This document discusses various sleep disorders and approaches to evaluating and treating patients with sleep problems. It covers topics like insomnia, obstructive sleep apnea, narcolepsy, restless leg syndrome, circadian rhythm disorders, and parasomnias. The key points are obtaining a thorough patient history, performing tests like polysomnography and multiple sleep latency tests to diagnose the underlying cause, and treating the specific disorder through lifestyle changes, medications, CPAP, or other therapies.
The document discusses various topics related to sleep including:
1. Sleep accounts for about 1/3 of our lifetime and 1/3 of the population has a sleep disorder.
2. Sleep is regulated by our circadian rhythm located in the hypothalamus and lasts approximately 24 hours.
3. A normal sleep cycle occurs every 90 minutes and includes NREM sleep, which accounts for 70-80% of sleep, and REM sleep, which accounts for 20-25% of sleep.
4. More than 80 known sleep disorders are classified as dyssomnias involving difficulties initiating or maintaining sleep or daytime sleepiness, or parasomnias involving abnormal events during sleep.
NREM sleep accounts for 75-80% of sleep time in adults and is divided into 3 stages - N1, N2, and N3. REM sleep makes up the remaining 20-25% and is characterized by low muscle tone and rapid eye movements. Common sleep disorders include insomnia, sleep apnea, restless leg syndrome, and narcolepsy. Obstructive sleep apnea is the most common sleep disorder and involves repetitive pauses in breathing during sleep due to upper airway collapse. Narcolepsy involves irresistible daytime sleep attacks and loss of muscle tone in response to emotions.
Sleep is essential for health and cognitive function. It involves NREM and REM sleep stages measured using polysomnography. Common sleep disorders include insomnia, hypersomnolence, and narcolepsy. Insomnia is difficulty initiating or maintaining sleep and is treated with sleep hygiene, relaxation, and medication. Hypersomnolence involves excessive daytime sleepiness and is treated with stimulants. Narcolepsy involves REM sleep intrusion and is diagnosed by decreased REM latency on polysomnography.
The outcome of this course is for the learner to describe the normal stages of sleep, common sleep measurement tools sleep characteristic, common sleep disorders, the changes that affect the quality and quantity of sleep as an individual ages, and methods the healthcare provider can use to assess and assist clients with sleep disorders.
This document provides a summary of a presentation on sleep disorders organized into three main sections: physiology of normal sleep, disordered sleep, and sleep studies. It describes the stages and cycles of normal sleep including NREM and REM sleep. It discusses several common sleep disorders like insomnia, narcolepsy, restless leg syndrome, sleep apnea, and parasomnias. It also covers sleep disturbances related to medical, neurological and psychiatric conditions. Finally, it provides an overview of polysomnography and its clinical applications in diagnosing and managing various sleep disorders.
This document provides information about sleep disorders and sleep hygiene. It defines sleep and describes the stages of sleep including NREM, REM sleep, and the progression through stages 1-3. It discusses factors that affect sleep, consequences of poor sleep, and categories of sleep disorders like insomnia. Assessment of insomnia and interventions like CBT and medications are outlined. General sleep recommendations are provided regarding sleep schedules, environment, and habits. Sleep hygiene tips conclude the document.
Jessica Peeling was a 4th year medical student from UNECOM in Biddeford, Maine on rotation at the Falcon Clinic in Utica, NY. She gave a presentation on "Insomnia" during a luncheon at the office.
The document discusses various topics related to sleep including:
1. Sleep accounts for about 1/3 of our lifetime and 1/3 of the population has a sleep disorder.
2. Sleep is regulated by our circadian rhythm located in the hypothalamus and lasts approximately 24 hours.
3. A normal sleep cycle occurs every 90 minutes and includes NREM sleep, which accounts for 70-80% of sleep, and REM sleep, which accounts for 20-25% of sleep.
4. More than 80 known sleep disorders are classified as dyssomnias involving difficulties initiating or maintaining sleep or daytime sleepiness, or parasomnias involving abnormal events during sleep.
NREM sleep accounts for 75-80% of sleep time in adults and is divided into 3 stages - N1, N2, and N3. REM sleep makes up the remaining 20-25% and is characterized by low muscle tone and rapid eye movements. Common sleep disorders include insomnia, sleep apnea, restless leg syndrome, and narcolepsy. Obstructive sleep apnea is the most common sleep disorder and involves repetitive pauses in breathing during sleep due to upper airway collapse. Narcolepsy involves irresistible daytime sleep attacks and loss of muscle tone in response to emotions.
Sleep is essential for health and cognitive function. It involves NREM and REM sleep stages measured using polysomnography. Common sleep disorders include insomnia, hypersomnolence, and narcolepsy. Insomnia is difficulty initiating or maintaining sleep and is treated with sleep hygiene, relaxation, and medication. Hypersomnolence involves excessive daytime sleepiness and is treated with stimulants. Narcolepsy involves REM sleep intrusion and is diagnosed by decreased REM latency on polysomnography.
The outcome of this course is for the learner to describe the normal stages of sleep, common sleep measurement tools sleep characteristic, common sleep disorders, the changes that affect the quality and quantity of sleep as an individual ages, and methods the healthcare provider can use to assess and assist clients with sleep disorders.
This document provides a summary of a presentation on sleep disorders organized into three main sections: physiology of normal sleep, disordered sleep, and sleep studies. It describes the stages and cycles of normal sleep including NREM and REM sleep. It discusses several common sleep disorders like insomnia, narcolepsy, restless leg syndrome, sleep apnea, and parasomnias. It also covers sleep disturbances related to medical, neurological and psychiatric conditions. Finally, it provides an overview of polysomnography and its clinical applications in diagnosing and managing various sleep disorders.
This document provides information about sleep disorders and sleep hygiene. It defines sleep and describes the stages of sleep including NREM, REM sleep, and the progression through stages 1-3. It discusses factors that affect sleep, consequences of poor sleep, and categories of sleep disorders like insomnia. Assessment of insomnia and interventions like CBT and medications are outlined. General sleep recommendations are provided regarding sleep schedules, environment, and habits. Sleep hygiene tips conclude the document.
Jessica Peeling was a 4th year medical student from UNECOM in Biddeford, Maine on rotation at the Falcon Clinic in Utica, NY. She gave a presentation on "Insomnia" during a luncheon at the office.
This document provides information about various sleep disorders. It begins with definitions and descriptions of normal sleep stages. It then discusses specific sleep disorders like insomnia, hypersomnia, sleep apnea, narcolepsy, restless leg syndrome and circadian rhythm disorders. Diagnosis involves questionnaires, sleep diaries and polysomnography. Treatment depends on the disorder but may include lifestyle changes, medications, therapies and surgery. Sleep disorders can negatively impact quality of life so proper diagnosis and management is important.
