Sleep Disorders.ppt
Transcript of Sleep Disorders.ppt
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Sleep Disorders
Audrea Elliott
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What is sleep?
• Sleep is a behavior that follows a circadian rhythm.
• Sleep is not uniform, but organized into cycles.
• Sleep is defined behaviorally into four criteria: reduced motor activity, decreased response to activity, stereotypic postures, reversibility.
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Sleep Cycle
• There are five stages of sleep; four stages are considered non-REM sleep and one stage of REM sleep
Allan & Bacon 2004
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REM Sleep
• Accounts for about 25% of sleep.
• In humans, occurs once every 90 minutes.
• Brain activity is high during REM.
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Sleep Deprivation
• Studies with humans have found that sleep deprivation takes it’s greatest toll on cognitive abilities.
• When allowed to sleep again, all stages of sleep are not made up evenly.
• Studies with lab animals have shown that with enough sleep deprivation the animals will become sick and eventually die.
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Neural Control of Arousal and Sleep
Allan & Bacon 2004
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Sleep Disorders DSM-IV-TR
• Primary Sleep Disorders- -Dyssomnias - Insomnia - Hypersomnia - Narcolepsy - Breathing-Related Sleeping Disorders - Circadian Rhythm Sleep Disorders - NOS
- Parasomnias - Nightmare Disorder - Sleep Terror Disorder - Sleepwalking Disorder - POS
• Secondary Sleep Disorders-
- Sleep Disorder Related to Another Mental Disorder
- Sleep Disorder Due to a General Medical Condition
- Substance- Induced Sleep Disorder
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Insomnia
• Difficulty initiating and maintaining sleep; non restorative sleep.
• Clinically significant distress/impairment in social, occupational, or other important areas.
• Disturbance of sleep is not due to another sleep disorder.
• Disturbance of sleep is not due to another mental disorder
• Not due to direct effects of substance use or general medical condition.
• Affects about 60 million Americans have chronic insomnia. About two percent have excessive sleepiness. Most common sleep complaint.
• Affects 40% of women and 30 % of men.
• # 1 cause is thought to be sleep medication
• Acute or Chronic• Treatment: medication or
behavior modification.
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Hypersomnia• Excessive sleepiness with one
month as evidence by either sleep episodes or day time sleep episodes that occur almost daily.
• Excessive sleepiness caused clinically significant distress/impairment in social, occupational, or other important areas
• Excessive sleepiness not better accounted for by insomnia, other sleep disorder, or inadequate sleep.
• Not a result of other mental disorder, physical condition, substance use, or medical condition.
• Recurrent: 3 days concurrent several times a year for at least two years.
• 5-10% of sleep clinic patients
• Lifetime prevalence of at least 16%.
• Adult population prevalence is 0.5- 5%.
• Four year prevalence about 8%.
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Narcolepsy• Sleep attack must occur daily
over period of one year over a period of at least three months.
• Must experience either cataplexy or recurrent intrusions of elements of REM sleep.
• Disturbance not due to physical condition, substance use, or medical condition.
• A disorder characterized by sudden and uncontrollable, though often brief, attacks of deep sleep.
• Sometimes is accompanied by paralysis and hallucinations
• Chronic disease due to brains inability to regulate sleep-wake cycles.
• Hypocretin system implicated in development.
• Treatment: keep a regular schedule, take short daytime naps, drug therapy
• Many people go years before seeking treatment.
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Cataplexy
• Neurological condition in which the person experiences sudden bilateral loss of muscle tone and falls, usually experienced right after a strong emotion (anger, fear, or excitement). Can last from seconds to minutes.
• Can be a symptom of Narcolepsy (60-100%)
• Treated with antidepressants; imipramine or desipramine
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Sleep Paralysis
• A condition either at on set of sleep or at awaking when a person is aware of their surroundings, but not able to move.
• Often associated with Narcolepsy.
• Treated with antidepressants and SSRI’s
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Sleep Apnea
• Sleep disruption leading to excessive sleepiness or less commonly insomnia due to abnormalities of ventilation during sleep.
• Sleep disruption not accounted for by another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
• Physiological disorder in which reduced muscle tone results in blocked air passages.
• Apnea is the cessation of breath for ten or more seconds. This leads to frequent brief arousals from sleep.
• May be caused by decreased levels of Serotonin in the hypoglossal nucleus.
