Class 12- Sleep Disorders

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  • Circadian Rhythm: biological clock that regulates the daily patterning of sleep. It can be influenced by endogenous factor and exogenous factor i.e.. Light and dark, and travel (jet lag)
  • Narcolepsy -> restrictions in life -> suicidal attempts Sleep deprivation -> less alert,
  • Allows one to conceptualize how acute insomnia develops into a chronic condition and what factors should be targeted for treatment.
  • Class 12- Sleep Disorders

    1. 1. SLEEP DISODERS
    2. 2. Americans <ul><li>62% have sleep problems once wkly or more </li></ul><ul><li>40% sleepy enough during the day to interfere with activities </li></ul><ul><li>62% drive while drowsy </li></ul><ul><li>27% have fallen asleep while driving </li></ul><ul><li>60% children feel parents are tired during the day </li></ul><ul><li>15% children admit falling asleep at school </li></ul>
    3. 3. Women <ul><li>79% report sleep disturbance during pregnancy </li></ul><ul><li>36% peri-menopausal women have disturbed sleep </li></ul><ul><li>25% suffer from significant daytime sleepiness </li></ul><ul><li>30% disturbed sleep interferes with daily activity, 27% job performance is impaired </li></ul><ul><li>24% say sleep gets in the way of caring for family </li></ul>Males 1/3 of men get less than 6 hours sleep (during week)
    4. 4. COMORBIDITIES <ul><li>40-45% of those with insomnia & hypersomnia have another Axis I disorder </li></ul><ul><li>Mood Disorders – 4x higher </li></ul><ul><li>Anxiety Disorders </li></ul><ul><li>Schizophrenia </li></ul><ul><li>Substance abuse </li></ul>
    5. 5. Normal Sleep <ul><li>Normal Sleep patterns (cycles) </li></ul><ul><li>Non REM </li></ul><ul><li>REM </li></ul><ul><li>Circadian rhythm </li></ul><ul><li>Drugs influence on sleep </li></ul><ul><li>Genetics of sleep </li></ul>
    6. 6. Sleep Disorder <ul><li>Physiology of sleep </li></ul><ul><li>Sleep Stages </li></ul><ul><ul><li>NREM Sleep </li></ul></ul><ul><ul><li>REM Sleep </li></ul></ul><ul><li>Sleep-Regulating Processes </li></ul><ul><ul><li>Circadian Rhythm </li></ul></ul><ul><ul><ul><li>Endogenous vs. exogenous factor </li></ul></ul></ul><ul><ul><li>Homeostasis </li></ul></ul><ul><ul><ul><li>Balance o f sleep and awake </li></ul></ul></ul>
    7. 7. Influences on Sleep <ul><li>Developmental Changes </li></ul><ul><ul><li>Newborns and Infants </li></ul></ul><ul><ul><li>Children </li></ul></ul><ul><ul><li>Adolescents </li></ul></ul><ul><ul><li>Young and Middle Adults </li></ul></ul><ul><ul><li>Older Adults – myth </li></ul></ul><ul><li>Amount of sleep=F (genetics, preferences, lifestyle, environment) </li></ul>
    8. 8. Influences on Sleep (Cont’d) <ul><li>Medical Disorders and Treatments i.e.. Asthma, hyperthyroidism, COPD </li></ul><ul><li>Drugs and Chemical Substances i.e. alcohol, lithium, cocaine-> CNS was affected </li></ul><ul><li>Jet lag </li></ul>
    9. 9. Sleep Disorders <ul><li>Etiology </li></ul><ul><li>Signs and Symptoms/Diagnostic Criteria </li></ul><ul><li>Dyssomnias : abnormalities in the amount, quality, or timing of sleep </li></ul><ul><ul><li>Narcolepsy </li></ul></ul><ul><ul><li>breathing-related sleep disorders </li></ul></ul><ul><ul><li>periodic limb movement disorder </li></ul></ul><ul><ul><li>insomnia </li></ul></ul><ul><li>Parasomnias : abnormal behavioral or physiological events associated with sleep </li></ul><ul><ul><li>sleepwalking </li></ul></ul><ul><ul><li>tooth grinding </li></ul></ul>
    10. 10. DYSSOMNIAS
    11. 11. PRIMARY INSOMNIA <ul><li>difficulty initiating and maintaining sleep </li></ul><ul><li>awakenings that occur much earlier than desired </li></ul><ul><li>sleep that is non-restorative and of poor quality </li></ul><ul><li>result in impairment in daytime function. </li></ul>
    12. 12. <ul><li>Prevalence rates are higher in women and increase with age. </li></ul><ul><li>Associated with reduced quality of life, mood disorders and increased health services usage </li></ul><ul><li>Represents a significant economic burden in the US, with estimated direct costs of $13.9 billion annually. </li></ul>
    13. 13. <ul><ul><li>Change in sleep environments </li></ul></ul><ul><ul><li>Jet lag </li></ul></ul><ul><ul><li>Changes in work shift </li></ul></ul><ul><ul><li>Excessive noise </li></ul></ul><ul><ul><li>Unpleasant room temperature </li></ul></ul><ul><ul><li>Stressful life events </li></ul></ul><ul><ul><li>Medical condition </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Poor sleep hygiene </li></ul></ul>Causes of Insomnia
    14. 14. Behavioral Model of Insomnia <ul><li>Insomnia occurs acutely in relation to both predisposing and precipitating factors </li></ul><ul><li>The chronic form of the disorder is maintained by maladaptive coping behaviors. </li></ul><ul><li>A state of “conditioned arousal” may develop in which situations associated with sleep become alerting rather than relaxing- further impairing sleep. </li></ul>
