Download Sleep Disorders

Psychology Term 2 - 2013/2014
SLEEP DISORDERS
IMPROVING YOUR SLEEP
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Avoid caffeine, nicotine, and other stimulants before bed
Don’t go to bed when you are full or hungry
Develop a nightly ritual, particularly one that is relaxing
Engage in regular aerobic exercise, but not late at night
Take a warm bath 90 minutes before bed
Avoid emotional stressors (e.g., balancing check book) right
before bed
Limit activities in your sleeping area
Avoid alcohol
Designate a regular bedtime and waking time
Minimize light and noises
TYPES OF SLEEP DISORDERS
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Dyssomnias: are a broad
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classification of Sleeping
disorders that make it difficult
to get to sleep, or to remain
sleeping.
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Eg:
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Insomnia
Sleep Apnea
Narcolepsy
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Parasomnias: behavioral or
physiological abnormalities during
sleep; are a category of sleep
disorders that involve abnormal
movements, behaviors, emotions,
perceptions, and dreams that occur
while falling asleep, sleeping,
between sleep stages, or during
arousal from sleep.
E.g.:
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Sleepwalking & Sleep talking
Disorder
Night terror & Nightmares Disorder
REM Behavior Disorder
SLEEP DISORDERS
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Dyssomnias: are a broad classification of Sleeping
disorders that make it difficult to get to sleep, or to
remain sleeping.
There are over than 30 kinds of sleep disorders but the
most common and serious sleep disorders known are:
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Insomnia: is the inability to obtain an adequate amount or
quality of sleep. The difficulty can be in falling asleep,
remaining asleep, or both.
Sleep apnea: is a potentially serious sleep disorder in which
breathing repeatedly stops and starts
Narcolepsy: is a chronic sleep disorder characterized by
overwhelming daytime drowsiness and sudden attacks of
sleep
INSOMNIA
Insomnia is a sleep disorder that is characterized by difficulty
falling and/or staying asleep.
People with insomnia have one or more of the following
symptoms:
 Difficulty falling asleep
 Waking up often during the night and having trouble going back
to sleep
 Waking up too early in the morning
 Feeling tired upon waking
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INSOMNIA
Types of Insomnia
 There are two types of insomnia:
primary insomnia and secondary
insomnia. 2 classifications;
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2.
Primary insomnia: Primary insomnia
means that a person is having sleep
problems that are not directly
associated with any other health
condition or problem.
Secondary insomnia: Secondary
insomnia means that a person is
having sleep problems because of
something else, such as a health
condition (like asthma, depression,
arthritis, cancer, or heartburn);
pain; medication they are taking; or
a substance they are using (like
alcohol).
Acute vs. Chronic Insomnia
 Insomnia also varies in how long it lasts
and how often it occurs.
 It can be short-term (acute insomnia) or
can last a long time (chronic insomnia).
 It can also come and go, with periods
of time when a person has no sleep
problems.
1.
Acute insomnia can last from one
night to a few weeks.
2.
Insomnia is called chronic when a
person has insomnia at least three
nights a week for a month or longer.
CAUSES OF ACUTE INSOMNIA CAN
INCLUDE:
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Continue reading below...
Significant life stress (job loss or change,
death of a loved one, divorce, moving)
Illness
Emotional or physical discomfort
Environmental factors like noise, light, or
extreme temperatures (hot or cold) that
interfere with sleep
Some medications (for example those
used to treat colds, allergies, depression,
high blood pressure, and asthma) may
interfere with sleep
Interferences in normal sleep schedule
(jet lag or switching from a day to night
shift, for example)
CAUSES OF CHRONIC INSOMNIA
INCLUDE:
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CAUSES OF INSOMNIA
Depression and/or anxiety
Chronic stress
Pain or discomfort at night
INSOMNIA
Symptoms of Insomnia
 Sleepiness during the day
 General tiredness
 Irritability
 Problems with concentration or memory
Diagnosing Insomnia by a healthcare
provider:
 An evaluation may include a physical
examination, a medical history, and a
sleep history.