• Treatment: Continual Positive Airway Pressure (CPAP), Lifestyle Changes, and Surgery.
• A new medicine modafinil (Provigil) is some times given to prevent day time sleepiness along with CPAP
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Circadian Rhythm Sleep Disorder
• Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia due to mismatch between sleep-wake schedule.
• Clinically significant distress/impairment in social, occupational, or other important areas.
• Disturbance of sleep is not due to another sleep disorder.
• Disturbance of sleep is not due to another mental disorder
• Not due to direct effects of substance use or general medical condition.
• Delayed Sleep Phase Type - A persistent pattern of late sleep
onset and late awakening times with an inability to fall asleep and awaken at a desired earlier time.
Shift Work Type - Night shift or shift changes - Can start in adolescence and last
for years or decades without intervention.
- shift work: sleep back to normal within 2 weeks after shift change.
- Jet Lag: one day per time zone
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Nightmares• Repeated awakening from the
major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats of survival, security, or self-esteem.
• On awakening from frightening dreams, person rapidly becomes oriented and alert.
• Dream experience or sleep disturbance resulting from the awakening results in clinically significant distress/impairment in social, occupational, or other important areas.
• Nightmares not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
• Dreams that occur in REM sleep, less intense then sleep terrors.
• Awakening usually occurs in second half of sleep period.
• Prevalence 10-50% kids 3-5 years old; 3% young adults; 50% adults suffer occasional nightmares.
• Likely to reoccur in children that are exposed to severe psychosocial stressors
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Sleep Terrors• Recurrent episodes of abrupt
awaking from sleep.• Intense fear and signs of
autonomic arousal such as tachycardia, rapid breathing, & sweating.
• Relative unresponsiveness to efforts of others to comfort the person during the episode.
• No detailed dreams are recalled and there is amnesia for the episode.
• The episode causes clinically significant distress/impairment in social, occupational, or other important areas.
• Not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
• Abrupt autonomic arousal in Stage 3-4 sleep that is interpreted as fear.
• Often occurs between 4-12 years or 20-30 years.
• Often resolves in adolescence.• Chronic sleep terrors waxes and
wanes.• Psychopathology is likely to be
associated with PTSD and general anxiety.
• Prevalence 1-6% children; less then 1% adults.
• No treatment in children, usually go away. Can give sleep medication.
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Sleep Walking (somnambulism)
• Repeated episodes of rising from bed during sleep and walking about.
• While sleep walking person has a blank staring face; is relatively unresponsive of others to communicate with him/her, and can be awakened only with great difficulty.
• On waking the person has amnesia.• Within several minutes after
awakening from sleep walking episode. There is no impairment, mental activity, or behavior. (May be a period of confusion disorientation.)
• Sleep walking causes clinically significant distress.
• Not due to another sleep disorder, mental disorder, physical condition, substance use, or medical condition.
• Stage 3 and 4 sleep• Prevalence 10-30% of
children at least once; 2-3% often. Occurs 1-7% of adults and 0.5%-0.7% have weekly or monthly attacks
• Gender differences occurs more often in females during childhood. Occurs mostly in males in adulthood.
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REM Behavior Disorder• A neurological disorder in which a
person does not become paralyzed during REM sleep, and acts out dreams his/her dreams.
• Degenerative neurological illness in 50% of affected persons.
• Often give Clonazepam
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Restless Leg Syndrome
• Neurological disorder that is characterized by unpleasant sensations of legs and an urge to move them when at the rest.
• Sleep movements can be so severe that causes chronic sleep disturbances and sleep deprivation
• Effects about 12 million Americans.• Causes: Mostly unknown (idiopathic)• Treatment: underlying cause, some meds, and
exercise.
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Reference
• Abad, V.C. & Guilleminault, C.(2004). Emerging drugs for narcolepsy. Expert Opinion Emerging Drugs, 9(2), 281-291.
• Erman, M.K. (2005). Therapeutic options in the treatment of insomnia. The journal of clinical psychiatry, 66(9), 18-23.
• Lemon, M.D. (2006). New medication choices for the treatment of insomnia. South Dakota journal of medicine, 59(2), 66-67.
• Roth, T. (2005). Prevalence, associated risks, and treatment patterns of insomnia. The journal of clinical psychiatry, 66(9), 10-13.