Multiple sleep latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) ...Murtaza Syed
The document provides information about the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). It describes how MSLT is used to test for excessive daytime sleepiness by measuring how quickly a person falls asleep during nap opportunities. Abnormally short sleep latencies or two or more sleep onset REM periods indicate narcolepsy. MWT measures ability to stay awake and is used to assess treatment effectiveness. Both tests involve daytime nap recordings preceded by an overnight sleep study and use similar protocols and equipment to objectively measure sleepiness and wakefulness.
The two-process model
The sleep-wake system is thought to be regulated by the interplay of two major processes, one that promotes sleep (process S) and one that maintains wakefulness (process C).
Process S is the homeostatic drive for sleep.
The need for sleep (process S) accumulates across the day, peaks just before bedtime at night and dissipates throughout the night.
Sleep disorders are characterized by disturbances in sleep amount, quality, or timing. There are over 70 different sleep disorders divided into two main categories - dyssomnias involving problems falling or staying asleep, and parasomnias involving abnormal behaviors during sleep. The document provides detailed descriptions of common sleep disorders like insomnia, narcolepsy, sleep apnea, circadian rhythm disorders, nightmares, and sleep terrors. Diagnostic criteria are also outlined for each disorder.
This document discusses sleep patterns and common sleep disorders in the elderly. It begins by noting that sleep complaints are common in over half of elderly patients. It then describes normal physiologic changes in sleep patterns with age, including decreased total sleep time and slow wave sleep. Common sleep disorders discussed include advance sleep phase disorder, sleep disordered breathing/obstructive sleep apnea, insomnia, periodic limb movement disorder, and REM sleep behavior disorder. Treatment options for obstructive sleep apnea such as CPAP and oral appliances are also summarized.
This document provides an overview of sleep, its functions, stages and disorders. It defines sleep as a state of unconsciousness where the brain is more responsive to internal stimuli. Sleep has restorative and homeostatic functions. There are two main stages - NREM and REM sleep. Dyssomnias are disorders of sleep quantity/timing and include insomnia, hypersomnia, narcolepsy and sleep apnea. Parasomnias involve abnormal behaviors during sleep transitions and include nightmares, sleepwalking and REM sleep behavior disorder. Many common sleep disorders are described along with their symptoms, causes and treatment options.
sleep disorders contains dyssomnias ,parasomnias ,and sleep disorder associated with other major medical disorders . Restless leg syndrome and PLM are also covered here. this ppt also shows how to differentiate between sleep terror and night mares . treatment of sleep disorders also included.
Understanding the sleep cycle is often the first step to better sleep quality. When you know, what affects your sleep cycle, you can take measures to cut out distractions and get ample restful sleep every night.
Also, to help you understand the various sleep stages and sleep cycles easily, we have also created an infographic for this.
Read more details on the source site: https://sleepsherpa.com/stages-of-sleep-and-sleep-cycles-explained/
Sleep paralysis is a phenomenon where a person experiences temporary paralysis either when falling asleep or waking up. It occurs when there is a disruption in the normal REM sleep pattern, where the brain is awake but the body remains paralyzed. Episodes involve an inability to speak or move and can last from a few seconds to several minutes. Risk factors include narcolepsy, sleep apnea, irregular sleep schedules, and certain medications. Treatment focuses on improving sleep habits and reassurance, as sleep paralysis itself is not medically harmful.
This document discusses the physiology of sleep and sleep disorders. It describes the different stages of non-REM sleep (stages 1-4) and REM sleep, and how they are characterized by changes in brain waves, eye movements, muscle tone, autonomic functions, and more. Sleep is essential for survival but disturbances can occur in psychiatric illnesses. Sleep is studied using electrodes to measure brain waves, eye movements, muscle activity, and other physiological signals.
Sleep apnea is a common sleep disorder where a person's breathing is interrupted during sleep. Left untreated, sleep apnea can increase the risk of high blood pressure, heart disease, strokes, and accidents. A sleep study can diagnose sleep apnea and treatment, such as CPAP therapy, can significantly reduce health risks and improve symptoms like daytime sleepiness.
This document provides an overview of sleep, sleep disturbances, and sleep disorders. It discusses the physiology and stages of normal sleep, including non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. It describes factors that affect sleep such as circadian rhythms, lifestyle, environment, and medications. Common sleep disorders are explained, including insomnia, sleep apnea, narcolepsy, and parasomnias. Diagnostic tests and treatments for sleep disturbances are also summarized.
Classification of sleep disorders and parasomniasEnoch R G
Sleep is made up of two physiological states: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. There are several brain regions and neurotransmitters that regulate the sleep-wake cycle, including serotonin, norepinephrine, acetylcholine, melatonin, and dopamine. Sleep disorders are classified in the DSM-5 and ICSD-2 and include insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm sleep-wake disorders, parasomnias, and other sleep-related movement disorders.
This document discusses sleep physiology and sleep disorders. It begins by defining sleep and outlining the three basic physiological processes of wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. It then describes sleep architecture and the stages of NREM and REM sleep in detail. Key aspects of sleep such as circadian rhythms, sleep requirements, neurobiology, and disorders like insomnia are also summarized. The document provides an overview of normal sleep patterns and processes as well as common sleep disorders.
Polysomnography (PSG) is the gold standard test for diagnosing sleep disorders like obstructive sleep apnea. It involves simultaneous monitoring of multiple physiologic parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. PSG is used to diagnose sleep disorders, determine appropriate treatments like CPAP, and assess treatment effectiveness. It provides valuable information about sleep architecture and respiratory events that can help characterize a patient's condition.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
1. The document discusses various sleep disorders including insomnia, hypersomnia, parasomnias, and sleep-related breathing disorders.
2. Key diagnostic tests mentioned are polysomnography, multiple sleep latency test, and actigraphy which objectively measure sleep patterns.
3. Treatment options described for different sleep disorders include lifestyle changes, medications like benzodiazepines, melatonin agonists, antidepressants, and CPAP machines for sleep apnea.
The document discusses sleep scoring using the American Academy of Sleep Medicine (AASM) guidelines. It outlines the different sleep stages including light sleep, slow-wave sleep, and REM sleep. Electrodes are placed at specific locations to monitor brain waves, eye movements, muscle activity, and heart rate. There are two main sleep scoring methods, Rechtschaffen & Kales and AASM, and this document uses the AASM method. The characteristics of each sleep stage are then defined based on the patterns seen in brain waves, eye movements, and muscle activity.