 Also as a method of monitoring
improvement or deterioration, patient
might be asked to keep a sleep diary.
 There are also specialized sleep centers
for diagnosing, monitoring and treating.
Treatment for Insomnia:
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Acute insomnia may not require
treatment.
2.
Mild insomnia often can be
prevented or cured by practicing good
sleep habits.
3.
If your insomnia makes it hard for
you to function during the day
because you are sleepy and tired,
your health care provider may
prescribe sleeping pills for a limited
time.
N.B.:
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Avoid using over-the-counter sleeping pills
for insomnia, because they may have
undesired side effects and tend to lose
their effectiveness over time.
Rapid onset, short-acting drugs can help
you avoid effects such as drowsiness the
following day.
ASSIGNMENT
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Compare between the two types of sleep disorders ,
with explanation of each type giving examples.
SLEEP APNEA
Obstructive sleep apnea is a common and serious sleep disorder that
causes you to stop breathing during sleep.
Causes of Sleep Apnea:
 The airway repeatedly becomes blocked, limiting the amount of air that
reaches your lungs.
 When this happens, you may snore loudly or making choking noises as you
try to breathe.
 Your brain and body becomes oxygen deprived and you may wake up.
 This may happen a few times a night, or in more severe cases, several
hundred times a night.
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Further physiological explanation :
 It is caused by the tissue in the back of the throat collapsing.
 The muscles of the upper airway relax when you fall asleep.
 If you sleep on your back, gravity can cause the tongue to fall back.
 This narrows the airway, which reduces the amount of air that can reach your lungs.
 The narrowed airway causes snoring by making the tissue in back of the throat
vibrate as you breathe
SLEEP APNEA
Major symptoms :
 Sleep apnea can make you wake
up in the morning feeling tired or
unrefreshed even though you
have had a full night of sleep.
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During the day, you may feel
fatigued, have difficulty
concentrating or you may even
unintentionally fall asleep.
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WHY? because your body is
waking up numerous times
throughout the night, even though
you might not be conscious of
each awakening.
Other symptoms of sleep apnea
include:
 Loud or frequent snoring
 Choking or gasping while you sleep
 Pauses in breathing
 Morning headaches
 Excessive daytime sleepiness
 Insomnia due to difficulty staying
asleep
 Waking up with dry mouth or a sore
throat
 Frequent need to urinate during the
night
 Trouble concentrating
 Memory or learning problems
 Moodiness, irritability or depression
SLEEP APNEA
Diagnosis:
 In-lab overnight sleep study: You will sleep with sensors
hooked up to various parts of your body. These record your
brain waves, heartbeat, and breathing among other things.
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Home sleep test: The testing equipment differs in that it is
less complicated than what is used in an overnight sleep
study. A staff member will show you how to hook up the
testing equipment yourself. Once you are finished, you can
take the device back to the sleep center or send it by mail.
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Sleep Diary for recording your daily improvement or
deterioration.
SLEEP APNEA RISK FACTORS
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Excess weight – An adult with a BMI of 25 or higher is considered to
be overweight. Your risk of sleep apnea increases with the amount of
excess body weight.
Large neck size (>17 inches for men, > 16 inches for women) – A
large neck will have more fatty tissue that can block your airway.
Older age (40+ for men, 50+ for women) – Sleep apnea occurs more
often in older adults, especially people older than 60.
Being male – Men have twice the risk having sleep apnea compared
to women
Smoker – Smokers have a higher risk of sleep apnea
Hypertensive – High blood pressure is very common in people with
sleep apnea
Family history – Sleep apnea can appear more often among family
members. This may be a result of either inherited traits or common
lifestyles.
