class 12- sleep disorders
TRANSCRIPT
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SLEEP DISODERS
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Americans
• 62% have sleep problems once wkly or more
• 40% sleepy enough during the day to interfere with activities
• 62% drive while drowsy• 27% have fallen asleep while
driving• 60% children feel parents are tired
during the day• 15% children admit falling asleep
at school
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Women• 79% report sleep disturbance during
pregnancy• 36% peri-menopausal women have
disturbed sleep• 25% suffer from significant daytime
sleepiness• 30% disturbed sleep interferes with daily
activity, 27% job performance is impaired• 24% say sleep gets in the way of caring
for family
Males1/3 of men get less than 6 hours sleep (during week)
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COMORBIDITIES
• 40-45% of those with insomnia & hypersomnia have another Axis I disorder
• Mood Disorders – 4x higher • Anxiety Disorders • Schizophrenia • Substance abuse
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Normal Sleep
• Normal Sleep patterns (cycles)• Non REM• REM• Circadian rhythm • Drugs influence on sleep• Genetics of sleep
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Sleep DisorderPhysiology of sleep • Sleep Stages
– NREM Sleep – REM Sleep
• Sleep-Regulating Processes – Circadian Rhythm
•Endogenous vs. exogenous factor– Homeostasis
•Balance o f sleep and awake
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Influences on Sleep • Developmental Changes
– Newborns and Infants – Children – Adolescents – Young and Middle Adults – Older Adults – myth
• Amount of sleep=F (genetics, preferences, lifestyle, environment)
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Influences on Sleep (Cont’d)
• Medical Disorders and Treatments i.e.. Asthma, hyperthyroidism, COPD
• Drugs and Chemical Substances i.e. alcohol, lithium, cocaine-> CNS was affected
• Jet lag
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Sleep Disorders • Etiology• Signs and Symptoms/Diagnostic
Criteria • Dyssomnias: abnormalities in the
amount, quality, or timing of sleep – Narcolepsy– breathing-related sleep disorders– periodic limb movement disorder– insomnia
• Parasomnias: abnormal behavioral or physiological events associated with sleep– sleepwalking – tooth grinding
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DYSSOMNIAS
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PRIMARY INSOMNIA• difficulty initiating and maintaining
sleep • awakenings that occur much earlier
than desired • sleep that is non-restorative and of
poor quality • result in impairment in daytime
function.
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• Prevalence rates are higher in women and increase with age.
• Associated with reduced quality of life, mood disorders and increased health services usage
• Represents a significant economic burden in the US, with estimated direct costs of $13.9 billion annually.
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– Change in sleep environments– Jet lag– Changes in work shift– Excessive noise– Unpleasant room temperature– Stressful life events– Medical condition– Medications– Poor sleep hygiene
Causes of Insomnia
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Behavioral Model of Insomnia
• Insomnia occurs acutely in relation to both predisposing and precipitating factors
• The chronic form of the disorder is maintained by maladaptive coping behaviors.
• A state of “conditioned arousal” may develop in which situations associated with sleep become alerting rather than relaxing- further impairing sleep.
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Insomnia Cycle
MALADAPTIVE HABITS•Excessive time in bed•Irregular sleep schedule•Daytime napping•Sleep- incompatible activities
AROUSAL•Emotional•Cognitive
•Physiologic
DYSFUNCTIONAL COGNITIONS•Worrying over sleep loss
•Ruminating over consequences•Unrealistic Expectations
CONSEQUENCES•Mood Disturbances
•Fatigue•Performance impairments
•Social Discomfort
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Cognitive Behavioral Therapy for Insomnia
• change poor sleep habits and faulty beliefs about sleep
• promote good sleep hygiene
THROUGH…….• sleep restriction, stimulus control,
relaxation techniques, education and good sleep practices.
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• CBT is as successful as medications in the acute treatment (4-8 weeks) of insomnia.
• It is more effective than medications in the long term.
• Average of 50-60% improvement• Long term studies reveal a sustained
improvement in sleep quality and duration.
• Patients continued to experience improvement over follow-up periods of >1year.
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Other Treatments
• Pharmacologic therapy– Benzodiazepines / related
hypnotics– Antidepressants– Antihistamines– Melatonin
• Light
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BREATHING-RELATED SLEEP DISORDER• Unlike people with insomnia, this is a
structural/ anatomical problem with physiological consequences
• Treatment with oral appliance or surgery is needed
• Sleep maintenance, sleep walking, or other consequences are generally relieved after treatment but…..
• Co-occurring sleep disorders may need psychological treatment.
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Sleep Apnea
• Obstructive sleep apnea– Clinical manifestations
• Central sleep apnea– Restrictive lung disease– Neuromuscular disease– Cardiac– Neurological
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Other sleep disorders
Narcolepsy
– Genetic Aspects of narcolepsy– Irresistible attacks of refreshing sleep
daily for 3 months– Diagnosis
• Cataplexy- brief periods of loss of muscle tone
• REM disordered transitions- can report hallucinations, sleep paralysis at transitions between wakefulness and sleep
– Treatment of narcolepsy• Stimulants, REM suppressants • Behavioral adjustments
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Circadian Rhythm Sleep Disorder
• Causes insomnia because of a lack of synchronization between an individual’s internal clock and the external schedule
• Treatment is best accomplished with chronotherapy and/ or phototherapy
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Specifiers
• Delayed Sleep Type- late sleep onset & late awakening
• Shift Work Type
• Unspecified Type
• Jet Lag Type……
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… Jet Lag Type
• Use activities (eating, exercise, sightseeing) and exposure to light to try to synchronize body rhythms with those of the new environment
• Melatonin 3 mg about 30 minutes before bedtime on the day of travel and for up to four days after arrival is appropriate
• A dose of 0.5 mg has less effect on sleep, but otherwise helps adaptation similarly
• Adult travelers crossing five or more time zones are likely to benefit from melatonin
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DYSSOMNIA NOS
• Environmental Issues
• “Restless Legs Syndrome”
• Periodic Limb Movements
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PARASOMNIAS
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Parasomnias
• Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions.
• Parasomnias typically do not cause insomnia or excessive sleepiness
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• Sleep Terror- awakening with fear, dream amnesia and unresponsiveness VS.
• Nightmare- awakening with detailed threatening dream recall with rapid alertness
• Sleepwalking- activities without responsiveness and difficulty awakening
• NOS
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GMC and Sleep
• Parkinsonism• Neuromuscular disease• Respiratory disease• Dementia• Epileptic seizures• Cardiovascular disease