The document discusses various sleep disorders including primary sleep disorders like insomnia, narcolepsy, breathing-related sleep disorders, and circadian rhythm sleep disorders. It also discusses parasomnias such as nightmares, night terrors, sleepwalking, sleep paralysis, and restless leg syndrome. Insomnia is characterized by difficulty falling or staying asleep and can be acute or chronic, treated with medication or behavior modification. Other disorders discussed include sleep apnea, circadian rhythm disorders, narcolepsy which involves daytime sleepiness and cataplexy, and various parasomnias. Maintaining good sleep hygiene through a regular schedule, light and temperature control can help address sleep problems.
This document summarizes several primary sleep disorders, including dyssomnias and parasomnias. It provides detailed information on primary insomnia, primary hypersomnia, narcolepsy, and breathing-related sleep disorders. Key details include diagnostic criteria, associated features, prevalence, course, and specific characteristics of each disorder. Specific pages cover topics like insomnia symptoms, hypersomnia symptoms, narcolepsy symptoms including cataplexy, and the three forms of breathing-related sleep disorders.
This document provides information about various sleep disorders. It begins with definitions and descriptions of normal sleep stages. It then discusses specific sleep disorders like insomnia, hypersomnia, sleep apnea, narcolepsy, restless leg syndrome and circadian rhythm disorders. Diagnosis involves questionnaires, sleep diaries and polysomnography. Treatment depends on the disorder but may include lifestyle changes, medications, therapies and surgery. Sleep disorders can negatively impact quality of life so proper diagnosis and management is important.
Multiple sleep latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) ...Murtaza Syed
The document provides information about the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). It describes how MSLT is used to test for excessive daytime sleepiness by measuring how quickly a person falls asleep during nap opportunities. Abnormally short sleep latencies or two or more sleep onset REM periods indicate narcolepsy. MWT measures ability to stay awake and is used to assess treatment effectiveness. Both tests involve daytime nap recordings preceded by an overnight sleep study and use similar protocols and equipment to objectively measure sleepiness and wakefulness.
The two-process model
The sleep-wake system is thought to be regulated by the interplay of two major processes, one that promotes sleep (process S) and one that maintains wakefulness (process C).
Process S is the homeostatic drive for sleep.
The need for sleep (process S) accumulates across the day, peaks just before bedtime at night and dissipates throughout the night.
Sleep disorders are characterized by disturbances in sleep amount, quality, or timing. There are over 70 different sleep disorders divided into two main categories - dyssomnias involving problems falling or staying asleep, and parasomnias involving abnormal behaviors during sleep. The document provides detailed descriptions of common sleep disorders like insomnia, narcolepsy, sleep apnea, circadian rhythm disorders, nightmares, and sleep terrors. Diagnostic criteria are also outlined for each disorder.
This document discusses sleep patterns and common sleep disorders in the elderly. It begins by noting that sleep complaints are common in over half of elderly patients. It then describes normal physiologic changes in sleep patterns with age, including decreased total sleep time and slow wave sleep. Common sleep disorders discussed include advance sleep phase disorder, sleep disordered breathing/obstructive sleep apnea, insomnia, periodic limb movement disorder, and REM sleep behavior disorder. Treatment options for obstructive sleep apnea such as CPAP and oral appliances are also summarized.
This document provides an overview of sleep, its functions, stages and disorders. It defines sleep as a state of unconsciousness where the brain is more responsive to internal stimuli. Sleep has restorative and homeostatic functions. There are two main stages - NREM and REM sleep. Dyssomnias are disorders of sleep quantity/timing and include insomnia, hypersomnia, narcolepsy and sleep apnea. Parasomnias involve abnormal behaviors during sleep transitions and include nightmares, sleepwalking and REM sleep behavior disorder. Many common sleep disorders are described along with their symptoms, causes and treatment options.
sleep disorders contains dyssomnias ,parasomnias ,and sleep disorder associated with other major medical disorders . Restless leg syndrome and PLM are also covered here. this ppt also shows how to differentiate between sleep terror and night mares . treatment of sleep disorders also included.
Understanding the sleep cycle is often the first step to better sleep quality. When you know, what affects your sleep cycle, you can take measures to cut out distractions and get ample restful sleep every night.
Also, to help you understand the various sleep stages and sleep cycles easily, we have also created an infographic for this.
Read more details on the source site: https://sleepsherpa.com/stages-of-sleep-and-sleep-cycles-explained/
Sleep paralysis is a phenomenon where a person experiences temporary paralysis either when falling asleep or waking up. It occurs when there is a disruption in the normal REM sleep pattern, where the brain is awake but the body remains paralyzed. Episodes involve an inability to speak or move and can last from a few seconds to several minutes. Risk factors include narcolepsy, sleep apnea, irregular sleep schedules, and certain medications. Treatment focuses on improving sleep habits and reassurance, as sleep paralysis itself is not medically harmful.
This document discusses the physiology of sleep and sleep disorders. It describes the different stages of non-REM sleep (stages 1-4) and REM sleep, and how they are characterized by changes in brain waves, eye movements, muscle tone, autonomic functions, and more. Sleep is essential for survival but disturbances can occur in psychiatric illnesses. Sleep is studied using electrodes to measure brain waves, eye movements, muscle activity, and other physiological signals.
Sleep apnea is a common sleep disorder where a person's breathing is interrupted during sleep. Left untreated, sleep apnea can increase the risk of high blood pressure, heart disease, strokes, and accidents. A sleep study can diagnose sleep apnea and treatment, such as CPAP therapy, can significantly reduce health risks and improve symptoms like daytime sleepiness.
This document provides an overview of sleep, sleep disturbances, and sleep disorders. It discusses the physiology and stages of normal sleep, including non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. It describes factors that affect sleep such as circadian rhythms, lifestyle, environment, and medications. Common sleep disorders are explained, including insomnia, sleep apnea, narcolepsy, and parasomnias. Diagnostic tests and treatments for sleep disturbances are also summarized.
Classification of sleep disorders and parasomniasEnoch R G
Sleep is made up of two physiological states: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. There are several brain regions and neurotransmitters that regulate the sleep-wake cycle, including serotonin, norepinephrine, acetylcholine, melatonin, and dopamine. Sleep disorders are classified in the DSM-5 and ICSD-2 and include insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm sleep-wake disorders, parasomnias, and other sleep-related movement disorders.
This document discusses sleep physiology and sleep disorders. It begins by defining sleep and outlining the three basic physiological processes of wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. It then describes sleep architecture and the stages of NREM and REM sleep in detail. Key aspects of sleep such as circadian rhythms, sleep requirements, neurobiology, and disorders like insomnia are also summarized. The document provides an overview of normal sleep patterns and processes as well as common sleep disorders.
Polysomnography (PSG) is the gold standard test for diagnosing sleep disorders like obstructive sleep apnea. It involves simultaneous monitoring of multiple physiologic parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. PSG is used to diagnose sleep disorders, determine appropriate treatments like CPAP, and assess treatment effectiveness. It provides valuable information about sleep architecture and respiratory events that can help characterize a patient's condition.