SLEEP APNEA –VE IMPACT
Very important info:
The lack of oxygen your body receives can have negative
long-term consequences for your health. This includes:
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High blood pressure
Heart disease
Stroke
Pre-diabetes and diabetes
Depression
http://www.sleepeducation.com/sleep-disorders/sleep-apnea/treatment
SLEEP APNEA TREATMENT
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CPAP (Continuous Positive Airway Pressure): a machine that uses a steady
stream of air to gently keep your airway open throughout the night by a
mask so you are able to breathe.
Oral Appliance Therapy: It may resemble a sports mouth guard or an
orthodontic retainer. The device prevents the airway from collapsing by
holding the tongue in position or by sliding your jaw forward so that you
can breathe when you are asleep
Surgery: reduce or eliminate the extra tissue in your throat that collapses
and blocks your airway during sleep. More complex procedures can adjust
your bone structures including the jaw, nose and facial bones. Weight loss
surgery may also be an option
Weight Management: weight loss can help improve or eliminate your sleep
apnea symptoms if you are overweight or obese (not guaranteed to be
effective but it helps).
Positional Therapy: it would help by improving or eliminating your
symptoms by changing your sleep position. Your airway may open if you
sleep on your side instead of your back.
Lifestyle Changes: quitting smoking or not drinking alcohol may improve
sleep apnea symptoms. Alcohol relaxes your throat muscles which can
cause you to snore or for your airway to collapse.
NARCOLEPSY
Narcolepsy is a sleep disorder that causes
overwhelming and severe daytime sleepiness.
 Pathologic sleepiness is characterized by the fact
that it occurs at inappropriate times and places.
 The daytime sleep attacks may occur with or
without warning, and can occur repeatedly in a
single day.
 Persons with narcolepsy often have fragmented
nighttime sleep with frequent brief awakenings.
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NARCOLEPSY
Symptoms:
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Excessive daytime sleepiness (most common and obvious)
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Cataplexy (sudden and temporary loss of muscle tone often
triggered by emotions such as laughter) (common)
3.
Hallucinations (vivid dreamlike experiences that occur while falling
asleep or upon awakening) (less common)
4.
Sleep paralysis (paralysis that occurs most often upon falling
asleep or waking up; the person is unable to move for a few
minutes, least common symptom)
NARCOLEPSY
Causes:
 Narcolepsy is believed to result from a genetic
predisposition and abnormal neurotransmitter
(hypocretin) functioning and sensitivity.
Diagnosis:
 Questionnaires are used to measure excessive
sleepiness.
 Sleep lab visits & monitoring.
 CSF (cerebrospinal fluid) hypocretin test
NARCOLEPSY
Treatment:
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Self-Care at Home
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Many people have an improvement in their
symptoms if they maintain a regular sleep
schedule, usually seven to eight hours of sleep per
night.
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Scheduled naps during the day also help.
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Patient's with narcolepsy should also avoid heavy
meals and alcohol (as it can interfere with sleep).
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Driving should be restricted when the patient feels
sleepy.
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Children should be encouraged to participate in
after-school activities and sports.
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Parents should request school personnel to excuse
the child from activities if he or she appears
drowsy.
Medical Treatment: The main focus of
medical treatment is symptomatic relief
of excessive daytime sleepiness and
cataplexy with stimulants of the central
nervous system and antidepressants.
SLEEP DISORDERS
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Parasomnias: behavioral or physiological abnormalities
during sleep; are a category of sleep disorders that involve
abnormal movements, behaviors, emotions, perceptions,
and dreams that occur while falling asleep, sleeping,
between sleep stages, or during arousal from sleep.
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Most parasomnias are dissociated sleep states which are
partial arousals during the transitions between wakefulness
and NREM sleep, or wakefulness and REM sleep:
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Sleepwalking & Sleep talking Disorder
Night terror & Nightmares Disorder
REM Behavior Disorder
SLEEP WALKING DISORDER
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Sleepwalking is a sleep disorder that causes people to get up and walk while sleeping.
