factors </li></ul> Dyssomnias General information
  22. 22. <ul><li>Bruxism </li></ul><ul><li>Tooth grinding during sleep (stage 2) </li></ul><ul><li>Can lead to tooth damage and jaw pain </li></ul><ul><li>Treated with dental appliance worn at night or corrective orthodontia </li></ul> Parasomnias General information
  23. 23. <ul><li>Sleepwalking disorder </li></ul><ul><li>Repetitive walking around during sleep </li></ul><ul><li>No memory of the episode on awakening </li></ul><ul><li>Begins in childhood (usually 4-8 years of age) </li></ul><ul><li>Occurs during delta sleep </li></ul> Parasomnias General information
  24. 24. <ul><li>Sleep terror disorder </li></ul><ul><li>Repetitive experiences of fright in which a person (usually a child) screams in fear during sleep </li></ul><ul><li>The person cannot be awakened </li></ul><ul><li>The person has no memory of having a dream </li></ul><ul><li>Occurs during delta sleep </li></ul><ul><li>Onset in adolescence may indicate temporal lobe epilepsy </li></ul> Parasomnias General information
  25. 25. <ul><li>Nightmare disorder </li></ul><ul><li>Repetitive, frightening dreams that cause nighttime awakenings </li></ul><ul><li>The person usually can recall the nightmare </li></ul><ul><li>Occurs during REM sleep </li></ul> Parasomnias General information
  26. 26. <ul><li>REM sleep behavior disorder </li></ul><ul><li>REM sleep without skeletal muscle paralysis </li></ul><ul><li>Patients can injure themselves or their sleeping partners </li></ul> Parasomnias General information

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