Sleep Disorders-NREM

1
Sleep Disorders-NREM

• NREM is 75 of all sleep time (gtslower)
• Stage 1-5 of the night
• Stage 2-48 of the night
• Stage 3 (delta)-7 of the night
• Stage 4-15 of the night
• Muscles mover during NREM, metabolic functions
  slow down 20 of dreams

2
Sleep Disorders-REM

• During REM, you have muscle paralysis, erections
  and much more vivid dreams
• Newborns dream 80 of time
• By age 2, REM sleep is 33 of total sleep time,
  approaching adolescent levels

3
Sleep Disorders

• Insomnias (gt 30 to fall or return to sleep,
  3/wk)
• Insomnia (middle and late in elderly)
• Dysomnias (or less than satisfying sleep)
• Psysiological causes
• Sleep Apnea (obstructive or central)
• Narcolepsy (REM on a rampage)
• Periodic limb movement/restless leg syndrome

4
Assessment

• Measures
• Epworth Sleepiness Scale
• Pittsburgh Quality Index
• Duration, at least 1 month, but usually 6
• Assess routine (including a 2 week sleep diary
  )and meds.
• Ex. Recent study found that people who sleep with
  TV or noise have poorer QOS.even white noise
• Ex. Acetimiophen has caffiene where Iboprfen does
  not

5
How to Become an Insomniac

• Keep unrealistic sleep goal
• Catastrophize about not meeting this goal
• Nap in daytime/spend more time in bed
• Spend all of the desperate hours fighting to get
  to sleep in bed (stimulus for upset)
• Make bed center for activity
• Start taking sleep medications (REM reb.)

6
Sleep Hygiene-Avoid

• Excessive noise
• Stress (activities of worries _at_ bedtime)
• Uncomfortable bed
• Caffeine (lt 2 hours of bedtime)
• Cigarettes (lt 2 hours of bedtime)
• Alcohol
• Napping (longer awake, faster/deeper sleep)
• Extra wink in morning
• Variable bedtimes or morning wake-up times

7
Sleep Hygiene-Maintain

• 60-65 degrees Fahrenheit in bedroom
• Early afternoon or evening exercise
• Satisfying (safe) sex
• Light snacks (hunger aggravates sleep)
• Warm milk or Ovaltine
• Awake same time/go to bed only when sleepy
• Imagine a tranquil place and calming sounds
• If repeatedly awake 20 minutes after retiring,
  relax in another room and return to bed only when
  tired

8
Treatment
9
Treatment

• Most treatments are initially behavioral
  conditioning-stimulus control
• Cognitive Arousal/Refocusing
• Exs. Paradoxical or focus on the sensation in
  body part
• Physiological
• PMR
• Imaging
• Biofeedback