Episodes of sleepwalking typically occur when a person is in the deep stages of sleep.
The sleepwalker is unable to respond during the event and does not remember sleepwalking.
In some cases, sleepwalking is associated with incoherent talking.
Sleepwalking occurs most commonly in childhood, typically between the ages of 4 and 8, but can last
into adulthood.
Sleepwalkers walk with their eyes opened with a glassy, staring appearance.
Symptoms of Sleepwalking
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Episodes of sleepwalking can range from quiet walking about the room to agitated running or
attempts to "escape." Typically, the eyes are open with a glassy, staring appearance as the person
quietly roams the house. On questioning, responses are slow or absent. If the person is returned to
bed without awakening, they usually does not remember the event.
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Older children, who may awaken more easily at the end of an episode, often are embarrassed by the
behavior (especially if it was inappropriate).
What Causes a Person to Sleepwalk?
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Several different factors may be involved in the development of sleepwalking. These may include
genetics (traits that run in families), environment, and medical conditions.
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Sleepwalking is not associated with other sleep problems, sleeping alone in a room or with others,
fear of the dark, or anger outbursts.
Genetics
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Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if a firstdegree relative has a history of sleepwalking. Therefore, it is thought the condition can be inherited.
SLEEP WALKING DISORDER
Environmental Factors
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Certain factors may cause a person to sleepwalk, such as:
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Sleep deprivation
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Chaotic sleep schedules
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Stress
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Alcohol intoxication
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Drugs such as sedative/hypnotics (drugs that promote relaxation or sleep), neuroleptics (drugs used
to treat psychosis), stimulants (drugs that increase activity), and antihistamines (drugs used to treat
symptoms of allergy)
Medical conditions that have been linked to sleepwalking include:
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Arrhythmias (abnormal heart rhythms)
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Fever
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Gastroesophageal reflux (food or liquid regurgitating from the stomach up into the food pipe)
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Nighttime asthma
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Nighttime seizures (convulsions)
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Obstructive sleep apnea (condition in which breathing stops temporarily while sleeping)
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Psychiatric disorders, for example, posttraumatic stress disorder, panic attacks, or dissociative states,
such as multiple personality disorder
http://www.webmd.com/sleep-disorders/guide/sleepwalking-causes
SLEEP TALKING DISORDER
What causes sleep talking?
 Sleep talking usually occurs by itself and is most often harmless. However, in some
cases, it might be a sign of a more serious sleep disorder or health condition.
 REM sleep behavior disorder (RBD) and sleep terrors are two types of sleep
disorders that cause some people to shout during sleep. Sleep terrors, also called
night terrors, usually involve frightening screams, thrashing, and kicking. It's hard to
wake someone having a sleep terror. Children with sleep terrors usually sleep talk
and sleepwalk.
 People with RBD yell, shout, grunt, and act out their dreams, often violently.
 Sleep talking can also occur with sleepwalking and nocturnal sleep-related eating
disorder (NS-RED), a condition in which a person eats while asleep.
Other things that can cause sleep talking include:
 Certain medications
 Emotional stress
 Fever
 Mental health disorder
 Substance abuse
http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/talking-in-your-sleep?page=2
SLEEP TALKING DISORDER
What is sleep talking?
 Sleep talking, or somniloquy, is the act of speaking during sleep. It's a type of
parasomnia -- an abnormal behavior that takes place during sleep. It's a very
common occurrence and is not usually considered a medical problem.
 The nighttime chatter may be harmless, or it could be graphic, even R rated.
Sometimes, listeners find the content offensive or vulgar. Sleep talkers normally
speak for no more than 30 seconds per episode, but some people sleep talk many
times during a night.
 The late-night diatribes may be exceptionally eloquent, or the words may be
mumbled and hard to decipher. Sleep talking may involve simple sounds or long,
involved speeches. Sleep talkers usually seem to be talking to themselves. But
sometimes, they appear to carry on conversations with others. They may whisper, or
they might shout. If you share a bedroom with someone who talks in his or her sleep,
you might not be getting enough shut-eye.
