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Sleep Disorders Presentation

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Jamie Giannotti

on 6 April 2011

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Transcript of Sleep Disorders Presentation

Parasomnias Dyssomnias SLEEP DISORDERS Sleep Disorder Related to Other Mental Disorder Sleep Disorder Related to General Medical Disorder
Substance Induced Sleep Disorder Insomnia
High Prevalence of Insomnia in mental disorders Insomnia
Mixed Hyperthyroidism Viral Encephalitis Insomnia
Mixed Alcohol Opiods Amphetamines Caffeine Cocaine
Sedatives Hypnotics Anxiolytics Narcolepsy
Circadian Rhythm Sleep Disorder Breathing-Related Sleep Disorder Primary Insomnia Primary Hypersomnia Nightmare Disorder Sleep Terror Disorder Sleep Walking Disorder dyssomnias are problems with the quantity and timing of sleep parasomnias are problems with the quality of sleep PRIMARY INSOMNIA
Etiology: related to psychological, social and medical stress

Symptoms: difficulty falling asleep, staying asleep, or non-restorative sleep, lasts for at least 1 month, causes significant distress and or impairment in functioning, not related to other sleep disorder, substance use or other medical condition.

Course: sudden onset in young adulthood, middle age, course varies from months to longer (previous insomnia is the strongest risk factor for current insomnia)
Other studies suggest insomnia is more prevalent for seniors.

Familial Pattern: inconsistent results for insomnia PRIMARY HYPERSOMNIA
Etiology: unknown
Symptoms: excessive sleepiness, prolonged sleep episodes, daytime sleep, sufficiently severe to cause distress and or impairment in functioning, not related to other sleep disorder, mental disorder, substance use or other medical condition
KLEINE-LEVIN SYNDROME is the recurrent form, where clients spend 18-20hrs a day in bed
Sleep Drunkeness= the prolonged impairment of alertness at the sleep wake transition where client may be confused, combative or ataxic.

Course: onset age 15-30, progressive, chronic and stable unless treated

Familial Pattern: individuals with autonomic dysfunction with primary hypersomnia are more likely to have family with primary hypersomnia NARCOLEPSY
Etiology: genetic predisposition and abnormal neurotransmitter sensitivity

Symptoms: excessive daytime sleepiness, sleep attacks, cataplexy, hypnagogic hallucinations, sleep paralysis

Course: onset between 15-30, not progressive, may reduce over time

Familial Pattern: stronger correlation between children what get it early and it running in the family BREATHING-RELATED SLEEP DISORDER
Etiology: overweight, narrowed breathing passage ways.

Symptoms: sleep disruptions due to breathing issues, excessive daytime sleepiness, insomnia

Course: presents at 40-60 years, insidious onset, gradual progression, chronic course

Familial Pattern: linked to family history
Etiology: trauma, accidents, surgery, travel, Alzheimers, food/caffeine, work shift
Delayed Sleep Phase Type
Jet Lag Type
Shift Work Type
Symptoms: sleep and wakefulness are out of sync with regular daylight pattern

Course: onset during adolescence, or following a psychosocial stressor, lasts for years to decades, may correct itself

Familial Pattern: family history may be present in 40% of individuals with Delayed Sleep Phase NIGHTMARE DISORDER
Etiology: can be caused by stress, anxiety, and some drugs. Often, there is no clear cause. (WebMD, 2008)

Symptoms: repeated frightening dreams that wake person from sleep, significant distress due to nightmare, arising during REM sleep

Course: onset between 3-6 years, usually improves over time SLEEP TERROR DISORDER
Etiology: possibly caused by over-exhaustion

Symptoms: extreme terror and temporary inability to regain conciousness, arising during NREM sleep

Course: children 4-6, usually disappears by adolescence

Familial Pattern: strong hereditary link SLEEP WALKING DISORDER
Etiology: sleep deprivation, stress, in adults possible substance use or neurological condition

Symptoms: repeated episodes of complex motor activity intiated during sleep, arising during NREM sleep

Course: onset 4-8 years, prevalence at 12 years, more complex behavior in adulthood

Familial Pattern: linked to family history Sleep can be divided into two types: rapid eye movement (REM) sleep and non-REM (NREM) sleep. NREM sleep has four stages of increasingly deep sleep. Stage 1 sleep is the lightest, while stage 4 is the deepest

