Making Your Sleep Healthy and Happy: Sleep Disorders

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• Making Your Sleep Healthy and Happy Sleep
  Disorders

Dr. Barbara C. Fisher United Psychological
Services Director Certified Behavioral Sleep
Medicine 47818 Van Dyke Rd. Shelby Twp., MI
48317 586.323-3620
www.unitedpsychologicalservices.com
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Seminar Objectives

• Defining sleep
• Sleep parameters Process S and C, sleep stages
• Aging changes
• Common sleep disorders Circadian Rhythm, Sleep
  Apnea, RLS, PTSD
• Good sleep hygiene
• Behavioral therapies

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Sleep Disorders

• Two factors influence how sleepy or alert anyone
  is during a 24 hour period of time.
• 1. Sleep-Wake Balance Process S How long it has
  been since you last slept- the longer you stay
  awake the sleepier you become
• 2. Circadian Rhythm Process C Your bodys
  biological clock the natural timing system which
  tells you when to sleep and when to be awake.

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Circadian Rhythm

• Master clock
• Modulates daily cycles of
• Core body temperature
• Blood pressure
• Hormone secretion
• Immune response
• Sleep wake cycle

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Normal Adult Sleep

• Average amount of sleep per night range of 6.5
  to 8.3 hours
• Normal sleep latency 10 minutes
• Normal sleep structure
• 5 stage 1
• 50 stage 2
• 15-25 stages 3 and 4 (slow wave sleep)
• 25 REM
• Napping occurs at the beginning and the end of
  life (in our culture)

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Poor sleep at night leads to

• Mood and emotional changes
• Aggressiveness, poor impulse control
• Augments depression
• Cognitive deficits attention, memory, confusion,
  not thinking clearly, easier to make mistakes

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Sleep Changes with Age

• Increased awakenings and arousals
• Decreased REM sleep
• (Probably) decreased SWS
• Increased stage shifts
• Fewer cycles
• Reduced sleep efficiency
• Phase advancement

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Circadian Rhythm Sleep Disorders

• Delayed Sleep Phase type
• Advanced Sleep Phase type
• Irregular sleep-wake type
• Free Running Type
• Jet Lag type
• Shift Work type
• Due to medical condition or substance abuse

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Sleep Related Breathing Disorders

• Central Sleep Apnea (Cheyne Stokes, High
  altitude, Medical condition, Substance abuse,
  Infancy)
• OSA (arrthymia 58)
• Sleep related Hypoventilation/Hypoxemic Syndrome
• Sleep related Hypoventilation/Hypoxemic due to
  medical condition
• Sleep Related Breathing Disorder/ Upper Airway
  Resistance Syndrome (UARS)

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Sleep Apnea

• Decreased REM sleep, sleep not refreshing
• Chronic, loud snoring, gasping or choking
  episodes
• Excessive daytime sleepiness (drowsy when
  driving)
• Automobile or work related accidents due to
  fatigue
• Personality changes or cognitive difficulties
• Neuropsychological evaluation reveals memory
  deficits and frontal deficits

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Causes of Sleep Apnea

• Age (tonicity decreases)
• Smaller than normal jaw
• Enlarged tonsils
• Lateral pharyngeal walls close in
• Large tongue
• Tongue moves posterior which displaces the soft
  palate
• Tissues that partially block the entrance to the
  airway

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Insomnia

• Adjustment Insomnia
• Psychophysiological Insomnia
• Paradoxical Insomnia
• Idiopathic Insomnia
• Inadequate Sleep Hygiene
• Behavioral Insomnia of Childhood
• Insomnia due to substance abuse
• Insomnia due to a medical condition

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Factors Affecting the Development of Insomnia
Situational Environmental Medical Psychiatric
Prescription Medication
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Periodic Limb Movement Disorder (PLMD)

• Stereotypic, repetitive movements of the legs (or
  arms)
• During sleep / inactivity
• Every 20-40 seconds
• May be associated with arousals from sleep
• Occur in minimum clusters of 4