Who talks in their sleep?
 Many people talk in their sleep. Half of all kids between the ages of 3 and 10 years
old carry on conversations while asleep, and a small number of adults -- about 5% -keep chit-chatting after they go to bed. The utterances can take place occasionally or
every night. Experts think that sleep talking may run in families.
What are the symptoms of talking in your sleep?
 Usually, people will tell you they've heard you shout out during the night or while you
were napping. Or maybe someone might complain that your sleep talking is keeping
him or her up all night.
NIGHT TERROR & NIGHTMARES DISORDER
Definition of Night terror & Nightmares Disorder : sleep disorders in which a person
abruptly awakens from sleep in a frightened or panicked state.
 The condition most often happens during the first third of the night and is
sometimes accompanied by sleepwalking.
 It usually run in families.
 It happens to adults , but more common in children, that usually outgrow after
adolescence.
Causes:
 The condition may be triggered by a variety of Psychological factors including:
anxiety, stress, depression or conflict in the household, Fatigue, sleep
deprivation
 Also, some underlying medical conditions such as: sleep apnea, a head injury, or
migraines.
 Certain medications including: antihistamines, sedatives, or sleeping pills may
trigger an episode as well.
 Addiction or dependency: Adults with an alcohol or other drug dependency are at
a greater risk for night terrors than others.
NIGHT TERROR & NIGHTMARES DISORDER
Symptoms:
 Sit up in bed
 Scream or shout
 Kick and thrash
 Sweat, breathe heavily and have a racing pulse
 Be hard to awaken
 Get out of bed and run around the house
 Engage in violent behavior (more common in adults)
 Stare wide-eyed
Treatment:
 Comfort to child if he or she has night terrors.
 Adults with night terrors may benefit from stress reduction, coping strategies, or
psychotherapy.
 Complications of night terrors are rare and medication is rarely used.
REM BEHAVIOR DISORDER (RBD)
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In a person with REM sleep behavior disorder (RBD), the
paralysis that normally occurs during REM sleep is
incomplete or absent, allowing the person to "act out" his or
her dreams.
RBD is characterized by the acting out of dreams that are
vivid, intense, and violent.
Dream-enacting behaviors include talking, yelling, punching,
kicking, sitting, jumping from bed, arm flailing, and grabbing.
An acute form may occur during withdrawal from alcohol or
sedative-hypnotic drugs.
RBD is usually seen in middle-aged to elderly people (more
often in men).
REM BEHAVIOR DISORDER (RBD)
Causes:
 55%
has unknown cause, while the rest (45%) are
associated with:
 Alcohol
 Sedative-hypnotic
withdrawal
 Some antidepressants
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RBD is highly associated with Parkinson’s Disease*,
however not all RBD patients have Parkinson’s.
*Parkinson’s disease involves the malfunction and death of vital nerve cells in the brain, called neurons. Some
of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that
controls movement and coordination.
REM BEHAVIOR DISORDER (RBD)
Treatment & Management:
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Treatment usually includes medication as Clonazepam (drug
having anxiolytic, anticonvulsant, muscle relaxant, sedative,
and hypnotic properties.
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Management includes removal of harmful objects from the
surrounding area of sleeping, locking patient and monitoring
and sometimes tying patient to bed.
ASSIGNMENT
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Compare between the two types of sleep disorders , with
explanation of each type giving examples.
Define: Insomnia, Sleep Apnea, Narcolepsy, Sleep walking,
Sleep Talking, Night terrors & nightmares, RBD.
What are the different classifications of Insomnia explain
each.
What are the causes of Insomnia?
What are the treatment or management ways of insomnia?
What is the dangers or risks of having sleep Apnea?
What are the major symptoms of a Narcolepsy?
What are the main causes of Night terrors & Nightmares?
What are the main steps for RBD Management?