During normal sleep, you cycle through these types and stages of sleep. But if your sleep is repeatedly interrupted and you cannot cycle normally through REM and NREM sleep, you may feel tired, fatigued, and have trouble concentrating and paying attention while awake. Sleepy individuals are at greater risk for driving and other accidents.
(WebMD, 2008) Night terrors Nightmares People who drink coffee, smoke cigarettes, or drink alcohol are more likely to have sleep problems than people who do not. (WebMD, 2008) Men with insomnia have a fourfold higher death rate than normal sleepers who get at least 6 hours sleep a night, a 14-year study finds. (DeNoon, 2010) An Ancient Angle on a Modern Malady
Ayurveda, the healing science associated with yoga, tells us that all disease is caused by indigestion. That is, at some level-either physical, mental, or emotional-we haven't completed extracting what is helpful and eliminating what is indigestible. This is one of the keys to understanding insomnia.
On the physical level, indigestion is caused either by bad food or by weak digestion and leads to conditions like heartburn (a contributor to insomnia), flatulence, and diarrhea. Mental indigestion is the inability to let go of a certain incident or thought-usually an unpleasant experience. This can be a distant tragedy like the earthquake in Japan, criticism from someone whose opinion we value, or a work-related problem we're trying to solve. Emotional indigestion is the recurrence of a feeling, often sadness or anger, long after the precipitating event. The emotion has not been sufficiently digested and remains just under the surface, springing up for no apparent reason. Mental and emotional indigestion are the most common causes of insomnia. Some of us even grind our teeth while we sleep in an attempt to chew and digest recurring thoughts and emotions.
(Angus, 2004) Sleep education.
Cognitive control and psychotherapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
Sleep restriction. Limiting the amount of time you spend in bed can make you sleepier when you do go to bed.
Remaining passively awake.
Stimulus control therapy.
Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. You may be told to avoid napping and taught to maintain a consistent sleep schedule. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
Relaxation training.
Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.
Sleep diary.
(Mayo Clinic, 2011) Treatments Fifty-three minutes after sleep onset in the sleep lab, a 19-year-old male suddenly begins to growl and then 28 s later he leaves the bed and crawls away in the manner of a large jungle cat, as noted by the sleep technologist. A nine channel EEG indicates a corresponding wakeful state. For 4 years, once or twice weekly, he had acted like a large jungle cat (with deep, persistent growling) for 30–60 min during the nocturnal sleep period at home. His parents commented on his 'super-human strength' during these episodes, such as leaping far from his bed, lifting a marble table with his jaws, lifting a mattress with his jaws and then dragging it across a room. He frequently left imprints of his teeth on wooden furniture. He often bruised and lacerated himself all over his body from aggressive and violent behaviour during these episodes, and also repeatedly injured his lips and gums from biting sharp objects. He has never had a dissociative episode during the daytime, so his case represents an exclusively nocturnal, sleep-related animalistic dissociative (multiple personality) disorder. Reprinted from Schenck et al. (1989b), with permission.
(WebMD, 2010) Nocturnal Dissociative Disorders

Dissociative disorders are defined as a disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment that occur without the conscious awareness of the part of the individual
(American Psychiatric Association, 2000). A 36-year-old female with nocturnal frontal lobe epilepsy since the age of 13. Seizures occurred up to 10 times a night and were characterized by an abrupt awakening from sleep with a feeling of chest tightness and dyspnoea, and progressed to tonic posturing of the limbs and hyperkinetic features, including elevation and extension of the left arm (B) and pedalling (A and C). The patient was fully aware during the seizure but was unable to speak. She had sustained several injuries including fractures of her fingers when hitting objects during the seizures.
(WebMD, 2010) An 82-year-old male with a 2-year history of symmetrical extrapyramidal symptoms and cognitive dysfunction, attributed to vascular leucencephalopathy. According to his wife, he displayed frequent vocalizations and violent behaviour during sleep. Polysomnographic recordings (D) show loss of normal muscle atonia during REM sleep and increased phasic muscle activity, as well as acting out of dreams with kicking (A), hitting (B) and menacing gestures (C). A practicle example of sleep violence SLEEP & VIOLENCE
Reports date back to medieval times, regarding a Silesian woodcutter, who after a few hours of sleep woke up abruptly, aimed his axe at an imaginary intruder and killed his wife instead (Gastaut and Broughton, 1965). Another early case was reported by Yellowless in 1878 and describes a young man with a history of sleep terrors who killed his 18-month-old son by smashing him against the wall during the night, taking him for a wild beast that was about to attack his family. In 1893, Charcot was asked to pronounce himself on a case of attempted murder that occurred during an apparent episode of somnambulism, in which a servant, shortly after falling asleep, injured his landlady and another employee with a gun (Brouardel et al., 1893). Nowadays, dramatic reports of somnambulistic homicide still gain considerable attention in the media (Broughton et al., 1994; Cartwright, 2004).
(Siclari et al. 2010) Bikram says Half Tortoise pose, done correctly, can accomplish the same as 8 full hours of sleep. Cataplexy, a symptom exclusive to narcolepsy, is a strong loss of bilateral muscle tone that can last from a few seconds up to 30 minutes. It is stimulated by emotions, such as laughter, anger, or surprise.
(Macedo & English, 2011) Individuals with narcolepsy are often obese, with a higher than normal body mass index (BMI), probably due to low metabolic rate.
(Macedo & English, 2010) "The pills don't get most people seven or eight hours of sleep. At most they get six. A whole subset of patients immediately feels bad when they take these drugs. And then there are insomniacs for whom they seem like miracle pills, until they take them for a year and they don't work anymore."
(DeNoon, 2010) Vgontzas team showed that both women and men with insomnia suffer higher blood pressure, more diabetes, and more neurocognitive deficits than normal sleepers.
(DeNoon, 2010) Increased death risk was seen only in self-described insomniacs who, when tested in a sleep lab, slept less than six hours a night. People who said they did not have insomnia but who slept less than six hours a night did not have a significantly increased death risk. Neither did self-described insomniacs who slept more than six hours in the lab. Insomnia is linked to being in a continuous state of fight or flight. This state of arousal can be extremely taxing on your body . Hypnotics
generic name brand name
flurazepam = Dalmane
temazepam = Restoril
triazolam = Halcion
estazolam = ProSom
quazepam = Doral
zolpidem = Ambien
zaleplon = Sonata
eszopiclone = Lunesta
ramelteon = Rozerem
diphenhydramine = Benadryl Antianxiety Meds
generic name brand name
lorazepam = Ativan
alprazolam = Xanax these are habit forming and supress deep sleep most are habit forming! exercise regular exercise during the day can improve sleep Psychoanalysis Freud believed that dreams and nightmares represented the fulfillment of a wish. (Freud, 1917)

