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I disordini del sonno


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I disordini del sonno

  1. 1. Sleep Disorders
  2. 2. Sleep <ul><li>- Sleep is unconsciousness from which the person can be aroused by sensory or other stimuli </li></ul><ul><li>- Coma is unconsciousness from which the person cannot be aroused </li></ul>
  3. 3. Sleep <ul><li>1. Slow-wave sleep (non REM sleep) </li></ul><ul><li>2. Rapid eye movement sleep (REM sleep) </li></ul>
  4. 4. Slow-wave deep (non-REM) <ul><li>-Most sleep during night (75%). </li></ul><ul><li>-Exceedingly restful. </li></ul><ul><li>-Dec. peripheral vascular tone. </li></ul><ul><li>-10-30% dec. in blood pressure, resp. rate and basal metabolic rate. </li></ul><ul><li>-dreams are usually not remembered. </li></ul>
  5. 5. Rapid Eye Movement (REM) <ul><li>-Occurs in normal night sleeps. </li></ul><ul><li>-Last for 5-30 min. and occur every 90 min. </li></ul><ul><li>-Rapid movement of the eyes. </li></ul><ul><li>-Usually ass. With active dreaming and active bodily muscle movement. </li></ul><ul><li>-The heart rate and resp. rate become irregular (dream). </li></ul><ul><li>-The brain is highly active. </li></ul>
  6. 6. Theories of sleep <ul><li>passive theory of sle ep: excitatory areas of (RAS) in the upper brain stem fatigued and became inactive. </li></ul><ul><li>active inhibitory process: </li></ul><ul><li>Stimulation of center located below the midpontile level of the brain stem inhibiting excitatory areas of (RAS) in the upper brain stem leading to sleep. </li></ul>
  7. 7. Sleep Disorders <ul><li>-1/3 of U.S. people suffer from sleep disorders. </li></ul><ul><li>-It is classified into: </li></ul><ul><li>1. Primary ( Dyssomnias and Parasomnias ) </li></ul><ul><li>2. Secondary </li></ul>
  8. 8. Causes of 2ry sleep disorders <ul><li>-Medical conditions (pain, met dis, endo dis) </li></ul><ul><li>-Physical conditions (obesity) </li></ul><ul><li>-Sedative withdrawal </li></ul><ul><li>-Use of stimulants </li></ul><ul><li>-Major depression </li></ul><ul><li>-Mania or anxiety </li></ul><ul><li>-Neurotransmitter abnormalities ( dopamine or norepinephrine, ACH, serotonin). </li></ul>
  9. 9. Dyssomnias (1ry sleep dis.) <ul><li>It is disturbance in the amount , quality or timing of sleep. It is subdivided into: </li></ul><ul><li>1.Primary Insomnia </li></ul><ul><li>2.Primary hypersomnia </li></ul><ul><li>3.Narcolepsy </li></ul><ul><li>4.Breathing-Related Disorder </li></ul><ul><li>5.Circadian Rhythm Sleep Disorder </li></ul>
  10. 10. 1. Primary Insomnia <ul><li>-Difficulty in initiating or maintaining sleep . </li></ul><ul><li>-Occurs 3x or more per week for at least 1 month. </li></ul><ul><li>-Affects 30% of the population. </li></ul><ul><li>-Often exacerbated by anxiety and preoccupation with getting enough sleep. </li></ul>
  11. 11. Primary Insomnia (cont.) <ul><li>Treatment: </li></ul><ul><li>1. Sleep hygiene measures (1 st line) </li></ul><ul><li>2. Pharmacotherapy (for short term use): </li></ul><ul><li>-Benadryl </li></ul><ul><li>-Ambien (zolpidem) </li></ul><ul><li>-Sonata (zaleplon) </li></ul><ul><li>-Desyrel (trazodone) </li></ul>
  12. 12. 2. Primary Hypersomnia <ul><li>-At least 1 month of excessive daytime sleepiness not due to any medical or other condition. </li></ul><ul><li>- Treatment: </li></ul><ul><li>1. Stimulant drugs as amphetamine (1 st line) </li></ul><ul><li>2. SSRI may be useful in some patients. </li></ul>
