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
Sleep Paralysis
Paralysis of voluntary muscles due to recurrent intrusions of REM sleep in the sleep–wake cycles
Treatment Options for Narcolepsy
No cure
Stimulant medication, modafinil (Provigil), and behavioral structuring, such as scheduling naps at convenient times
Characteristics of Sleep-Related Breathing Disorders
Excessive sleepiness or, less commonly, insomnia
May have loud snoring or gasping with episodes of sleep apnea (depending on type)
Naps usually not effective
Causes: Abnormalities in ventilation during sleep (e.g., obstruction, airway collapse – may be related to factors such as structural, overweight, alcohol/drugs, sedatives
Obstructive Sleep Apnea
Repeated episodes of upper airway obstruction
Central Sleep Apnea
Episodic cessation of ventilation without airway obstruction
More common in the elderly, while obstructive sleep apnea and central alveolar hypoventilation are commonly seen in obese individuals
Central Alveolar Hypoventilation
Hypoventilation resulting in low arterial oxygen levels
Treatment Options for Sleep-Related Breathing Disorders
Lifestyle changes
Nonsurgical treatment (e.g., CPAP during sleep, position change, weight loss, oral appliance)
Surgical treatment (e.g., tracheotomy)
Circadian Rhythm
Pattern repeating itself in a 24-hour cycle
Physical, mental, & behavioral changes: Driven by a circadian/biologic clock (e.g., most physiologic functions lowest mid-sleep; body temp. lowest in morning & highest mid-evening)
- Regulated by melatonin
Natural changes in rhythm occur with age
“Internal clock” able to reset itself in response to some changes but not all
Circadian Rhythm Disorders
Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands.
Delayed Sleep Phase
Person’s own circadian schedule is incongruent with needed timing of sleep
Ex) An individual being unable to sleep or remain awake during socially acceptable hours as a result of a work schedule or the like
Jet Lag
Conflict of sleep–wake schedule and a new time zone
Shift-Work
Conflict between circadian rhythm and demands of wakefulness for shift work
Unspecified Circadian Rhythm Disorders
Circadian rhythm pattern is longer than 24 hours despite environmental cues, resulting in varying sleep problems
Treatment Options for Circadian Rhythm Disorders
Goals:
- Strengthen timed clues (when to go to sleep)
- Adequately timed bright light (stay awake during day)
- Adequately timed exogenous melatonin
Interventions:
- Sleep Hygiene Measures
- Chronotherapy: Progressively delay bedtime
- Chronopharmacotherapy: Sedative-hypnotics or caffeine
- Luminotherapy: Bright light therapy
- Supplemental melatonin therapy
- Teach travel tips
Parasomnias
Occur with sleep, specific sleep stages, or sleep–wake transitions and characterized by abnormal behavioral, experiential, physiological, or psychological events
Causes: Unknown etiology; possible genetic predisposition
Examples of parasomnias:
- Nightmare disorder
- Sleep terror disorder
- Sleepwalking disorder
Nightmare Disorder
Repeated occurrence of frightening dreams that lead to waking from sleep.
The dreams are often lengthy and elaborate, provoking anxiety or terror and causing the individual to have trouble returning to sleep and to experience significant distress and, sometimes, lack of sleep.
There is no widely accepted treatment
Sleep Terror Disorder
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry.
Children with sleep terror disorder are confused and upset upon awakening and have no memory of a dream either at the time of awakening or in the morning.
Initially, it is difficult to fully awaken or console the child.
Sleep terror disorder tends to go away in adolescence.
Sleepwalking Disorder
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.
Persons appear disoriented and confused and on occasion may become violent.
Usually, they return to bed on their own or can be guided back to bed.
Sleepwalking occurs most often in children between the ages of 4 and 8 years, and it tends to dissipate by adolescence
No treatment is required
Sleep Disorders Related to Another Mental Health Disorder
May involve insomnia or hypersomnia.
Mood disorders, anxiety disorders, schizophrenia, and other psychotic disorders are often associated with sleep disturbances.
Treatment of the underlying mental disorder is indicated to resolve the sleep disorder
Sleep Disorder due to General Medical Disorder
May involve insomnia, hypersomnia, parasomnias, or a combination of these attributable to a medical condition.
These sleep disturbances may result from degenerative neurologic illnesses, cerebrovascular disease, endocrine conditions, viral and bacterial infections, coughing, or pain.
Sleep disturbances of this type may improve with treatment of the underlying medical condition or may be treated symptomatically with medication for sleep.
Substance-Induced Sleep Disorder
Involves prominent disturbance in sleep due to the direct physiological effects of a substance, such as alcohol, other drugs, or toxins.
Insomnia and hypersomnia are most common.
Treatment of the underlying substance use or abuse generally leads to improvement in sleep