This document provides information about sleep apnea, including its causes, signs and symptoms, risk factors, diagnosis, treatment, and self-care strategies. It defines two main types of sleep apnea - obstructive, which occurs when throat muscles relax and block the airway, and central, which occurs when the brain fails to signal breathing muscles. Common signs include loud snoring, breathing pauses during sleep, daytime sleepiness, and morning headaches. Risk factors include excess weight, neck size, and family history. Treatments may include devices like CPAP machines, oral appliances, surgery, weight loss, and yoga practices targeting the breathing, throat, and nasal areas.
1. The document discusses various sleep disorders including insomnia, hypersomnia, parasomnias, and sleep-related breathing disorders.
2. Key diagnostic tests mentioned are polysomnography, multiple sleep latency test, and actigraphy which objectively measure sleep patterns.
3. Treatment options described for different sleep disorders include lifestyle changes, medications like benzodiazepines, melatonin agonists, antidepressants, and CPAP machines for sleep apnea.
The document discusses sleep scoring using the American Academy of Sleep Medicine (AASM) guidelines. It outlines the different sleep stages including light sleep, slow-wave sleep, and REM sleep. Electrodes are placed at specific locations to monitor brain waves, eye movements, muscle activity, and heart rate. There are two main sleep scoring methods, Rechtschaffen & Kales and AASM, and this document uses the AASM method. The characteristics of each sleep stage are then defined based on the patterns seen in brain waves, eye movements, and muscle activity.
The document discusses various sleep disorders including primary sleep disorders like insomnia, narcolepsy, breathing-related sleep disorders, and circadian rhythm sleep disorders. It also discusses parasomnias such as nightmares, night terrors, sleepwalking, sleep paralysis, and restless leg syndrome. Insomnia is characterized by difficulty falling or staying asleep and can be acute or chronic, treated with medication or behavior modification. Other disorders discussed include sleep apnea, circadian rhythm disorders, narcolepsy which involves daytime sleepiness and cataplexy, and various parasomnias. Maintaining good sleep hygiene through a regular schedule, light and temperature control can help address sleep problems.
This document summarizes several primary sleep disorders, including dyssomnias and parasomnias. It provides detailed information on primary insomnia, primary hypersomnia, narcolepsy, and breathing-related sleep disorders. Key details include diagnostic criteria, associated features, prevalence, course, and specific characteristics of each disorder. Specific pages cover topics like insomnia symptoms, hypersomnia symptoms, narcolepsy symptoms including cataplexy, and the three forms of breathing-related sleep disorders.
This document provides an overview of physiology of sleep and sleep disorders. It discusses brain waves during different sleep stages, the cycles of non-REM and REM sleep, theories of what causes sleep, the effects of sleep on physiological functions, comparative aspects of sleep across species, and consequences of sleep deprivation. Key topics covered include the different sleep stages, roles of neurotransmitters like serotonin in regulating sleep, and restoration of brain and body during sleep.
The document provides an overview of common sleep disorders, classifying them into different categories such as dyssomnias, parasomnias, intrinsic sleep disorders, extrinsic sleep disorders, and circadian rhythm disorders. It describes several specific disorders including narcolepsy, obstructive sleep apnea, restless leg syndrome, and delayed sleep phase syndrome. Treatment options are mentioned for some disorders which include stimulants, CPAP, dopaminergic agents, anticonvulsants, and addressing underlying causes or sleep hygiene.
There are two main categories of sleep disorders: dyssomnias, which involve problems with the quantity or quality of sleep; and parasomnias, which involve unusual physical or experiential events during sleep. Some common sleep disorders discussed in the document include insomnia, sleep deprivation, sleep apnea, restless leg syndrome, REM sleep behavior disorder, narcolepsy, and cataplexy. Insomnia is the inability to fall asleep, while sleep deprivation means not getting enough sleep, which can impact judgment and coordination. Sleep apnea involves interrupted breathing during sleep due to issues like obesity or nasal passages. Narcolepsy causes uncontrollable sleep attacks and is associated with cataplexy, sleep paralysis, and
Sleep is essential for optimal functioning as it allows the brain to catalog experiences, prime memory, and regulate hormones. Getting less than 7-8 hours of sleep per night can negatively impact concentration, creativity, mood and productivity. Different stages of the sleep cycle, including deep sleep and REM sleep, are important for physical renewal, learning, memory processing and higher level thought. Lack of sufficient sleep, especially REM sleep, makes tasks like concentrating, multitasking and understanding subtleties more difficult. Managers can get more from their sleep by avoiding caffeine late in the day, creating a restful sleep environment, and taking short 10-20 minute power naps if needed.
This document discusses sleep disorders and provides information on various types of sleep disorders including dyssomnias, parasomnias, and disorders of sleep-wake schedules. It describes insomnia, hypersomnia, narcolepsy, sleep apnea, Kleine-Levin syndrome and other sleep disorders. It also discusses assessments and treatments for sleep disorders as well as nursing diagnoses and interventions to promote restful sleep.
This document provides an overview of various sleep disorders including:
1. Dyssomnias are primary sleep disorders involving changes in sleep amount, quality or timing including insomnia, hypersomnia, and narcolepsy.
2. Parasomnias are disorders where sleep physiology or behaviors are affected, such as nightmares.
3. Circadian rhythm sleep disorders result from a mismatch between sleep-wake patterns and environmental demands like jet lag or shift work.
4. Breathing-related sleep disorders interrupt sleep through breathing problems like sleep apnea.
This document provides an overview of sleep and sleep disorders. It defines sleep and describes the physiology and stages of normal sleep. It discusses factors that influence sleep such as circadian rhythms, neurotransmitters, and the sleep-wake cycle. Common sleep disorders are explained like insomnia, narcolepsy, sleep apnea, restless leg syndrome and parasomnias. Assessment methods and treatment options for sleep disorders are also summarized.
This document discusses sleep and the brain waves associated with it. It defines sleep and describes the two types: slow wave sleep and REM sleep. It explains that sleep is an active process involving different neuronal centers and neurohormonal substances that cause different stages of sleep. The brain waves associated with different stages are also described, including alpha, beta, theta, and delta waves. Various sleep disorders are also mentioned.
Dreams occur during REM sleep and can reflect our unconscious thoughts and concerns. While the exact purpose of dreaming is unknown, deprivation of REM sleep has been shown to have negative mental and physical effects. Daydreams and fantasies allow us to imagine possibilities when awake. Recurring and nightmares may indicate unresolved issues, while lucid dreaming involves realizing one is dreaming.
