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Psykiske lidelser > Kap 10 Sleep disorders > Flashcards

Kap 10 Sleep disorders Flashcards

1
Q

Why is it important to classify sleep disorders as its own category?

A

They can trigger some conditions

They can appear alone

They can significantly impair the life quality of a person

They need their own therapeutic treatments

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2
Q

Definition of sleep

A

A state of decreased consciousness and wakefulness

With inhibition of sensory information and lowered muscle tone and activity

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3
Q

What is the purpose of sleep?

A
  • Restoring energy
  • Regenerating tissues
  • Consolidating memories
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4
Q

How long does one sleep cycle usually last?

A

Around 90 minutes

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5
Q

How many sleep cycles does one usually have during the night?

A

4-6 sleep cylces

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6
Q

What are the 4 sleep stages?

A

REM
NREM1
NREM2
NREM3

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7
Q

Is it normal to have short times of being awake when sleeping?

A

Yes and people will mostly not remember them

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8
Q

How are the different sleep phases differentiated from another?

A

They are usually measured with an EEG

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9
Q

For which sleep phase is the pressure the strongest?

A

Deep sleep

Which is probably why it dominates the first half of the night

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10
Q

Which sleep phase is dominant in the first half of the night and which one in the second half of the night?

A

First half: Deep sleep
Second half: REM sleep

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11
Q

What is the Spielmann 3-factor Model of insomnia?

A
  1. Predisposing:
    Hyperactivity (high heart rate, metabolism, sympatic activity)
    High HPA-axis activity -> high Cortisol
    High EEG activity
    High in worries and uncontrolled thought activity (tankevirksomhet)
  2. Precipitating factors:
    Interpersonal conflicts
    Stress
    Loss
    Trauma
    Psychic disorders
    Bad Sleep hygiene
  3. Perpetuating factors:
    Conditioning (bed is associated with no Sleep/sleep anxiety -> less sleep response)
    Bad Sleep hygiene
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12
Q

What are common risk factors for developing insomnia?

A
  • old age
  • being female
  • having other disorders
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13
Q

What is the comorbidity of Insomnia (percentage)?

And which disorders are usually the main comorbid disorders?

A

40% comorbidity

Anxiety and Depression

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14
Q

What does daylight saving say about sleep?

A

In the spring, when the clocks are set one hour earlier, people sleep an hour less, which suddenly increases car accidents the day after (and opposite in fall) -> Sleep is vital!

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15
Q

How can Insomnia be treated?

A

CBT-I
Cognitive Behavioral Model Of Insomnia

Medication:
Benzodiazepines
Nonbenzodiazepines
Antihistamines

Valerian (a plant, but badly documented effects)

With comorbidities:
Antidpressiva: Mirtazapine, Amitriptyline, Doxepin, Mianserin
Antipsychotics: Chlorprothixene, Levomepromazine

Medication should be taking carefuly, beause they have a potential of being addictive and tolerance building!

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16
Q

What is good sleep hygiene?

A

Less substances: Alcohol, nicotine and caffeine

No sleeping longer during days off
No naps
Daily physical activity
3-4 hours of downtime before sleeping
-> no intellectual, emotional
physical intense activities (because that increases activity and body temperature)
Regular sleep and waking times
Reduced (blue) light during the evening
Don’t go hungry to bed
Don’t check the time during the night
dark, cold and quiet bedroom

17
Q

What is stimulus control and why does it work with Insomnia?

A

It tries to remove the cues that keep one awake when lying in bed.

It works, because one has classically conditioned onesself to not associated sleep with ones bed.

18
Q

What are measures to take under Stimulus control?

A

Don’t go to bed before sleepy
Only use bed for sex or sleep
If you cannot fall asleep (>15min) leave the bed until sleepy again
Get up at the same time, regardless how much you slept
Sleep deprivation therapy

19
Q

What is a paradoxal intervention for sleep

A

Let the client try to stay awake for as long as possible
(Probably without distractions)

20
Q

What are factors that influence the circadian rhythm?

A

Daylight
Regular meals
Physical activity
Social interaction

21
Q

Why do paradoxical interventions work?

