The document summarizes various sleep disorders. It describes normal sleep cycles including slow-wave sleep and REM sleep. It then outlines different types of primary and secondary sleep disorders such as insomnia, hypersomnia, narcolepsy, breathing-related disorders like sleep apnea, and parasomnias including nightmares, night terrors, and sleepwalking. Causes, risk factors, treatments and important details are provided for each sleep disorder category.

1. Sleep Disorders

2. Sleep - Sleep is unconsciousness from which the person can be aroused by sensory or other stimuli - Coma is unconsciousness from which the person cannot be aroused

3. Sleep 1. Slow-wave sleep (non REM sleep) 2. Rapid eye movement sleep (REM sleep)

4. Slow-wave deep (non-REM) -Most sleep during night (75%). -Exceedingly restful. -Dec. peripheral vascular tone. -10-30% dec. in blood pressure, resp. rate and basal metabolic rate. -dreams are usually not remembered.

5. Rapid Eye Movement (REM) -Occurs in normal night sleeps. -Last for 5-30 min. and occur every 90 min. -Rapid movement of the eyes. -Usually ass. With active dreaming and active bodily muscle movement. -The heart rate and resp. rate become irregular (dream). -The brain is highly active.

6. Theories of sleep passive theory of sle ep: excitatory areas of (RAS) in the upper brain stem fatigued and became inactive. active inhibitory process: 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.

7. Sleep Disorders -1/3 of U.S. people suffer from sleep disorders. -It is classified into: 1. Primary ( Dyssomnias and Parasomnias ) 2. Secondary

8. Causes of 2ry sleep disorders -Medical conditions (pain, met dis, endo dis) -Physical conditions (obesity) -Sedative withdrawal -Use of stimulants -Major depression -Mania or anxiety -Neurotransmitter abnormalities ( dopamine or norepinephrine, ACH, serotonin).

9. Dyssomnias (1ry sleep dis.) It is disturbance in the amount , quality or timing of sleep. It is subdivided into: 1.Primary Insomnia 2.Primary hypersomnia 3.Narcolepsy 4.Breathing-Related Disorder 5.Circadian Rhythm Sleep Disorder

10. 1. Primary Insomnia -Difficulty in initiating or maintaining sleep . -Occurs 3x or more per week for at least 1 month. -Affects 30% of the population. -Often exacerbated by anxiety and preoccupation with getting enough sleep.

11. Primary Insomnia (cont.) Treatment: 1. Sleep hygiene measures (1 st line) 2. Pharmacotherapy (for short term use): -Benadryl -Ambien (zolpidem) -Sonata (zaleplon) -Desyrel (trazodone)

12. 2. Primary Hypersomnia -At least 1 month of excessive daytime sleepiness not due to any medical or other condition. - Treatment: 1. Stimulant drugs as amphetamine (1 st line) 2. SSRI may be useful in some patients.

13. 3. Narcolepsy -Repeated, sudden attacks of sleep during the day for at least 3 months , ass. With: 1. Cataplexy (collapse due to sudden loss of muscle tone). 2. Short REM latency. 3. Sleep paralysis ( brief paralysis upon awakening). 4. Hypnagogic, hypnopompic hallucinations.

14. Narcolepsy (cont.) -Occur in 0.02-0.16% of population. - Equal incidence in males and females. -Onset most commonly in childhood and adolescence. -May have genetic component. -Patients usually have poor nighttime sleep.

15. Narcolepsy (cont.) - Treatment: 1. Timed daily naps. 2. Stimulant drugs (amphetamines and methylphenidate). 3. SSRI or oxalate for patients with cataplexy.

16. 4. Breathing-Related dis. -Sleep disruption and excessive daytime sleepiness caused by abnormal sleep ventilation from either: 1. Obstructive Sleep Apnea [OSA] which is correlated to snoring or 2. Central Sleep Apnea [SPA] which is correlated to heart failure .

17. OSA risk factors: -Male gender. -Obesity -male shirt collar size >17 -Previous upper airway surgeries. -Deviated nasal septum. - retrognathia Large uvula

18. Breathing-Related dis. (cont.) - Treatment: 1. OSA: Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery or uvulopalatoplasty. 2. CSA : Mechanical ventillation with a backup rate.

19. Parasomnias -Abnormal events in behavior or physiology during sleep. It is subdivided into: 1. Nightmare disorder. 2. Night Terror disorder. 3. Sleep Walking disorder (somnambulism).

20. 1. Nightmare dis. -Repeated awakenings with recall of extremely frightening dreams. -Occurs during REM sleep. -Onset most often starts at childhood . -Occur more frequently during time of stress. - NO SPECIFIC TREATMENT but tricyclics could be used.

21. 2. Night Terror disorder -Repeated episodes of fearfulness during sleep. -Episodes usually occur during the slow-wave deep stage of sleep. -Patients usually don ’ t remember the episodes. -It usually begins with a scream and ass. With intense anxiety.

22. Night Terror dis. (cont.) -Usually occur in children . -More common in boys . -Tend to run in families. -High ass. With comorbid sleepwalking dis. - No specific treatment but giving diazepam before bedtime might be effective.

23. 3. Sleepwalking dis. (Somnambulism) -Repeated episodes of getting out of bed and walking. -Ass. With blank stare and difficulty in being awakened . -Onset bet. Age 4-8 yrs. run in family to tends boy - More common in -The best treatment is to prevent injury in surrounding environment.

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