Download Sleep Disorders

Sleep Disorders
A Primer on Sleep
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Sleep is an active, recuperative process. It is
critical to survival.
Sleep deprivation = decreased functioning,
hallucinations at extreme
Chronic sleep deprivation may precipitate
disorders (diathesis-stress)
Stages of Sleep
1.
2.
3.
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Stage 1 = between awake/asleep. Body relaxes
Stages 2 -4 = relaxing muscles, no eye movement.
Increasing depth of sleep
REM = brain waves suggest light sleep, but
wakening is difficult. Body is paralyzed, brain
waves are complex & varied
Move through several stages several times in one
night
Children/fetuses show higher rates of REM
Types of Sleep Disorders
1.
Dyssomnias - difficulty initiating or maintaining
sleep, excessive sleep. Affect sleep and
functioning when awake
2.
Parasomnias - abnormal behavior or physiology
occurring during sleep or transitioning between
stages of sleep
* Not in the context of another type of disorder (e.g.,
depression)
Dyssomnias
1.
2.
3.
4.
5.
Primary Insomnia
Primary Hypersomnia
Narcolepsy
Breathing-related
sleep disorders
Circadian rhythm
sleep disorders
Assessing Sleep Problems
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Polysomnographic evaluation
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Respiration, airflow
Leg movements
Brain waves
Eye movements, muscle movements
Heart activity
Sleep efficiency - % of time asleep in bed
Primary Insomnia
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Difficulty falling asleep or maintaining it
Person does not feel rested the next morning
33-50% of adults complain of insomnia
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DSM estimate only 1-10% qualify for diagnosis
Common among elderly individuals
Causes of Insomnia
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Other disorders
Biological
clock/temperature
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Higher, with less
variation
Drug use
Environmental factors
Cognitions regarding
sleep
Primary Hypersomnia
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Excessive sleep
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Prevalence is unknown
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Sleeping for long periods of time
Taking frequent naps during the day
0.5 - 5% of adults complain of sleepiness during
day
Usually begins in late adolescence or early
adulthood
Narcolepsy
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Repeated and irresistible “attacks” of sleep
 Often in response to strongly emotional
situations
 May involve cataplexy (immediate muscle
paralysis and REM)
Narcolepsy
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1/3 experience
hypnogogic
hallucinations
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Prevalence is low
(0.03-0.16%
population)
Narcolepsy
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Equal among men &
women
First signs = intense
daytime sleepiness
Often interferes with
daily functioning
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Driving
Jobs
Relationships
Parasomnias
1.
2.
3.
Nightmare Disorder
Sleep Terror Disorder
Sleepwalking Disorder
Nightmare Disorder
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Frequent awakening due to frightening
dreams
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Involves detailed recall of content
Cause distress & sleep problems
Impair daytime functioning
Nightmare Disorder
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Not diagnosed if another diagnosis accounts
for the symptoms better (e.g, PTSD)
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50% of children experience occasional
nightmares
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1 in 30 young adults
Sleep Terror Disorder
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Abrupt awakening from sleep, often with
screaming
Unlike a nightmare, no quick orientation to
where they are & feelings continue for
several minutes
Sleep Terror Disorder
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Difficult to comfort/reassure
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Report no dream content & do not occur
during REM
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More common in children than adults
Sleepwalking Disorder
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Complex motor behavior during sleep
Must cause distress for diagnosis
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This makes prevalence rates low
2% of children frequently sleepwalk
1 in 200 adults frequently
Sleepwalking Disorder
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Usually returns to bed with no recollection
later
If awakened, will be confused (this is not
dangerous as many people believe)
What Causes Parasomnias?
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Less is known about prevalence or causes
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Individuals often unaware of the experience
Other psychopathologies (PTSD)
Genetic risk for sleepwalking
What Causes Parasomnias?
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All can precede sleepwalking:
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Stress
Mood/anxiety
Sleep deprivation
Medical conditions
Shift work
Biological Treatments for
Sleep Disorders
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May include sleep
medication
 Ineffective for
chronic insomnia
 lose effectiveness
after few nights
 rebound insomnia
Environmental Changes
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Change circadian rhythm
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Phase delays or advances
Dental devices or surgery
Continuous Positive Airway Pressure
Light treatment
Psychological Treatments
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Many problems due to poor sleep hygiene
Stimulus control
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E.g. getting out of bed if not asleep
Sleep reduction - do not go to bed until normal sleep
time (e.g., 2am)
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Progressive muscle relaxation
Meditation
Preventing Sleep Disorders
and Problems
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Address sleep hygiene
Sleep Hygiene
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Avoid consuming caffeine during the evening
Avoid smoking just before falling asleep or
when you wake up in the night; Nicotine is a
stimulant
Sleep Hygiene
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Do not use alcohol as a sleep aid. It may help
you fall asleep, but it causes awakening
during the night and decreases the
restfulness of sleep
Sleep Hygiene
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Sleep in a comfortable environment. Block
noise with earplugs or a white noise machine.
Maintain a cooler temperature & keep the
room reasonably dark
Sleep Hygiene
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Do not stay in bed if you are not tired! Trying
to force yourself to sleep makes it less likely
you will! Get up, read, watch TV and don’t go
back to bed until you are tired
Sleep Hygiene
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If you are having trouble sleeping, do not
watch the clock, as it will increase anxiety.
Turn it around so that you cannot see the
time
Only use your bedroom for sleep & sex (e.g.
do not do homework on your bed, you should
not associate your bed with anything else)
Sleep Hygiene
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Do not rely on sleep medications. They lose
effectiveness if used over and over again.
Only use them for occasional bouts of
sleeplessness