Slides from talk, showing how academic achievement (in the form of exam passes) are way down the list when it comes to employability, and the importance of 'soft skills'.
Este documento trata sobre el ritmo circadiano y su relación con los trastornos del sueño. Explica que el ritmo circadiano sigue un ciclo de 24 horas de luz y oscuridad que regula los estados de vigilia, no vigilia y sueño. También describe las diferentes fases del sueño y cómo la melatonina juega un papel clave en la regulación del ciclo sueño-vigilia. Finalmente, señala que las alteraciones o desajustes en el reloj circadiano pueden dar lugar a problemas como insomnio psicofisi
Neurobiology of sleep_disorders_lattova(5280ab0cb6099)Hena Jawaid
This document provides an overview of neurobiology of sleep and sleep disorders. It defines normal sleep, describes the circadian rhythm and two-process model that regulate sleep-wake cycles. It outlines the reticular activating system and flip-flop switch that control transitions between wake and sleep states. Non-REM and REM sleep are characterized based on EEG patterns. Polysomnography and other tools for measuring sleep are discussed. Common sleep disorders like insomnia are introduced.
This document discusses sexual dysfunction, defining it as any problem that occurs during the sexual response cycle and prevents sexual activity. It notes that dysfunction can affect any gender at any age but is more common in ages 40-65. The sexual response cycle and common types of dysfunction like desire disorders, arousal disorders, orgasm disorders, and pain disorders are defined. Potential causes include physical factors like disease or psychological factors like stress and relationship issues. Suggested treatments involve medication, mechanical aids, sex therapy, lifestyle changes, psychotherapy, and education.
This document is a collection of photo credits from various photographers used in a Haiku Deck presentation on SlideShare. The photos were taken by photographers named Kevin Dooley, Rob Unreall, lapidim, Daveography.ca, emagdi, Dreemreeper, giulia.forsythe, gliageek, RachelHermosillo, Jim Nix / Nomadic Pursuits, and mpisti. The document encourages the reader to get started creating their own Haiku Deck presentation.
Sleep is essential to our overall health and well-being. It is key to our ability to perform cognitive and physical tasks, engage fully in life, and function productively and safely. The average sleep requirement varies by age, from 16-20 hours for infants to 6-8 hours for adults. There are two main types of sleep disorders - dyssomnias which affect sleep amount, timing or quality, and parasomnias which involve abnormal physical or experiential events during sleep. Sleep disorders can be treated through lifestyle modifications, behavioral therapies, medication, and treating any underlying medical conditions. Maintaining good sleep hygiene is important for promoting healthy sleep.
Do You Want a place to party? Do you have a problem with finding out places in Dhanbad which ensure you the safety to take your friends to? ThePartyPlace will give you the places all over in Dhanbad, specially to party and celebrate events for students.
Circadian rhythms regulate the body's sleep-wake cycle over 24 hours, with alertness peaking around noon and 6pm and dipping around 3am. The hypothalamus influences glands like the pineal gland to secrete melatonin and induce sleepiness according to our internal biological clocks. There are two main theories for why we sleep: the adaptive theory proposes sleep evolved to avoid nocturnal predators, and the restorative theory suggests sleep is necessary to physically replenish our bodies and repair cellular damage during rest.
This document provides an overview of narcolepsy, including its definition, types, symptoms, diagnosis, and treatment. Narcolepsy is a chronic neurological sleep disorder characterized by excessive daytime sleepiness and sudden attacks of sleep. There are two main types - type 1 involves cataplexy in addition to excessive daytime sleepiness, while type 2 only involves excessive daytime sleepiness. Diagnosis involves polysomnography and multiple sleep latency tests. Treatment focuses on managing excessive daytime sleepiness with stimulants and sodium oxybate, and managing cataplexy with antidepressants. Lifestyle modifications like exercise and sleep hygiene are also recommended.
This document provides an overview of sleep, its functions, stages and disorders. It defines sleep as a state of unconsciousness where the brain is more responsive to internal stimuli. Sleep has restorative and homeostatic functions. There are two main stages - NREM and REM sleep. Dyssomnias are disorders of sleep quantity/timing and include insomnia, hypersomnia, narcolepsy and sleep apnea. Parasomnias involve abnormal behaviors during sleep transitions and include nightmares, sleepwalking and REM sleep behavior disorder. Many common sleep disorders are described along with their symptoms, causes and treatment options.
This document discusses various sleep and wake disorders including insomnia, hypersomnia, parasomnia, sleep apnea, narcolepsy, and restless legs syndrome. It covers the classification, clinical manifestations, causes, diagnosis, and treatment options for each disorder. Key points include that insomnia is characterized by issues initiating or maintaining sleep, hypersomnia involves excessive sleepiness, and parasomnia involves abnormal behaviors during sleep stages. Disorders are classified as intrinsic, extrinsic, or circadian rhythm related. Treatment involves lifestyle changes, medications, CPAP, surgery, or oral appliances depending on the underlying cause.
Sleep disorders can be classified into six main categories. Narcolepsy is characterized by excessive daytime sleepiness and irregular sleep-wake cycles. It is caused by a lack of hypocretin in the brain and symptoms include sleep attacks, cataplexy, hallucinations, and sleep paralysis. Obstructive sleep apnea is the most common breathing-related sleep disorder and involves repetitive collapse of the upper airway during sleep causing fragmented sleep and oxygen deprivation. Parasomnias are abnormal behaviors that occur during sleep like sleepwalking, nightmares, and REM sleep behavior disorder. Restless legs syndrome involves unpleasant sensations in the legs when trying to fall asleep that are relieved by movement. Polysomnography and the
This document provides an overview of extrapyramidal diseases. It defines extrapyramidal diseases as disorders of the basal ganglia and connected brain structures outside the pyramidal tract. The document classifies extrapyramidal diseases into hypokinetic disorders like Parkinson's disease which cause decreased movement, and hyperkinetic disorders like chorea which cause increased involuntary movements. It then discusses specific diseases like Parkinson's disease, Huntington's disease, dystonia, chorea, ballism, myoclonus, and drug-induced disorders in terms of symptoms, causes, treatment approaches.
This document summarizes treatment approaches for Parkinson's disease. It describes how dopamine replacement with levodopa is the first-line treatment and discusses the use of dopamine agonists, MAO-B inhibitors, COMT inhibitors, and other adjunctive therapies. Surgical procedures like deep brain stimulation are also mentioned. The pathogenesis of Parkinson's involves degeneration of dopaminergic neurons in the substantia nigra leading to motor and non-motor symptoms.
