Download for Sleep Disorders

Disorders of Sleep
“Outline and Evaluate explanations of one or more sleep disorders” (24 marks)
Insomnia
Narcolepsy
Sleep Walking
How will I know if I am learning?
By the end of the lesson…
E
Will be able to explain what insomnia,
Narcolepsy and Sleepwalking are
C Will be to give explanations for each of the
disorders
A
Will be able analyse research that
support/challenge the different explanations
What is a Sleep Disorder?
Any condition that involves difficulty
experienced when sleeping, resulting in
• Daytime fatigue
• Severe distress and impairment to work, social
or personal functioning.
Two categories of sleep disorder
Type
Description
Daytime
sleepiness?
Examples
Dysomnias
Problems with
amount or
quality of
sleep.
Yes
Insomnia
Narcolepsy
Parasomnias
Behavioural or
physiological
events during
sleep
Not usually
Sleep walking
Night terrors
Insomnia
• What is it?
• More than just “ I can’t sleep”, we all get that
from time to time, maybe because we are
stressed, anxious or excited.
• To be diagnosed with insomnia you need
proper diagnostic criteria.
Diagnosing Insomnia- criteria
Takes more than 30 min to fall asleep
Spend less than 85 % of time in bed actually
asleep
Wake up frequently
Suffer at least 3 times a week
• Must last longer than a month to be
diagnosed as clinical insomnia!
10 things you need to know about sleep clip
Insomnia worksheet
Narcolepsy
First identified as a medical
condition in early 20th century.
Onset is early adulthood or
adolescence but can occur
early or later in life
Affects about 0.5-1 in 1000
people worldwide so very rare.
My day out with narcolepsy
•
•
•
Watch the clip.
What is life like from this mans
perspective.
How does his sleep disorder affect
his life?
http://www.youtube.com/watch?v=3MBCeKn0Oeo
http://www.youtube.com/watch?v=3MBCeKn0
Oeo
Narcolepsy Symptoms
4 general symptoms associated with Narcolepsy:
1) Excessive daytime sleepiness and sudden sleep attacks:
These can occur at anytime (even while eating or driving).
An episode lasts about 10-20 mins.
2) Sleep paralysis: A consciously experienced inability to
move just prior to falling asleep or waking up.
3) Dreamlike experiences: whilst still awake and just before
falling asleep or just before being fully awake
4) Cataplexy: Skeletal muscles weaken or are paralysed and
the person collapses and enters REM sleep. It is often
triggered by an emotional event (Laughter or anger)
Sleep Walking (SW)
• Most common in childhood, affecting 20% of
children and less than 3% of adults.
• In severe cases (one or more episodes a night)
• SW occurs only during NREM/SWS and is
related to night terrors which are also only
found in children.
• A SW is not conscious and later has no
memory of the events.
Explanations of Sleep Disorders
Teaching Towers
Insomnia
 Primary/Secondary
 Risk Factors- Age and gender, Sleep Apnoea
(other parasomnias)
 Personality
Narcolepsy
 REM hypothesis
 HLA
 Hypocretin
Sleep Walking
 Incomplete arousal
 Other factors
 Children
Instructions
Key words
1.
2.
Cause/Explanation 1
3.
Cause/Explanation 2
4.
In groups use the info to complete
your tower
One person now stays with your
tower to teach other groups
about your topic
The others need to split up and
visit the other towers to learn
another topic each
Regroup and teach each other the
two new tower topics
• Around the room are a series of studies on
economic theories of relationships.
– What is the study? Describe it.
– What does the study suggest?
Which theory does it support or challenge?
– Is there anything wrong with
the study? Is it up for debate? Can you
evaluate it in terms of AO3 methods? AIDs?
A.I.Ds Real World application
Cases of murder
Is a person really sleepwalking?
E.g. Jules Lowe killed his father & Brian Thomas
killed his wife
Plenary
•
•
•
You are suffering from a sleep disorder – describe your
symptoms (write them down) 2mins
Pass your symptoms along 4 people
Now diagnose the patient who has been passed to you– how
will you treat this client? Why?
Essay Questions Outline and evaluate explanations of two or more sleep disorders (24 Marks)
A survey of 4,000 11-17 year olds showed that 25% experienced insomnia and 5% said it interfered with their ability to function (Roberts et al).A year
later 41% reported continuing problems
Twin studies show a 50% variance in the risk for insomnia is related to genes (Watson et al)
Such genetic factors might lead to physiological differences such as hyperarousal. Insomniacs have been found to experience hyperarousal during the say and night (Bonnet and Arand)
Vogel observed the sleep patterns during narcoleptic episodes in one patent, and found (as predicted) that REM patterns were present at the beginning of each episode.
Sudden attacks of sleepiness might occur to disguise sexual fantasies (Lehrman and Weiss)
Siegel recorded activity in brainstem of narcoleptic dog, and found the same activity during cataplexy as found in REM sleep
Mignot et al found that the HLA mutation was present in many, but not all, narcoleptics and was also reasonably common in the general population.
Findings from dogs are confirmed in humans, e.g. narcoleptics have lower levels of hypocretin in their cerebrospinal fluid (Nishino et al) Honda et al (1983) found increased frequency of
one type of human leukocyte antigen in narcoleptics.
1990s American research team found that mice who could not make the neurotransmitter called hypocretin (aka orexin) displayed sleep attacks and cataplexy
Lin et al (1999) found some strains of dogs (Labradors & Dobermans) also exhibited narcolepsy following excitement. The researchers identified a mutant gene on chromosome 12 in
the dogs which affects neurons that secrete hypocretin.
hypocretin levels in the cerebrospinal fluid of narcoleptics are v low and narcoleptics have lost 90% of hypocretin-secreting neurons from the hypothalamus (Nishino 2000)
•
Low levels of hypocretin are not linked to inherited factors because narcolepsy doesn’t run in families (Mignot)
Genetic basis for SW
Prevalence of SW in first degree relatives is 10X greater than the general population (Broughton 1968) 50% concordance in MZ twins compared with only 15% in DZ twins Gene
identified for sleep walking (DQB1*05 gene)
Maturity of brain circuits-immaturity leads to SW Amount of SWS e.g. factors such as sleep deprivation increase SWS so SW becomes more likely
Being a child is related to all of above (immature and high levels of SWS)
40 patients referred to a clinic for suspected SW were observed before and after 25 hours of sleep deprivation. Before sleep deprivation 50% of the patients showed episodes of SW and
after it rose to 90%.-Triggered by sleep deprivation.
It is not always clear if insomnia is primary or secondary. Ohayon and Roth did a survey of 15,000 Europeans and found that insomnia often preceded depression (i.e. it was primary)
Storms and Nisbett gave insomniacs a pill and told them it would either stimulate them or make them sleepy. Those insomniacs who expected the pill to simulate them went to sleep
faster because they attributed their usual bedtime arousal to the pill and therefore relaxed.
Speilman and Glovinsky distinguished between risk factors that predispose, precipitate of perpetuate insomnia. Genetic factors predispose an individual (nature) Environmental
stressors (Nurture) trigger primary insomnia (diathesis stress model)
Perpetuating factors include expectations of having difficulty sleeping. (Self fulfilling prophecy)
Treatments focus on relaxation techniques, sleep hygiene (reduce caffeine, naps etc) Phototherapy can also be used.
19
Insomnia AO2
What?
(supporting
studies)
So What?
However?
Insomnia can be
Primary or secondary
Risk Factors
Narcolepsy AO2
What?
So What?
However?
REM hypothesis
HLA
Hypocretin
Sleepwalking AO2
What?
So What?
However?
Incomplete arousal
Various factors
Why children?