SLEEP DISORDERS

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SLEEP DISORDERS
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The Nature of Sleep

• Occupies 1/3 of our Lives (3,000 hrs /year)
• Necessary for Physical and Mental Health
• 50 Billion / Year in Lost Productivity

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What is Normal Sleeping
Behavior?

• Amount Varies
• By Persons
• By Age
• Sensitive to Waking Behavior
• Problems are Common

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The Nature of Sleep

• Biological State

• Two Major Periods
• NREM
• Non-Rapid Eye Movement
• REM
• Rapid Eye Movement

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Identifying the Stages of Sleep

• Polysomnographic (PSG) Evaluation

• Electrooculograph (EOG)
• Electroencephalograph (EEG)

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Identifying the Stages of Sleep

• Sleep Assessment

• Sleep Efficiency
• Sleep Latency Test
• 10-15 minutes Average
• lt 7 minutes Problem

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The Four Stages of Sleep

• STAGE 1 (NREM)

• Transitional
• Theta Waves

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The Four Stages of Sleep

• STAGE 1 (NREM)
• STAGE 2 (NREM)
• First True Sleep State
• Sleep Spindles
• K-Complexes

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The Four Stages of Sleep

• STAGE 1 (NREM)
• STAGE 2 (NREM)
• STAGE 3 4 (NREM)
• Deeper Sleep
• Delta Waves
• Slow Wave

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The Four Stages of Sleep

• STAGE 1 (REM)
• Rapid Eye Movement
• Body is Atonic
• Brain Highly Active
• STAGE 2 (NREM)
• STAGE 3 4 (NREM)

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Depriving Someone of REM Sleep
Compensation Rebound
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Causes of Sleep and Wakefulness

• Brain-Related Activity
• Reticular Activating System
• Activates!
• Raphe Nuclei
• Inhibits RAS

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An Overview of Sleep Disorders

• Two Major Categories

• Dyssomnias
• Difficulties Getting Enough Sleep
• Amount, Quality, Timing
• Parasomnias
• Abnormal Behavior During Sleep

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sleep self-test

• I have difficulty falling asleep
• Thoughts race through my mind and prevent me from
  getting to sleep
• I anticipate a problem with sleep several times a
  week
• I often wake up and have trouble going back to
  sleep

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sleep self-test

• I worry about things and have trouble relaxing
• I wake up earlier in the morning than I would
  like to
• I lie awake for a half an hour or more before I
  fall asleep
• I often feel sad or depressed because I cant
  sleep

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sleep self-test

• ADD ALL TRUES
• SCORE gt 3, you have symptoms of INSOMNIA
• INSOMNIA is a persistent inability to fall asleep
  or stay asleep

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The Nature of Dyssomnias

• Primary Insomnia

• Most Common Sleep Disorder
• Trouble Initiating Sleep
• Trouble Maintaining Sleep
• Have Nonrestorative Sleep
• Clinical Description

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The Nature of Dyssomnias

• Primary Insomnia

• Facts and Statistics
• Common (1/3 Population)
• 17 Have it in Severe Form
• Females Report Problem gt Males
• Common in Older Populations

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sleep self-test

• I have noticed (or others have commented) that
  parts of my body jerk during sleep
• I have been told that I kick and jerk during
  sleep
• When trying to go to sleep, I experience an
  aching or crawling sensation in my legs
• I experience leg pain or cramps at night

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sleep self-test

• Sometimes I cant keep my legs still at night, I
  just have to move them to feel comfortable
• Even though I slept through the night, I feel
  sleepy during the day

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sleep self-test

• ADD ALL TRUES
• SCORE gt 3, you have symptoms of
• PERIODIC LIMB MOVEMENT DISORDER--uncontrollable
  leg or arm jerks during sleep
• or RESTLESS LEG SYNDROME--uncomfortable feelings
  in the legs at night

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The Nature of Dyssomnias

• Primary Insomnia

• Related Conditions
• Restless Leg Syndrome
• Periodic jerky legs
• 10 Cases
• Relief With Movement
• Gets Worse With Age