  13. 13. 3. Narcolepsy <ul><li>-Repeated, sudden attacks of sleep during the day for at least 3 months , ass. With: </li></ul><ul><li>1. Cataplexy (collapse due to sudden loss of muscle tone). </li></ul><ul><li>2. Short REM latency. </li></ul><ul><li>3. Sleep paralysis ( brief paralysis upon awakening). </li></ul><ul><li>4. Hypnagogic, hypnopompic hallucinations. </li></ul>
  14. 14. Narcolepsy (cont.) <ul><li>-Occur in 0.02-0.16% of population. </li></ul><ul><li>- Equal incidence in males and females. </li></ul><ul><li>-Onset most commonly in childhood and adolescence. </li></ul><ul><li>-May have genetic component. </li></ul><ul><li>-Patients usually have poor nighttime sleep. </li></ul>
  15. 15. Narcolepsy (cont.) <ul><li>- Treatment: </li></ul><ul><li>1. Timed daily naps. </li></ul><ul><li>2. Stimulant drugs (amphetamines and methylphenidate). </li></ul><ul><li>3. SSRI or oxalate for patients with cataplexy. </li></ul>
  16. 16. 4. Breathing-Related dis. <ul><li>-Sleep disruption and excessive daytime sleepiness caused by abnormal sleep ventilation from either: </li></ul><ul><li>1. Obstructive Sleep Apnea [OSA] which is correlated to snoring or </li></ul><ul><li>2. Central Sleep Apnea [SPA] which is correlated to heart failure . </li></ul>
  17. 17. OSA risk factors: <ul><li>-Male gender. </li></ul><ul><li>-Obesity </li></ul><ul><li>-male shirt collar size >17 </li></ul><ul><li>-Previous upper airway surgeries. </li></ul><ul><li>-Deviated nasal septum. </li></ul><ul><li>- retrognathia </li></ul><ul><li>Large uvula </li></ul>
  18. 18. Breathing-Related dis. (cont.) <ul><li>- Treatment: </li></ul><ul><li>1. OSA: </li></ul><ul><li>Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery or uvulopalatoplasty. </li></ul><ul><li>2. CSA : </li></ul><ul><li>Mechanical ventillation with a backup rate. </li></ul>
  19. 19. Parasomnias <ul><li>-Abnormal events in behavior or physiology during sleep. It is subdivided into: </li></ul><ul><li>1. Nightmare disorder. </li></ul><ul><li>2. Night Terror disorder. </li></ul><ul><li>3. Sleep Walking disorder (somnambulism). </li></ul>
  20. 20. 1. Nightmare dis. <ul><li>-Repeated awakenings with recall of extremely frightening dreams. </li></ul><ul><li>-Occurs during REM sleep. </li></ul><ul><li>-Onset most often starts at childhood . </li></ul><ul><li>-Occur more frequently during time of stress. </li></ul><ul><li>- NO SPECIFIC TREATMENT but tricyclics could be used. </li></ul>
  21. 21. 2. Night Terror disorder <ul><li>-Repeated episodes of fearfulness during sleep. </li></ul><ul><li>-Episodes usually occur during the slow-wave deep stage of sleep. </li></ul><ul><li>-Patients usually don ’ t remember the episodes. </li></ul><ul><li>-It usually begins with a scream and ass. With intense anxiety. </li></ul>
  22. 22. Night Terror dis. (cont.) <ul><li>-Usually occur in children . </li></ul><ul><li>-More common in boys . </li></ul><ul><li>-Tend to run in families. </li></ul><ul><li>-High ass. With comorbid sleepwalking dis. </li></ul><ul><li>- No specific treatment but giving diazepam before bedtime might be effective. </li></ul>
  23. 23. 3. Sleepwalking dis. (Somnambulism) <ul><li>-Repeated episodes of getting out of bed and walking. </li></ul><ul><li>-Ass. With blank stare and difficulty in being awakened . </li></ul><ul><li>-Onset bet. Age 4-8 yrs. </li></ul><ul><li>run in family to tends boy - More common in </li></ul><ul><li>-The best treatment is to prevent injury in surrounding environment. </li></ul>
  24. 24. Thank you