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SBS 04-19-05
Sleep Disorders
1. Major Categories of Primary Sleep Disorder
Dyssomnias
- problems in the timing, quality, or amount of sleep
Parasomnias
- abnormalities in physiology or in behavior associated with sleep
2. Primary vs. Secondary Sleep Disorders
Primary
- sleeping disorders in which the difficulty is with the sleep itself
- includes both dyssomnias and parasomnias
Secondary
- sleeping disorders resulting from some other medical or
environmental situations
3. List and Define Sleep Disorders Under Each Major Category
Dyssomnias
Insomnia
- difficulty falling asleep or staying asleep that occurs three times per
week for at least one month
o leads to sleepiness during the day
o causes problems fulfilling social or occupational obligations
- caused from a variety of things including:
o caffeine or stimulants
o pain, endocrine, and metabolic disorders
o psychological conditions (depression, mood, anxiety)
Breathing Related Sleeping Disorder
- cessation of breathing for periods during sleep
o leads to anoxia and nighttime awakenings
o results in chronic daytime sleepiness
- can be a central (brain) problem or an obstructive (nasopharyngeal)
problem
- treatment includes sleep diary, sleep studies, and use of a breathing
machine (CPAP)
Narcolepsy
- episodes of sudden daytime sleepiness that occur daily for at least 3
months despite a normal amount of sleep at night
o instant REM sleep
- aggravated by emotions → cataplexy
- may experience sleep paralysis, hypnagogic or hypnopompic
hallucinations
o strange perceptual experiences just as pt falls asleep or wakes
up (respectively)
- helped by daytime naps and stimulants
Primary Hypersomnias
- recurrent bouts of excessive sleepiness occurring almost daily for at
least one month
- not relieved by daytime naps
- not better accounted for by narcolepsy or other disorder
- treated w/stimulants and antidepressants
Circadian Rhythm Sleep Disorders
- sleepiness at inappropriate times during the day b/c of inability to
sleep at appropriate times
o delayed → waking later than desired
o jet lag → 2-7 days after a change in time zones
o shift work → schedule causes mixed insomnia and sleepiness
Restless Leg Syndrome
- uncomfortable sensation in the legs (and sometimes arms)
necessitating frequent motion and causing insomnia and repetitive
limb jerking during sleep
- more common w/aging, pregnancy, and kidney disease
- associated w/deficiencies in dopamine, iron, and magnesium
Nocturnal Myoclonus
- repetitive, abrupt muscular contraction in the legs from toes to hips
causing nighttime awakenings
- more common in the elderly
Parasomnias
Bruxism
- tooth grinding, normally during stage 2 sleep
- can lead to tooth damage and jaw pain
- treated w/night guards
Nightmare Disorder
- repetitive, frightening dreams that occur during REM sleep
o recalled on nightmare awakenings
- treated with drugs that suppress REM sleep
Sleep Terror
- repetitive experiences of fright in which a person (usually a child)
screams in fear but cannot be awakened
o has no memory of dream
- occurs during slow-wave sleep
- may be an indication of epilepsy in adolescence
Sleepwalking Disorder
- repetitive walking during sleep
o no memory of walking
- occurs during slow-wave sleep
- begins in childhood, may have genetic component
REM Behavior Disorder
- REM sleep and dreaming w/out skeletal muscle atonia
- Pts may harm themselves and/or sleeping partners
4. Discuss Sleep Hygiene
Regularity
- going to bed and getting up at the same time everyday
- having the same temperature, lighting, quality of bedding, noise level,
etc.
Bed is for Sleeping (and sex)
- don’t use the bed for reading, watching television, working, etc
- if not asleep w/in ½ hour, get up
Control
-
use daytime naps to compensate for reduced night sleeping (but
avoid insomnia due to naps)
use of sleep restriction to improve sleep efficiency and sense of
control
5. Medications and Sleeping Disorders
Place of Medications
- meds play an important role in the management of sleep
- can be used to treat secondary sleep disorder to depression or
anxiety
- helpful in many primary sleep disorders as well
- be aware of dependence, rebound on discontinuance, and occasional
amnesia of the day following intake
Anti-Anxiety Agents (clonazepam/lorazeapm)
- help with insomnia, myoclonus, restless leg syndrome, sleep terror,
and REM behavior disorder
Stimulants/Provigil
- used for narcolepsy
- new drug that makes one feel as if they have slept
Antiepileptic
- used for REM behavior disorder, and nocturnal epilepsy
Melatonin
- limited and controversial use in the management of sleep disorders
- used for jet lag or night shift work
Hypnotics (triazolam, ambien)
- used for short term management of primary or secondary insomnia
Benzodiazepines
Benzodiazepines
½ Life
Dose (mg)
Dalmane
40-250 hrs
15-20
Temazepam
8-27
7.5-15
Triazolam
<6
0.125-0.5
Ambien
2.5
5, 10
Sonata
6
5, 10
Lunesta
1.0
1-3