Exploration of the unconscious through psychoanalysis may lead to the resolution of issues arising from a psychosexual stage of development.
Lucid Dreaming becoming conscious of dreaming while in the dream and taking control of your actions and outcomes can lead to resolution of recurring nightmares weight loss diet Cognitive Behavioral Therapy - CBT Alternative... Antidepressants, SSRIs
some tricyclics Recently, sleep disturbances or other factors that can diminish resiliency have been linked with an increased risk for PTSD. Similarly, case reports and studies of individuals surviving motor vehicle collisions, hurricanes, and traumatic injuries suggest that post traumatic sleep disturbances (eg, insomnia, nightmares) can predict both the development of PTSD and the severity of symptoms.

Nightmares are a common feature of PTSD, with a reported prevalence of 50%-90% in long-term epidemiologic follow-up studies. Insomnia (both sleep-onset and maintenance insomnia) is a problem for most patients, as is significantly disrupted nocturnal sleep.

(Orr, Lettieri, 2011) Sleep complaints are commonly experienced by patients with PTSD, and sleep disruptions are associated with the development of mood disorders. A clear cause and effect relationship seems to exist among sleep complaints, primary sleep disorders, and PTSD. Although this association is well accepted, the precise mechanism and the interdependent roles of these overlapping conditions are not fully understood.
(Orr, Lettieri, 2011) A 2001 randomized controlled trial of imagery rehearsal therapy for nightmares showed fewer nightmares, improved sleep quality, and reduced PTSD symptom severity after 3 brief sessions. ...numerous experts have argued that formal sleep evaluations and treatment should be considered in patients with PTSD, especially those with sleep-related symptoms.
(Orr, Lettieri, 2011) Doctor PTSD References

Angus, C. (2004) An Ancient Angle on a Modern Malady. Retrieved March 26, 2011

DeNoon, D. J., (2010) Men With Insomnia May Have Higher Death Risk.
Retrieved March 23, 2011, http://www.medscape.com/viewarticle/728065

Kling, J. (2010) Chronic Insomnia Increases Mortality.
Retrieved March 23, 2011 http://www.medscape.com/viewarticle/725126

Macedo, L., English, C. (2011) Pharmacologic Options for Treating Narcolepsy.
Retrieved March 23, 2011 http://www.medscape.com/viewarticle/736832_7

Mayo Clinic (2011) Insomnia treatment: Cognitive behavioral therapy instead of sleeping
pills. Retrieved March 23, 2011

Morton, K., (2010) The Various Types Of Sleep Disorders. Retrieved March 22, 2011

Orr, N.H., Lettieri, C. J., (2011) Sleep Disturbances and Posttraumatic Stress Disorder
Retrieved from Medscape March 26, 2011.

Preston, J. D., O’Neal, J.H & Talaga, M.C., (2010) Handbook of Clinical
Psychopharmacology for Therapists, Sixth Edition, Oakland, CA: New Harbinger Publications, Inc.

Siclari, F.; Khatami, R.; Urbaniok, F.; Nobili, L.; Mahowald, M. W.; Schenck, C. H.;
Cramer Bornemann, M. A.; Bassetti, C. L., (2010) Violence in Sleep.
Retrieved March 22, 2011

WebMD, Gelfand, J.L. (2007) The Basics of Insomnia and Sleep Problems.
Retrieved March 20, 2011, http://www.medscape.com/viewarticle/578702

a naturally occuring hormone produced by the pineal gland, supplements can aid in regulating sleep patterns
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