A

Paradoxical interventions work, because they go against the sustaining factor of a feedback loop

22
Q

How to use Melatonin and sunlight to shift the Circadian rhythm later?

A

Use Melatonin/No sunlight shortly after the Nadir

23
Q

How to use Melatonin and sunlight to shift the circadian rhythm earlier?

A

Use Melatonin 3-4 hours before normal sleeping time and sunlight exposure directly after waking

This will also have a stabilizing effect

24
Q

What is an optimal dose of exogenous melatonin?

A

Around 0,3mg

25
Q

What is sleep efficiency?

A

The ratio between time spendt in bed vs time actually slept

26
Q

What is sleep pressure?

A

Sleep pressure is the need to sleep that builds up by being awake for long. This is the buildup of adenosine and physical exhaustion

It is the second system in the two process model of sleep.

27
Q

How does sleep restriction therapy work?

A

Take the average time actually slept, and reduce the time in bed to this time, by setting the bedtime to later, but getting up at the same time regardless.

This increases sleep pressure over several days.

When sleep efficiency is at 85% time in bed can be increased by 15-30 min. If it is under 80% the time in bed is further restricted.

28
Q

How is body temperature connected to sleep and sleep deprivation?

A

Body temperature drops during the night and reaches its low during the Nadir

Short term sleep deprivation increases body temperature

Long term sleep deprivation decreases body temperature

This is one reason, why exercise before sleep is not a good idea

29
Q

What is the Nadir?

A

It is the lowest point of body temperature during the night (around 2 hours before waking)

30
Q

What is the Two-process model of sleep?

A

It is the idea that in order to sleep the circadian rhythm and the sleep pressure have to be high at the same time.

31
Q

What are other conditions that are connected to sleep problems?

A

Nightmare disorder
Sleep terrors
Obstructive sleep apnea
Restless legs syndrome
REM sleep behaviour disorder
Narcolepsy

32
Q

Why does sleep deprivation lead to decreased mood?

A

Because the activity of the medial prefrontal cortex is decreased and the activity in the amygdala is increased.

33
Q

What are defining features of REM sleep?

A

The body is paralyzed, except breath and eyes

Body temperature regulation stops

On an EEG, it looks like the person is awake

One has vivid dreams

Inhibited serotonin and noradrenaline
activated acetylcholine

34
Q

What is REM sleep behaviour disorder and which other disorder is it connected to?

A

It is connected to Parkinsons and Dementia with Lewy bodies

35
Q

How does CBT-I work?

A

Distorted perception of deficit: People usually overestimate how much they lie awake and underestimate how much they sleep. These perceptions can be challenged with tests and worked on, by giving them less attention

Worries: Setting aside time earlier on the day to ruminate and can help to avoid rumination during the evening. The longer this is done the better the effect. Here Metacognitive therapy for Insomnia can help.

Beliefs: These are beliefs about what constitutes a good night rest and how to best achieve that. Things like: just lying in bed longer (without sleep) helps or that only 8 hours are enough to function.

Selective attention and monitoring: The person focuses their attention on indicators for good/bad sleep during the day and night, which reinforced negative beliefs and thoughts about sleep and the consequence that they will not sleep tonight. It can also lead to increased cognitive load which can take away cognitive capacity for activities during the day.
Behavioural experiments can be made to find out whether focusing on inner out outer sensations is better for the patient or whether checking the time is helpful or not.

Safety behaviors: Trying to use behaviors to help with sleeping, that might worsen it, like controlling thoughts, imagery, using substances (alcohol) or being easy on one self during the day (naps or cancelling things) which have negative effects on energy, thoughts and circadian rhythm. This can be measured using the Sleep-Related Behaviour Questionnaire

Prevention: Summarizing the gained knowledge, making a relapse plan, making a behavioural experiment, where the patient sleeps 2 hours less and uses that time for something nice they like doing and see how much worse it really is.

36
Q

What is the prevalence of sleeping disorders?

A

In the normal population around 5%
Most have issues sometimes

Psykiske lidelser (14 decks)

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