Sleep disorders - a brief medical study

Sleep Disorders
Prepared by
Martin shaji
Pharm d 4th year
17G91T0023
1
martinsuja369@gmail.com

Introduction
Sleep is a state of unconsciousness in which the
brain is relatively more responsive to internal than
external stimuli .
A sleep disorder is any condition that involves
difficulty experienced when sleep , such disorders
involve daytime fatigue causing severe distresss and
impairment to work.
SD also have an impact upon social and personal
functioning

sleep is divided into two different phases.
1)D-sleep(desynchronized or dreaming sleep) or REM sleep(rapid
eye movement sleep) or active sleep or paradoxical sleep)
2)S-sleep(synchronized sleep) or NREM- sleep(non-REM sleep) or
quiet sleep or orthodox sleep.
S-sleep or NREM-sleep is further divided into 4 stages, from stage
1 to stage 4( deep sleep )
person first passes through these stages of NREM-sleep.
Depending on the duration of total sleep,two extremes of normal
sleeping patterns have been described

Depending on the duration of total sleep,two extremes of
normal sleeping patterns have been described.
1)long-sleepers = more than 9 hours/night
2)Short-sleepers = less than 6 hours/night
Classification
1) Primary Sleep Disorder
2) Sleep disorder related to another mental disorder
3) Other sleep disorder, most notably those due to a
general medical condition or substance-induced.

Primary Sleep Disorders:
-Dyssomnias( disorders of quality and timing of sleep)
Insomnia
Narcolepsy
Breathing-Related Sleeping Disorders
Circadian Rhythm Sleep Disorder
-Parasomnias ( abnormal behaviour during sleep or the transition
between sleep and wakefulness )
Nightmares
Night Terrors
Sleepwalking
Sleep Paralysis

Insomnia
Insomnia means one or more of the following:
1)Difficulty in initiating sleep.
2)Difficulty in maintaining sleep
This includes both: -frequent awakenings during the night,
and -early morning awakening.
3)Non-restorative sleep,i.e.despite adequate duration of
sleep, feeling of not having rested present(poor quality
sleep)

Chronic causes of insomnia
Medications
Drug or alcohol use
Psychiatric disorders (e.g., depression, anxiety)
Medical disorders
Sleep apnoea
Restless leg syndrome
Poor sleep hygiene

Insomnia treatment
Lifestyle changes often can help relieve acute (short-term)
insomnia. Sleep hygiene
A type of counseling called cognitive-behavioral therapy (CBT) can
help relieve the anxiety linked to chronic (ongoing) insomnia.
Anxiety tends to prolong insomnia.
Stimulus control therapy
Several medicines also can help relieve insomnia and re-establish
a regular sleep schedule.

Pharmacological treatment
Dietary supplements
melatonin
l- tryptophan
Short acting benzodiazepenes
z – drugs
Zolapedium
Low dose sedative antidepressant
Mitazepine
Long acting medicines such as
Flueazeporam
Quazepam
Other medications
nefazodone
Qutipine

HYPERSOMNIA
Excessive day time sleepiness or sometimes both
Sleep attacks during day time(falling asleep unintentionally)
Sleep drunkenness(person needs much more time to awaken
and during this period is confused or disoriented)
Causes / reason
Insufficient night sleep
Unsatisfactory sleep routine
Circadian rhythm sleep disorders
Chronic physical illness
Psychiatric disorders ………………………………………………….

Other pathological reasons are
Narcolepsy
Obstructive sleep apnea
CNS diseases
Drug effects
Kleine-levin Syndrome
Primary hypersomnia
sleep disturbance occurs daily for at least 1 month or for
recurrent periods of shorter duration, and that it causes
either marked distress or interferes with social and
occupational functioning.
Treatment
Stimulant drugs
Non sedating SSRIs

Sleep apnea
Repeated stoppage in breathing during sleep
Caused by lack of breathing drive (central) or by blockage
(obstructive)
Signs/Symptoms:
Snoring, headaches,
fatigue, poor sleep,
chronic congestion,
irritability, obesity,
sexual dysfunction
Treatment: Continual Positive Airway Pressure (CPAP),
Lifestyle Changes, and Surgery.

Medications
Albuterol
Attention Deficit Disorder Meds (e.g. Ritalin)
Decongestants (Pseudoephedrine, Phenylephrine)
Caffeine
“Diet pills"
Nicotine
Thyroid medications
Corticosteroids
SSRIs (antidepressants)
Phenytoin (seizure medication)
Chemotherapy (cancer medications)
Beta-blockers (high blood pressure meds)

Narcolepsy
Narcolepsy is a disorder that causes periods of extreme
daytime sleepiness due to trouble sleeping at night and is
sometimes accompanied by paralysis and hallucinations
Diagnosis
Polysomnography
Multiple sleep latency test
EEG
MRI
CT
Possible factors include:
Heredity. Some people may inherit a gene that
affects hypocretin. Up to 10% of people who
have narcolepsy report having a relative with
the same symptoms.
Infections
Brain injuries caused by brain tumors, strokes,
or trauma.
Autoimmune disorders
Low levels of histamine, a substance in the
blood that promotes wakefulness

Pathophysiology
Specialized neurons
Extend from lateral hypothalamus to RAS
There it produce neuropeptides ( orexins A & B also called
as hypocritin 1 & 2 ) responsible for maintaining sleep
cycle in brain center
Sleep disorders cause decreased levels of neuropeptides
Result in decreased neuronal activity
Nacrolepsy /hypersomnia and other SDs

Narcoleptic Cataplexy
This condition causes a sudden loss of muscle tone while
you're awake.
Muscle weakness can affect certain parts of your body or
your whole body. For example, if cataplexy affects your
hand, you may drop what you're holding. It may last
seconds or minutes.

Treatment
A complete cure for narcolepsy is not possible by drugs
The treatment consists of :-
Stimulant medication(eg:amphetamines)in some patients
and/or
Antidepressants(particularly when cataplexy is a prominent
symptoms)
Sedatives ( mild )
Hypnotics …………….Non- benzodiazepines

Non –pharmacological treatment
Reduce or stop caffeine ,alcohol or nicotine
Exercise
Meditation , yoga
Counselling under a clinical psychologist
Relaxation techniques
Cognitive therapy
Paradoxical intension

KLEINE-LEVIN SYNDROME
This is a rare syndrome characterized by:-
Hypersomnia.
Hyperphagia(usually present),with a varacious
appetite.
Hypersexuality

Circadian Rhythm Sleep Disorder
Persistent pattern of sleep disruption
leading to excessive sleepiness or
insomnia due to mismatch between
sleep- wake schedule.
Obvious distress/impairment in social
and occupational settings.
Delayed Sleep Phase Type
An unnatural sleeping pattern created by
falling asleep late and waking up late
which eventually establishes an inability
to fall asleep and awaken at a desired
earlier time.

parasomnias
Nightmares
Night Terrors
Sleepwalking (somanabulism )
Restless Leg Syndrome
Sleep Paralysis

Sleep disorders - a brief medical study

Sleep disorders - a brief medical study

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