Ch6, 7, 8, 9 and 16

Question 1

Recognize how sleep disorders are classified (Note: Dement’s book relied on older versions of the International Classification of Sleep Disorders (ICSD); the Echo360 lecture/video describes the most recent information from ISCD3, 2014.)

Answer 1

Classified as dyssomnias or parasomnias or CR related movement disorders.

Question 2

Define parasomnias and dyssomnias.

Answer 2

dyssomnias are disorders where they do not get enough sleep or too much sleep.

parasomnias are sleep disorders in which the transition from a specific sleep state fails, resulting in a hybrid state between waking and sleeping.

Question 3

Know the symptoms, causes, and treatments (& treatment issues) for sleep disorders, especially insomnia, apnea, narcolepsy, circadian rhythm disorders, restless legs syndrome

Answer 3

Insomnia: symptoms are self-explanatory and you can talk about them. Causes: Interruptions of the SCN or normal CR functioning for various reasons. Treatments: Behavioral treatments first, include CBTI, sleep hygiene education, sleep restriction therapy, stimulus control therapy, exercise, self monitoring, and relapse prevention.
Apnea:Central/Obstructive: C-PAP is best treatment, but also surgery to remove adenoids and other surgery to fix sinus issues and a mouth guard. causes can include weight and neurological issues. Use stop-bang assessment score and Mallampati score for the tongue and uvula. 
Narcolepsy: low hypocretin/orexin in some, runs in families, may be an autoimmune disorder.  activated by strong emotions, modafinil is standard treatment, plus caffeine and antidepressants for sleep paralysis. 
Circadian Rhythm Disorder: a class of disorders including advanced, delayed, irregular, non-24 hr disorder as well as Shift Work Disorder and Jet Lag Disorder. treatments vary but can include light therapy at given times, gradual adjustment and medication.
Restless Leg Syndrome:Runs in families, pregnancy and kidney failure. creepy crawly feeling, can't lie still, more in females than males, 5-10% of population. Standard treatment is medication.

Question 4

Transient, chronic, chronic intermittent insomnia. DSPS, ASPS (138-139).

Answer 4

Transient- short lived
Chronic- more than 3 days a week for three months.
CHronic intermittant- recurring, but shortlived.
DSPS-delayed
ASPS-advanced

Question 5

Describe Dement’s step by step approach to understanding insomnia cases.

Answer 5

1) does it bother you?
2) are you falling asleep too early or too late?
3) examine hyperarousal, time changes and sleep enviornment.
4) rule out other causes
5) if above are ruled out, may be a psychological emmotional or psychiatric problem requiring a sleep test for diagnosis and treatmnet.

Question 6

What are 3 common physical issues Dement discusses as typical causes of insomnia? (139+

Answer 6

Restless leg syndrome, gastroesophageal Reflux and fibromyalgia.

Question 7

Describe sleep state misperception; psychophysiological insomnia; idiopathic insomnia. (145-7)

Answer 7

Sleep state Misperseption: being wrong about how much sleep you get.
Psychophysiological insomnia: learned or conditioned insomnia; anxiety around getting ready for sleep. can untrain w CBTI.
Idiopathic insomnia:lifelong inability to adequately sleep.

Question 8

Describe Dement’s main points on the use of sleeping pills (controversial points & rebuttal) (and history & present use of sleeping pills) (157-164/7).

Answer 8

Recent resistance for sleeping pills has to do with the history of sleep medication. Early sleep medication was not great, causing a depression of the nervous system and possibly death in the case of overdoes. However, drugs like Ambien are not addictive and are relatively safe to prescribe, but most people don’t ask due to misperception, thinking sleeping pills are the only solution. only 10% of people with insomnia use sleeping pills.

Question 9

Pickwickian Syndrome

Answer 9

combination of apnea and hypoventilation.

Question 10

Discuss cultural, economic, health, and technological influences on fatigue.

Answer 10

Technological- wired for sleep wake cycle of sun and night but technology delays this by indoor lighting and electronics. can disrupt SCN.

Cultural: sleeping alone vs sleeping together can affect our sleep efficiency. Other cultural factors in how we are expected to sleep, at what times, what is appropriate, can all impact how we see sleep and how much we get.

Ecomonic: job can impact sleep (Work Shift Disorder). If you travel for work, can impact.

Health: various health conditions can affect sleep, including but not limited to: diabetes, hormones, weight gain, age, arthritis, illness, disease, autoimmune disorders,etc.

Question 11

Describe NASA’s (Rosekind’s) studies & results on fatigue and countermeasures for fatigue.

Answer 11

Studied effects of sleep deprivation on pilots and ways to prevent.l reaction time decreased 25% at night. frequently fell asleep for 5-10 seconds. 15% of episodes lasted longer than 15 seconds.

Question 12

Describe the medical personnel’s plight regarding sleep deprivation. Describe NY’s regulations for doctor’s work hours.

Answer 12

Shift cannot last more than 16 hours in a 24 hour period. Done after several malpractice lawsuits due to sleep deprivation.

Question 13

Describe the results of an anonymous survey of the house staff at San Francisco hospital (224).

Answer 13

42% admitted to killing a patient by making a fatigue related error.

Question 14

What percentage of traffic accidents are due to sleepiness?

Answer 14

33%

Question 15

What is the most frequent direct cause of truck accidents in which the driver is killed?

Answer 15

fatigue

Question 16

What % of truck drivers had sleep apena in Dement’s study?

Answer 16

70%

Question 17

What’s the “Saturday syndrome”?

Answer 17

After effects of drinking and staying out late every Saturday.

Question 18

Describe studies comparing alcohol impairment and sleep deprivation impairment.

Answer 18

Note: I think I forgot to mention this in lecture but when a person has been awake 17-19 hours, studies show that their performance is equivalent to some who is drunk at the .05 blood alcohol level; after 24 hours of wakefulness people perform as if drunk at the .10 level. I hope it is second nature to you to never drive drunk – but – does this make you think twice about drowsy driving?..

Question 19

What is “automatic behavior”?

Answer 19

repetitive behaviors shown by people with narcolepsy.

Question 20

Is there such a thing as “home field advantage”. Describe how Roger Smith explains the advantage.

Answer 20

West coast cities have an advantage over east coast cities when playing at night because it’s easier to delay sleep than going to bed before you’re tired.

Question 21

Summarize Dement’s discussion of medical school training regarding sleep.

Answer 21

they don’t get enough and the amount of physicians that are properly trained are not enough to deal with the percentage of population that suffers from sleep disorders.

Question 22

What specific advice does he give regarding talking to your doctor about sleep problems?

Answer 22

It won’t be easy, but you need a doctor that takes your sleep issues seriously.

1) make an appointment specifically for sleep.
2) don’t be afraid to bring in material supporting your argument.
3) remember that doctors are people.
4) Be persistant.
5) lay the groundwork now for future problem-solving.
6) know when and how to find a specialist.

Question 23

What are four reasons doctors lack the inclination or time to deal with sleep problems?

Answer 23

lack of training, lack of knowledge of the important side effects of sleep deprivation, lack of experts in the field, lack of time to spend with individual patients, etc.