Appendix A Disorders of Sleep & Wakefulness Flashcards
What is the primary element of insomnia?
Dissatisfaction w/ sleep quality or sleep quantity
Person has difficulty falling asleep, maintaining sleep, and/or early-morning wakening with an inability to return to sleep
Sleep
A natural state of rest
Diminished muscle movement
Decreased awareness of surroundings
- Relative state of unconsciousness
Necessary for human survival: Restores energy & well-being
Characteristics of Insomnia
Difficulty falling or staying asleep or waking early in the morning and being unable to return to sleep
Can be episodic, persistent, recurrent, or chronic
Most prevalent of all sleep-related problems
Prevalence increases with age; greater in women
A major problem in many mental disorders (e.g., depression) and also with medical conditions
- Often increases risk for relapse of mental disorder
May become obsessed/pre-occupied with sleep
What are the 5 categories of sleep & wakefulness disorders?
1) Insomnia
2) Hypersomnia
3) Sleep-related breathing disorders
4) Circadian rhythm disorders
5) Parasomnias
Inadequate Sleep Hygiene Insomnia Subtype
Engaging in behaviors not conducive to sleep or interfering directly with sleep
Included are:
- Consuming caffeine or nicotine before bedtime
- Excessive emotional or physical stimulation just prior to bedtime
- Daytime naps
- Wide variations of daily sleep–wake routines.
Treatment modalities include: sleep hygiene measures , cognitive–behavioral techniques, and medication
Sleep Hygiene Measures
Establish a regular schedule for going to bed and arising.
Avoid sleep deprivation and the desire to “catch up”
by excessive sleeping.
Do not eat large meals before bedtime; however, a light snack is permissible, even helpful.
Avoid daytime naps, unless necessitated by advanced age or physical condition.
Exercise daily, particularly in the late afternoon or early evening, as exercise before retiring may interfere with sleep.
Minimize or eliminate caffeine and nicotine ingestion.
Do not look at the clock while lying in bed.
Keep the temperature in the bedroom slightly cool.
Do not drink alcohol in an attempt to sleep; it will worsen sleep disturbances and produce poor-quality sleep.
Do not use the bed for reading, working, watching television, and so forth.
If you are worried about something, try writing it down on paper and assigning a designated time to deal with it—then, let it go.
Soft music, relaxation tapes, or “white noise” may be helpful; experiment with different methods to find those that are beneficial.
Psychophysiological Insomnia
Involves conditioned arousal associated with the thought of sleep (i.e., the bed, the bedroom).
Often associated with stress and anxiety.
Characteristics include:
- Excessive worry about sleep problems
- Trying too hard to sleep
- Rumination
- Increased muscle tension, and other anxiety symptoms.
Treatment consists of relaxation therapy, sleep hygiene measures, and stimulus control therapy
Paradoxical Insomnia
When the individual thinks they are awake or are not sleeping even though brain wave activity is consistent with normal sleep
Usually due to ruminative worrying that continues into sleep but causes the individual to believe they are awake
An interruption of rumination and diminished worry about not sleeping usually diminishes or eliminates the problem
Behavioral Insomnia of Childhood
When the child must have specific stimulation, objects, or setting for falling asleep, or returning to sleep
- Without limits, can lead to bedtime stalling or refusal
Idiopathic Insomnia
A lifelong inability to obtain adequate sleep. It is thought to be a neurologic deficit in the sleep–wake cycle and is, therefore, chronic and lifelong.
Treatment consists of improved sleep hygiene, relaxation therapy, and the long-term use of sleep-inducing medication
Insomnia due to Mental Disorder, Medical Condition, or Drug or Substance Abuse
Primary treatment of the underlying cause is helpful but may not eliminate the insomnia altogether.
Use of medications for sleep, sleep hygiene measures, and the avoidance of stimulants, including caffeine, and of medications that interfere with sleep are also effective.
Hypersomnolence Disorder
Excessive sleepiness for at least one month
May interfere with ADLs, functioning, concentration, and memory
Prolonged sleep periods at night (8-12 hrs) or daily daytime sleep episodes
Fall asleep easily but difficulty waking up (morning drunkenness)
Daily napping without feeling refreshed upon awakening
Causes: Environmental; sleep regulation dysfunction in the brain
Hypersomnolence Treatment Options
Sleep hygiene
Discourage naps
May self-medicate with caffeine
Possible treatment with antidepressants or stimulants
Narcolepsy
Chronic excessive sleeping
Repeated, irresistible ‘sleep attacks’ (sudden, uncontrollable urge to sleep at any time of the day regardless of the amount of previous sleep)
Sleep attacks are usually deep and short (10-20 min); often occur in inappropriate situations; can be disabling
Upon awakening, typically feel briefly refreshed, until the next attack
May also experience cataplexy, dreamlike hallucinations, or sleep paralysis
Causes: Unknown; may be due to deficit in neurotransmitter hypocretin
Cataplexy
Sudden episodes of bilateral, reversible loss of muscle tone that last for seconds to minutes