This document discusses various treatment options for Parkinson's disease. It begins by describing the symptoms and diagnosis of Parkinson's, including tremors, rigidity, and bradykinesia. The main pathological feature is the loss of dopaminergic neurons in the substantia nigra. The goal of treatment is to restore dopaminergic activity. Levodopa is the first-line drug as it is the metabolic precursor to dopamine. Peripheral decarboxylase inhibitors like carbidopa are used to reduce side effects from levodopa. When levodopa effectiveness declines, dopamine agonists may be used as an alternative or adjunct treatment.
The document provides an overview of sleep and sleep disorders presented by Dr. Kaushik Nandi. It discusses the neurobiology of sleep and wakefulness including the arousal spectrum and sleep/wake switch regulated by neurotransmitters and brain regions like the hypothalamus. The stages of sleep are described based on EEG patterns and physiological characteristics. Assessment methods and classifications of sleep disorders by the DSM-5 and ICSD-3 are outlined. Insomnia disorder and Narcolepsy are explained in more detail regarding their diagnostic criteria, epidemiology, etiology, pathophysiology and treatment approaches.
1. A seizure is caused by abnormal excessive neuronal activity in the brain and can be focal, generalized, or febrile.
2. Evaluation of a first seizure involves obtaining a detailed history, physical exam, EEG, and brain imaging to determine the cause and classify the seizure type.
3. Generalized seizures include absence seizures, myoclonic seizures, and generalized tonic-clonic seizures. Focal seizures can become secondary generalized seizures.
parkinson's disease by me ..........prakash mahala p.g. medical surgical nursing at himalayan college of nursing dehradun.......prakashjpmmahala@gmail.com
This document summarizes various breathing-related sleep disorders including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. It also discusses parasomnias, which are disorders of arousal during sleep stages. Common parasomnias include sleepwalking, sleep terrors, REM sleep behavior disorder, recurrent isolated sleep paralysis, and nightmares. Movement disorders like restless leg syndrome are also covered. Treatment options focus on lifestyle changes, medications, CPAP, and other therapies depending on the specific condition.
Explores impact of disturbed sleep on symptom management in patients with concurrent serious illness and at the end of life. Presented during Hospice and Palliative Medicine Fellowship at the University of Kansas 2014
This document discusses various sleep disorders including insomnia, narcolepsy, hypersomnolence disorder, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, and parasomnias. It covers the diagnostic criteria, epidemiology, etiology, pathophysiology, assessment, and treatment approaches for each disorder. Sleep is regulated by homeostatic and circadian processes in the brain and disrupted sleep can negatively impact brain function and health. A thorough evaluation including sleep history, exams, and sometimes polysomnography is needed to diagnose the underlying cause of the sleep problem.
Extra-nigral motor scenarios in Parkinson DiseaseHatem Shehata
PD is a Multi-system disorder. It A TIP OF ICEBERG WITH MOTOR AND NON-MOTOR FEATURES
Not all motor manifestations are DIRECTLY related to nigrostroatal dysfunction.
Involvement of Glutamate, NA, A.Ch is documented
LC (REM- behavior)
PPN (FOG)
Glu , Adenosine, Cannabinoid and Opioid systems (LID)
Central Nervous System, Epilepsy, Parkinson, Alzheimer, Stroke and Migraine.Dr. Kiran Dhamak
Central Nervous System is one of the unit in Pharmacotherapeutics Subject which is for Second Year Diploma in Pharmacy. The unit covers diseases like Epilepsy, Parkinson, Alzheimer, Stroke and Migraine. The presentation includes the point as per diploma in pharmacy students may understand very easily. The syllabus is framed by Pharmacy Council of India which is implemented by MSBTE ER 2020-2021
This document discusses various aspects of cognitive and neurological function in gerontological nursing. It covers the central nervous system, changes that occur in the brain and neurons with aging, effects on motor skills, senses, sleep patterns, and more. It also summarizes common conditions like depression, delirium, dementia, Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. Treatment options are mentioned for some conditions.
Neurodegenerative Disorders Pharmacotherapy Dr Jayesh Vaghelajpv2212
This document discusses pharmacotherapy for neurodegenerative disorders. It provides an overview of mechanisms of neuronal cell death like protein misfolding and aggregation. It then discusses selective vulnerability in different disorders and neuroprotective strategies. For Parkinson's disease specifically, it covers the introduction, etiology, pathophysiology, clinical manifestations, and pharmacotherapy including levodopa, dopamine agonists, COMT inhibitors, and their advantages and adverse effects.
Status epilepticus (SE) is a medical emergency defined by continuous seizure activity lasting more than 5 minutes for generalized seizures or more than 10 minutes for focal seizures. The condition requires rapid treatment to prevent neuronal injury and death from prolonged excitatory activity. Management involves initial airway and hemodynamic stabilization, followed by benzodiazepines as first-line treatment. If seizures continue, second-line drugs like phenytoin are used. Refractory SE fails to respond to first- and second-line drugs, while super-refractory SE continues despite anesthesia with midazolam or barbiturates. Early, aggressive treatment is needed to terminate seizures and prevent neurological complications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. “Unmet public health problem”
sleep deficiency and disorders cause :
Glucose
intolerance
Diabetes
Obesity
Metabolic
syndrome
Impaired
immune
responses
Accelerated
atherosclerosis
Cardiac
disease
Stroke
3. Sleep
NREM
N1
N2
N3
REM
•20-25% of sleep
•2nd hour of sleep
•EEG: low-
amplitude, mixed
frequency
•EOG-bursts of
rapid eye
movements
•EMG- absent
activity in all
skeletal muscles--
brainstem-
mediated muscle
atonia
Slow wave sleep
15-25%
Predom in 1st 1/3 of
night
Intense in child
absent in elderly
• increasing
arousal
threshold and
slowing of the
cortical EEG
• progress in
45–60 min
6. sleepiness or tiredness during
the day
Insomnia--difficulty initiating or
maintaining sleep at night
Parasomnias-- unusual behaviors
during sleep itself
7. Obtain careful history
Duration, severity and consistency of symptoms
When the patient typically goes to bed, fall asleep and
wake up, awaken during sleep, feel rested in the
morning and nap during the day
Daily sleep log for 1–2 weeks to define the timing and
amounts of sleep, work time, drug/alcohol use
Ask for snoring, witnessed apneas, restless sensations
in the legs, movements during sleep, depression,
anxiety
Seizures– GTCS with urinary incontinence or tongue
biting or stereotyped movements in partial complex
epilepsy in NREM-sl
O/E-- small airway, large tonsils or a neurologic or
9. Sleepiness
•propensity to fall
asleep
•most evident when the
patient is sedentary
•affect judgment in a
manner analogous to
Fatigue
• feeling of low physical or mental energy but without a tendency to actually sleep
• interfere with more active pursuits
• Won’t affect judgment
• common in inflammatory disorders such as cancer, multiple sclerosis, fibromyalgia,chronic fatigue syndrome,endocrine
deficiencies such as hypothyroidism or Addison’s disease
12. Symptoms related to intrusion of
REM sleep characteristics
• sudden muscle weakness