    15. 15. Insomnia Cycle <ul><li>MALADAPTIVE HABITS </li></ul><ul><li>Excessive time in bed </li></ul><ul><li>Irregular sleep schedule </li></ul><ul><li>Daytime napping </li></ul><ul><li>Sleep- incompatible activities </li></ul><ul><li>AROUSAL </li></ul><ul><li>Emotional </li></ul><ul><li>Cognitive </li></ul><ul><li>Physiologic </li></ul><ul><li>DYSFUNCTIONAL COGNITIONS </li></ul><ul><li>Worrying over sleep loss </li></ul><ul><li>Ruminating over consequences </li></ul><ul><li>Unrealistic Expectations </li></ul><ul><li>CONSEQUENCES </li></ul><ul><li>Mood Disturbances </li></ul><ul><li>Fatigue </li></ul><ul><li>Performance impairments </li></ul><ul><li>Social Discomfort </li></ul>
    16. 16. Cognitive Behavioral Therapy for Insomnia <ul><li>change poor sleep habits and faulty beliefs about sleep </li></ul><ul><li>promote good sleep hygiene </li></ul><ul><li>THROUGH……. </li></ul><ul><li>sleep restriction, stimulus control, relaxation techniques, education and good sleep practices. </li></ul>
    17. 17. <ul><li>CBT is as successful as medications in the acute treatment (4-8 weeks) of insomnia. </li></ul><ul><li>It is more effective than medications in the long term. </li></ul><ul><li>Average of 50-60% improvement </li></ul><ul><li>Long term studies reveal a sustained improvement in sleep quality and duration. </li></ul><ul><li>Patients continued to experience improvement over follow-up periods of >1year. </li></ul>
    18. 18. Other Treatments <ul><li>Pharmacologic therapy </li></ul><ul><ul><li>Benzodiazepines / related hypnotics </li></ul></ul><ul><ul><li>Antidepressants </li></ul></ul><ul><ul><li>Antihistamines </li></ul></ul><ul><ul><li>Melatonin </li></ul></ul><ul><li>Light </li></ul>
    19. 19. BREATHING-RELATED SLEEP DISORDER <ul><li>Unlike people with insomnia, this is a structural/ anatomical problem with physiological consequences </li></ul><ul><li>Treatment with oral appliance or surgery is needed </li></ul><ul><li>Sleep maintenance, sleep walking, or other consequences are generally relieved after treatment but….. </li></ul><ul><li>Co-occurring sleep disorders may need psychological treatment. </li></ul>
    20. 20. Sleep Apnea <ul><li>Obstructive sleep apnea </li></ul><ul><ul><li>Clinical manifestations </li></ul></ul><ul><li>Central sleep apnea </li></ul><ul><ul><li>Restrictive lung disease </li></ul></ul><ul><ul><li>Neuromuscular disease </li></ul></ul><ul><ul><li>Cardiac </li></ul></ul><ul><ul><li>Neurological </li></ul></ul>
    21. 21. Other sleep disorders <ul><li>Narcolepsy </li></ul><ul><ul><li>Genetic Aspects of narcolepsy </li></ul></ul><ul><ul><li>Irresistible attacks of refreshing sleep daily for 3 months </li></ul></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><ul><li>Cataplexy- brief periods of loss of muscle tone </li></ul></ul></ul><ul><ul><ul><li>REM disordered transitions- can report hallucinations, sleep paralysis at transitions between wakefulness and sleep </li></ul></ul></ul><ul><ul><li>Treatment of narcolepsy </li></ul></ul><ul><ul><ul><li>Stimulants, REM suppressants </li></ul></ul></ul><ul><ul><ul><li>Behavioral adjustments </li></ul></ul></ul>
    22. 22. Circadian Rhythm Sleep Disorder <ul><li>Causes insomnia because of a lack of synchronization between an individual’s internal clock and the external schedule </li></ul><ul><li>Treatment is best accomplished with chronotherapy and/ or phototherapy </li></ul>
    23. 24. Specifiers <ul><li>Delayed Sleep Type- late sleep onset & late awakening </li></ul><ul><li>Shift Work Type </li></ul><ul><li>Unspecified Type </li></ul><ul><li>Jet Lag Type…… </li></ul>
    24. 25. … Jet Lag Type <ul><li>Use activities (eating, exercise, sightseeing) and exposure to light to try to synchronize body rhythms with those of the new environment </li></ul><ul><li>Melatonin 3 mg about 30 minutes before bedtime on the day of travel and for up to four days after arrival is appropriate </li></ul><ul><li>A dose of 0.5 mg has less effect on sleep, but otherwise helps adaptation similarly </li></ul><ul><li>Adult travelers crossing five or more time zones are likely to benefit from melatonin </li></ul>
    25. 26. <ul><li>DYSSOMNIA NOS </li></ul><ul><li>Environmental Issues </li></ul><ul><li>“ Restless Legs Syndrome” </li></ul><ul><li>Periodic Limb Movements </li></ul>
    26. 27. PARASOMNIAS
    27. 28. Parasomnias <ul><li>Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions. </li></ul><ul><li>Parasomnias typically do not cause insomnia or excessive sleepiness </li></ul>
    28. 29. <ul><li>Sleep Terror- awakening with fear, dream amnesia and unresponsiveness VS. </li></ul><ul><li>Nightmare- awakening with detailed threatening dream recall with rapid alertness </li></ul><ul><li>Sleepwalking- activities without responsiveness and difficulty awakening </li></ul><ul><li>NOS </li></ul>
    29. 30. GMC and Sleep <ul><li>Parkinsonism </li></ul><ul><li>Neuromuscular disease </li></ul><ul><li>Respiratory disease </li></ul><ul><li>Dementia </li></ul><ul><li>Epileptic seizures </li></ul><ul><li>Cardiovascular disease </li></ul>

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