Kap 10 Sleep disorders

Question 1

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

Answer 1

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

Question 2

Definition of sleep

Answer 2

A state of decreased consciousness and wakefulness

With inhibition of sensory information and lowered muscle tone and activity

Question 3

What is the purpose of sleep?

Answer 3

• Restoring energy
• Regenerating tissues
• Consolidating memories

Question 4

How long does one sleep cycle usually last?

Answer 4

Around 90 minutes

Question 5

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

Answer 5

4-6 sleep cylces

Question 6

What are the 4 sleep stages?

Answer 6

REM
NREM1
NREM2
NREM3

Question 7

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

Answer 7

Yes and people will mostly not remember them

Question 8

How are the different sleep phases differentiated from another?

Answer 8

They are usually measured with an EEG

Question 9

For which sleep phase is the pressure the strongest?

Answer 9

Deep sleep

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

Question 10

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

Answer 10

First half: Deep sleep
Second half: REM sleep

Question 11

What is the Spielmann 3-factor Model of insomnia?

Answer 11

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

Question 12

What are common risk factors for developing insomnia?

Answer 12

• old age
• being female
• having other disorders

Question 13

What is the comorbidity of Insomnia (percentage)?

And which disorders are usually the main comorbid disorders?

Answer 13

40% comorbidity

Anxiety and Depression

Question 14

What does daylight saving say about sleep?

Answer 14

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!

Question 15

How can Insomnia be treated?

Answer 15

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!

Question 16

What is good sleep hygiene?

Answer 16

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

Question 17

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

Answer 17

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.

Question 18

What are measures to take under Stimulus control?

Answer 18

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

Question 19

What is a paradoxal intervention for sleep

Answer 19

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

Question 20

What are factors that influence the circadian rhythm?

Answer 20

Daylight
Regular meals
Physical activity
Social interaction

Question 21

Why do paradoxical interventions work?

Answer 21

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

Question 22

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

Answer 22

Use Melatonin/No sunlight shortly after the Nadir

Question 23

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

Answer 23

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

This will also have a stabilizing effect

Question 24

What is an optimal dose of exogenous melatonin?

Answer 24

Around 0,3mg

Question 25

What is sleep efficiency?

Answer 25

The ratio between time spendt in bed vs time actually slept

Question 26

What is sleep pressure?

Answer 26

Sleep pressure is the need to sleep that builds up by being awake for long. This is the buildup of adenosine and physical exhaustion ## Footnote It is the second system in the two process model of sleep.

Question 27

How does sleep restriction therapy work?

Answer 27

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.

Question 28

How is body temperature connected to sleep and sleep deprivation?

Answer 28

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

Question 29

What is the Nadir?

Answer 29

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

Question 30

What is the *Two-process model* of sleep?

Answer 30

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

Question 31

What are other conditions that are connected to sleep problems?

Answer 31

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

Question 32

Why does sleep deprivation lead to decreased mood?

Answer 32

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

Question 33

What are defining features of REM sleep?

Answer 33

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

Question 34

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

Answer 34

It is connected to Parkinsons and Dementia with Lewy bodies

Question 35

How does CBT-I work?

Answer 35

**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.

Question 36

What is the prevalence of sleeping disorders?

Answer 36

In the normal population around 5% Most have issues sometimes