without LOC , triggered by
strong emotions
cataplexy
• Brief,frequentSleep attacks
• dreamlike hallucinations at
sleep onset
hypnagogic
hallucinations
• dreamlike hallucinations
upon awakening
hypnopompic
hallucinations
• muscle paralysis upon
awakening
sleep paralysis
13. typically begins between age 10 and 20
If established,disease persists for life
loss of the hypothalamic neurons that produce the
orexin –hypocretins
Autoimmune process -- HLA DQB1*06:02 (90%)
Tumors,stroke
Consistent emotional triggers such as heartfelt
mirth when laughing at a great joke, happy surprise
at unexpectedly seeing a friend, or intense anger
14. polysomnogram followed by an MSLT
Polysomnogram -- rule out other possible causes of
sleepiness such as sleep apnea
MSLT
essential, objective evidence of sleepiness plus REM
sleep dysregulation
consists of five 20-min nap opportunities every 2 h
across the day
patient is instructed to try to fall asleep
average sleep latency across the naps of less than 8
min is considered objective evidence of excessive
daytime sleepiness
occurrence of REM sleep in two or more of the MSLT
15. adequate sleep each night and 15- to 20-min nap in the
afternoon
Modafinil (200–400 mg OD)
relatively long half life ,fewer S/E
Methylphenidate (10mg BD) /dextroamphetamine (10
mg BD)
sympathomimetic side effects, anxiety,potential for
abuse
Sodium oxybate (gamma hydroxybutyrate)
•NARCOLEPSYTreatment
16. Treating cataplexy
Antidepressants--Venlafaxine (37.5–150 mg
each morning) fluoxetine (10–40 mg each
morning)
TCAs-protriptyline (10–40 mg/d) or
clomipramine (25–50 mg/d)
Sodium oxybate-given at bedtime and 3–4 h
later
17. Obstructive sleep apnea/hypopnea
syndrome (OSAHS)
Risk factors
Obesity
Male sex
Mandibular retrognathia and micrognathia
Positive family history
Genetic syndromes that reduce upper airway patency (Down
syndrome, Treacher-Collins syndrome), adenotonsillar
hypertrophy,menopause (in women), acromegaly,
18. Health Consequences and
Comorbidities
Daytime sleepiness
Hypertension
Coronary Artery Disease
Heart failure
Arrythmias
Stroke
IR and Diabetes mellitus
Depression
19. Treatment:OSAHS
reduce weight
optimize sleep duration (7–9 hours) and regulate sleep
schedules (with similar bedtimes and wake times across
the week)
treat nasal allergies, eliminate alcohol ingestion within 3
h of bedtime and minimize use of sedatives
CPAP is the standard medical therapy --works as a
mechanical splint to hold the airway open, thus
maintaining airway patency during sleep
Oral appliances --advancing the mandible, thus opening
the airway by repositioning the lower jaw and pulling the
tongue forward
Upper airway surgery--Uvulopalatopharyngoplasty
20. Restless leg syndrome
RLS is very common / 5–10% of adults /
more common in women and older adults
Diagnostic
criteria
21. Causes
•Idiopathic
•Genetic factors --polymorphisms
in a variety of genes (BTBD9,
MEIS1, MAP2K5/LBXCOR, and
PTPRD)
Primary
• Iron deficiency
• Peripheral neuropathies
• Uremia
• Pregnancy
• Varicose veins
• Parkinsons disease
• Caffeine,alcohol,antidepressants,
lithium,neuroleptics and
Secondary
22. Treatment
Symptomatic
Treat underlying disorder
dopamine agonists :pramipexole or ropinirole
Opioids, benzodiazepines, pregabalin, and
gabapentin may also be of therapeutic value
23. PERIODIC LIMB MOVEMENT
DISORDER
rhythmic twitches of the legs that disrupt sleep
triple flexion reflex with extensions of the great toe
and dorsiflexion of the foot for 0.5 to 5.0 s, which
recur every 20–40 s during NREM sleep, in
episodes lasting from minutes to hours
polysomnogram -- includes recordings of the
anterior tibialis and sometimes other muscles
EEG - brief arousals that disrupt sleep and can
cause insomnia and daytime sleepiness
PLMD can be caused by the same factors that
cause RLS
Rx:dopamine agonists
24. INSOMNIA
difficulty initiating or maintaining sleep
• 30% of adults
• precipitated by stressful life events
• increased nocturnal light exposure, frequently
checking the clock, or attempting to sleep more
by napping, it can lead to chronic insomnia
Acute or short-
term insomnia
•>3 months
•10% of adults
• more common in women, older adults,
individuals with medical, psychiatric,
substance abuse disorders
Chronic
insomnia
25. • negative expectations
• worry about their insomnia
during the day and have
increasing anxiety as
bedtime approaches
• frequently check the clock,
which only heightens anxiety
and frustration
Psychophysiologic
Factors
• daytime napping
• irregular sleep-wake schedule
• use of wake-promoting substances
(caffeine, tobacco) too close to
bedtime
• engaging in alerting or stressful
activities close to bedtime
• using the bedroom for activities
other than sleep (e.g., TV, work)
Inadequate Sleep
Hygiene
26. •Depression--early
morning awakening,
interfere with the
onset and
maintenance of sleep
•Mania and
hypomania
•Anxiety disorders
•Panic attacks can
occur during sleep
•schizophrenia and
other psychoses--
fragmented sleep,
less deep NREM
sleep,reversal of the
day-night sleep
Caffeine
Theophylline
Stimulants
Antidepressants
Glucocorticoid
Withdrawal of
alcohol,
narcotics,BZD
Psychiatric
Conditions Medications and
Drugs of Abuse
27. day
altered circadian
rhythms
weakened output of the
brain’s sleep-
promoting
mechanisms
Parkinson’s disease --due to
rigidity, dementia
Fatal familial insomnia
rare neurodegenerative
condition
mutations in the prion protein
gene
thalamus undergo atrophy
asso with insomnia,dementia,
myoclonus,
dysarthria, or
autonomic dysfunction
Rheumatologic
disorders
Painful neuropathy
Asthma
COPD
Cystic fibrosis
Restrictive lung
disease
Congestive heart
failure
Menopause
GERD
Neurologic
Medical
Conditions
30. COGNITIVE BEHAVIORAL
THERAPY (CBT)
• cognitive psychology techniques --to reduce excessive
worrying about sleep
• Relaxation techniques--progressive muscle relaxation or
meditation, to reduce autonomic arousal, intrusive thoughts
and anxiety
PHARMACOTHERAPY
• Antihistamines-- diphenhydramine--produce rapid tolerance
and can produce anticholinergic side effects such as dry
mouth and constipation
• Benzodiazepine receptor agonists --lorazepam,
triazolam, clonazepam, zolpidem, zaleplon
31. Problems with drugs
Risk of injurious falls
Confusion in the elderly
Morning sedation can interfere with driving and
judgment
Benzodiazepines carry a risk of addiction and
abuse
Worsen sleep apnea
Complex behaviors during sleep--sleep
walking and sleep eating
32. PARASOMNIAS
abnormal behaviours or experiences that
occur during sleep
• Brief confusional arousals
• Sleep walking
• Sleep terrors
• Sleep bruxism
• Sleep enuresis
NREM
• REM sleep behavior disorder
(RBD)
• Nightmares
REM
33. Sleepwalking (Somnambulism)
carry out automatic motor activities that range from
simple to complex:walk, urinate inappropriately, eat, exit the
house, or drive a car with minimal awareness
NREM:N3 sleep, usually in the first few hours of the
night,children and adolescents
EEG usually shows the slow cortical activity of deep NREM
sleep even when the patient is moving about
worsened by insufficient sleep, alcohol, stress
Treatment:
antidepressants and benzodiazepines hypnosis
home safety relaxation techniques
34. Sleep Terrors
young children
NREM stage N3 sleep
child sits up during sleep and screams, exhibiting
autonomic arousal with sweating, tachycardia,
large pupils,hyperventilation
difficult to arouse and rarely recalls the episode on
awakening in the morning
Treatment --reassuring the parents that the
condition is self-limited and benign,improve by
avoiding insufficient sleep
35. Sleep Bruxism
involuntary, forceful grinding of teeth during
sleep t
10–20% of the population
age of onset is 17–20 years, and spontaneous
remission usually occurs by age 40.