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Patient Complaints with RLS

• Sleep disturbances
• Difficulty falling asleep and staying asleep
• Need to walk around (nightwalkers)
• Daytime sleepiness

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Associated Conditions

• Neuropathies, myelopathies, and radiculopathies
• Pregnancy
• Anemia (iron deficiency)
• Chronic renal failure
• Folate / B12 deficiency
• Medications (tricyclics, SSRIs, caffeine)
• Obesity
• Hypothyroidism

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RLS and ADHD

• RLS were greater in patients who had ADHD versus
  those who did not-(plt0.001)
• Recommendation if patient diagnosed with ADHD
  need to screen for RLS
• Recommendation if patient diagnosed with RLS need
  to screen for ADHD
• Consider medication such as dopamine agonists

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PTSD Sleep Problems

• Universal complaints, fragmented sleep
• Inability to sleep, difficulty initiating
  maintaining
• Anxiety arousals are common in PTSD
• REM and non-REM nightmares
• Repetitive nightmares are common
• Nightmares often represent a "re-living" of the
  original trauma and associated emotions

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Good Sleep Habits

• Regular routine to unwind
  at night
• Avoid all products containing caffeine (soda and
  chocolate)
• Avoid smoking and smokeless tobacco
• Avoid use of alcohols
• No stimulating activities in the evening
• Promote calm family atmosphere prior to bedtime

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Good Sleep Habits

• Avoid falling asleep while
  watching television or video
• Establish regular exercise routine and healthy
  diet
• Avoid late afternoon and evening bright light
• Avoid changing pattern on weekends
• Avoid napping-short power nap only American
  Academy of Sleep Medicine, 2002 

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Identify the Sleep Factors

• Sleep History and Sleep Schedule
• Sleep logs/diary morning and bedtime habits
• Actigraphy
• PSG
• Bedtime routine, bedroom environment
• Sleep related cognitions
• Daytime sleepiness, memory

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Behavioral Treatment

• Sleep hygiene
• Daytime, evening, morning habits
• Exercise-evening walk for the aged
• Limit napping
• Nocturnal activities hour
• Bedroom environment
• Cognitive behavioral therapy (CPT) 6 sessions
  for Insomnia

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Problematic Sleep Habits

• Night time habits
• Irregular sleep wake schedule
• Too much time in bed TIB
• Falling asleep to the radio/TVs
• Trying too hard to sleep
• Clock watching
• Long awakenings

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Problematic Sleep Habits

• Morning Habits
• Lingering in bed awake in morning
• Extra sleep on weekends
• Bedroom disturbance (noise,
  sun light)

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Address the Sleep Problem Dont Wait

• Daytime sleepiness is a big deal!
• Dont try to do everything at night-schedule your
  day for maximum performance
• Set specific times in office or
• home for paperwork vs. phone
• calls on daily basis-avoid
• build-up and worry

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Dont Worry-Be Happy

• Too anxious Exercise twenty minutes on a daily
  basis-often running or biking are helpful
• Feeling overwhelmed Watch the stress feeling
  overwhelmed- too many things are going on at one
  time

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Dont Worry-Be Happy

• Too much to do and no time to do it Manage time
  by specifically estimating each task- add up time
  for exact time estimates-to decrease
  over-planning
• Distractibility increased
• Stress lack of food tend to
  increase distractibility-
  increased lack of focus

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Dont Worry-Be Happy

• Staying up late to complete all your goals Issue
  of diminishing returns Time spent vs. being
  tired-examine from larger perspective- what
  really has to be done in the grand scheme of
  things.
• Is that last task more important than health?

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Dont Worry-Be Happy

• Easily frustrated- short fuse
• Result of too much stress, lack of food, feeling
  totally overwhelmed. These are wake up calls for
  life changes nice moments of time
• More tired Energy loss, channel clickers
• Wake up call for life changes Check sleep,
  eating habits. These are often the result of
  continually compensating for something else such
  as a sleep disorder or ADD/ADHD.

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Sleep is a necessary function of life

• Make it Healthy Increase your happiness
• Good Night and Good Luck