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The Nature of Dyssomnias

• Primary Insomnia

• Causes
• Higher Body Temperature
• Drug Use and Poor Sleep Hygiene
• Unrealistic Views About Sleep
• Stress and Trying to Sleep
• Use of Sleep Medications

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The Nature of Dyssomnias

• Primary
• Insomnia

• Primary Hypersomnia

• Problem of Sleeping Too Much
• Excessive Sleepiness
• Person Experiences it as a Problem
• Appear to Have Enough Sleep
• Little is Known About Causes
• Appears to Run in Families

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The Nature of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• The Sleep Attack
• Excessive Sleepiness Cataplexy
• Triggered by Strong Emotion
• Go Right Into REM
• Sleep Paralysis
• Hypnagogic Hallucinations

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The Nature of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Facts and Statistics
• Rare Condition
• Affects Males and Females Equally
• Often Begins in Adolescence
• Seems to Improve Over Time
• Behavior Also Seen in Dogs

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sleep self-test

• I have been told that I snore
• I have been told that I hold my breath when I
  sleep
• I have high blood pressure
• My friends and family say that Im often grumpy
  and irritable
• I wish I had more energy

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sleep self-test

• I get morning headaches
• I often wake up gasping for breath
• I am overweight
• I often feel sleepy and struggle to remain alert
  during the day
• I frequently wake with a dry mouth

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sleep self-test

• ADD ALL TRUES
• SCORE gt 3, you have symptoms of SLEEP APNEA
• SLEEP APNEA is a serious disorder that causes you
  to stop breathing repeatedly, often hundreds of
  times in the night during sleep

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The Nature of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Breathing-Related Sleep Disorders

• Sleep Apnea
• Breathing is Constrained or Ceases
• Snoring and Night Sweats
• Person Often Unaware of Problem
• Several Types of Sleep Apnea

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The Nature of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Breathing-Related Sleep Disorders

• Types Sleep Apnea
• Obstructive (OSA)
• Airflow Stops Related to Obesity
• Central (CSA)
• Cessation of Respiratory Activity
• Mixed Sleep Apnea
• Combination of OSA and CSA

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The Nature of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Apnea

• Circadian Rhythm Sleep Disorders

• Problem With Circadian Clock
• Disturbed Sleep
• Insomnia or Excessive Sleepiness
• The Biological Clock
• Suprachiasmatic Nucleus
• Melatonin May Help Set the Clock
• Jet Lag Shift Work Types

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The Treatment of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Apnea

• Medical Treatments
• Prescription and Over-the-Counter
• Poor Sleep Halcion and Dalmane
• Hypersomnia Narcolepsy
• Stimulants (e.g., Ritalin)
• Breathing-Related Disorders
• Medications and Devices

• Circadian

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The Treatment of Dyssomnias

• Insomnia

• Hypersomnia

• Narcolepsy

• Apnea

• Cognitive-Behavioral Treatments
• Modifying Timing of Sleep
• Phase Advances and Delays
• Improving Sleep Hygiene
• Addressing Beliefs About Sleep
• Stress and Relaxation Training

• Circadian

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improving your sleep

• Sleep Hygiene
• Exercise
• Dont Force Sleep
• 15 Minute Limit Getting to Sleep
• Avoid Naps
• Optimal Sleep Conditions

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improving your sleep

• Sleep Hygiene
• Snacking
• Avoid Alcohol Stimulants
• Set Wake-Up Time
• Relax Before Bed
• Bed Sleep

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An Overview of Sleep Disorders

• Two Major Categories

• Dyssomnias
• Difficulties Getting Enough Sleep
• Amount, Quality, Timing
• Parasomnias
• Abnormal Behavior During Sleep

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The Nature of Parasomnias

• Two Main Types

• During REM
• Nightmares
• During NREM
• Sleep Terrors
• Sleep Walking (somnambulism)