tooth guard is necessary to prevent tooth injury
Stress management /biofeedback can be
useful when bruxism is a manifestation of
psychological stress
36. Sleep Enuresis
Before age 5 or 6 years, nocturnal enuresis should be
considered a normal feature of development
Important causes of nocturnal enuresis in patients who were
previously continent for 6–12 months -- urinary tract
infections or malformations, cauda equina lesions, emotional
disturbances, epilepsy, sleep apnea, and certain medications
The condition usually improves spontaneously by puberty,
has a prevalence in late adolescence of 1–3%, and is rare in
adulthood
Treatment
blAdder training exercises
Behavioral therapy
Pharmacotherapy --desmopressin (0.2 mg qhs), oxybutynin
37. REM Sleep Behavior Disorder
(RBD)
patient or the bed partner usually reports agitated or
violent behavior during sleep, and upon awakening, the
patient can often report a dream that accompanied the
movements
movements can be dramatic, and it is not uncommon for
the patient or the bed partner to be injured
polysomnogram --limb movements during REM sleep,
lasting for seconds to minutes
older men, synucleinopathy such as Parkinson’s
disease, dementia with Lewy bodies or occasionally
multiple system atrophy ,antidepressants
Synucleinopathies -- cause neuronal loss in brainstem
regions that regulate muscle atonia during REM sleep
38. CIRCADIAN RHYTHM SLEEP
DISORDERS
disorder of sleep timing
ORGANIC
abnormality of
circadian pacemakers
ENVIRONMENTAL/BEHAVI
ORAL
disruption of environmental
synchronizers
39. Delayed Sleep-Wake
Phase Disorder
• young adults
• sleep onset and wake times
intractably later than desired
• normal sleep on
polysomnography (except for
delayed sleep onset)
• Dim-light melatonin onset
(DLMO) typically occurs later in
the evening than normal, which is
about 8:00–9:00 pm (1–2 h
before habitual bedtime)
• Treatment :
• phototherapy with blue-enriched
light during the morning
• melatonin administration in the
evening hours
Advanced Sleep-
Wake Phase
Disorder
• older people
• cannot sleep past 5:00 am
• wake up too early at least several
times per week
• sleepy during the evening hours
• normal sleep on
polysomnography (except for
early sleep onset)
• early onset of dim-light melatonin
secretion
• Treatment:
• bright-light and/or blue enriched
phototherapy during the evening
hours to reset the circadian
pacemaker to a later hour
40. Jet Lag Disorder
excessive daytime sleepiness, sleep-onset insomnia, and
frequent arousals from sleep, particularly in the latter half of
the night
transient, typically lasting 2–14 d depending on the number of
time zones crossed, the direction of travel, and the traveler’s
age and phase-shifting capacity
Travelers who spend more time outdoors at their destination
reportedly adapt more quickly than those who remain in hotel
rooms, presumably due to brighter (outdoor) light exposure
Laboratory studies suggest that low doses of melatonin can
enhance sleep efficiency, but only if taken when endogenous
melatonin concentrations are low (i.e., during the biologic
daytime).
41. SHIFTWORK DISORDER
Night shift workers :decreased alertness &
performance, increased reaction time, increased
risk of performance lapses, resulting in greater
safety hazards among night workers
Motor vehicle operators: accidents
Resident physicians: impairs psychomotor
performance, increases the risk of serious medical
errors in ICUs, including a fivefold increase in the
risk of serious diagnostic mistakes
42. Treatment
Postural changes, exercise, and strategic placement of
nap opportunities
Properly timed exposure to blue-enriched light or bright
white light --enhance alertness and facilitate more rapid
adaptation to night-shift work
Modafinil (200 mg) or armodafinil (150 mg) 30–60 min
before the start of each night shift -
Work schedules should be designed to minimize: (1)
exposure to night work (2) the frequency of shift
rotations (3) the number of consecutive night shifts (4)
43. MEDICAL IMPLICATIONS OF
CIRCADIAN RHYTHMICITY
Platelet aggregability is increased in the early morning hours-
-peak incidence of acute myocardial infarction, sudden
cardiac death and stroke
Recurrent circadian disruption combined with chronic sleep
deficiency(nightshift work) --increased plasma glucose
concentrations after a meal due to inadequate pancreatic
insulin secretion
Night shift workers with elevated fasting glucose have an
increased risk of progressing to diabetes
Blood pressure of night workers with sleep apnea is higher
than that of day workers
44. Diagnostic and therapeutic procedures may also be
affected by the time of day at which data are collected
(BP, Temp, dexamethasone suppression test, and
plasma cortisol)
The timing of chemotherapy administration has been
reported to have an effect on the outcome of treatment
both the toxicity and effectiveness of drugs can vary with
time of day(Anesthetic agents)
Finally, the physician must be aware of the public health
risks associated with the ever-increasing demands made
by the 24/7 schedules in our round-the-clock society.