L2: sleep problems Flashcards
why focus on sleep? (what happens when fatigued)(18)
brain needs sleep, otherwise
- decreased alertness & cog impairment
- impaired moral judgment
- severe jawning
- hallucinations
- adhd symptoms
- slower reaction times
- emotional suffering (mood, irritability, volatile emotions)
- declined memory
- sense of humour dissapears
other effects
- imparied immune system
- risk of diabetes type 2
- increased heart rate variability
- risk of heart disease
- tremors
- aches
- growth suppression
- risk of obesity
- decreased temperature
why do we sleep? (5)
- energy conservation
- immune function
- hormonal restoration
- cleansing of the brain
- memory (need sleep before learning to prepare for new info, need sleep after learning to consolidate those new learning memories)
what mechanisms help your memory during sleep? (3)
- hippocampus receives new memory files and during deep sleep transfers them to cortex for long term memory
- replay memories of the day fast during sleep, which strengthens the memory
- integration & association: sleep interconnects memories together
when is sleep the most important? (1)
right after learning smoething new (including right after a therapist treatment)
what 3 factors determine (not) sleeping
- sleep pressure & debt (homeostasis): the longer you’re awake, the higher the sleep pressure
- biological clock (circadian rhythm)
- stimulation arousal system: stress, pain, meds, psychiatric condition
what is the biological clock aka circadian rhythm? (6)
- 24h rhtyhm
- controlled from within
- light/sun synchronizes this biological clock
- w/o light its 24.2h (slightly longer in evening ppl)
- melatonin models biological clock (nighttime high, daytime low)
- also influenced by work, hobbies, timing of meals
what is core vs residual sleep (3)
- core sleep: first 3 sleep cycles (around 5h), almost all deep sleep, main part of dream sleep
- residual sleep: later hours of the night, not as important, contain a lot of dream sleep (more dream sleep)
-> quality over quantity!
what is healthy sleep? (5)
- sleep duration: large variation (65% 7-8h, 8% less than 5h, 2% more than 10h)
- more evening ppl than morning ppl so being evening person is fine
- falling asleep takes less than 30min (longer in elderly ppl, longer in women, menopause major influence on sleep)
- waking up briefly 2-3times is normal
- no complaints about daytime functioning
what are some false ideas about sleep? (3)
all untrue
- adults need 8h of sleep to function properly: varies a lot per person
- hours before midnight count double (just early sleep hours count more)
- someone who dreams a lot is a deep sleeper
what are different sleep disorders? (8)
- insomnia disorder
- hypersomnolence disorder
- narcolepsy
- breathing related sleep disorders (apnea)
- circadian rhythm sleep wake disorders
- parasomnias
- nightmares
- non REM sleep arousal disorders (sleepwalking/sleep terror, rapid eye movement sleep behaviour disorder)
what is hypersomnolence disorder? (4)
- not very prevalent in general pop (less than 1%), but more prevealent in sleep centers (7%)
- sleeping at least 7h and not being rested w/o being explained by other disorders
min 1 criteria: recurrent periods of sleeping during day; extended sleep period of more than 9h that is not invigorating; having difficulty waking up fully after suddenly wakig up - complaints are 2x week, min 3m
what is the treatment for hypersomnolence disorder? (3)
- lifestyle interventions
- structuring naps
- activation
what is sleep apnoea? (3)
- snoring, holding breath
- brief awakenings, often no awarness of waking up
- mostly surface sleep
what are the consequences of sleep apnoea? (8)
- daytime sleepiness
- decreased alertness/attention
- worse memory
- decreased driving ability
- irritability
- fatigue
- depression
- increased risk of high blood pressure/cardiovasc disease
what is the treatment of sleep apnoea? (4)
- sleep study in sleep clinic
- inventory of physical problems & med use
- CPAP
- surgery
what are common sleep disorders in ppl w PTSD? (4)
- nightmares (50-70%)
- apnoea (33-76%)
- restless legs (60%?)
- insomnia (40-50%)
what is narcolepsy? (4)
- daytime sleepiness
- sleep paralysis
- hallucinations
- cataplexy (suddenly falling asleep)
what is the treatment for narcolepsy (3)
- go sleep center
- lifestyle changes (regularity, fixed naps during day, possibly losing weight)
- medication (mainly symptom management)
what are type of circadian rhythm disorders? (6)
- delayed sleep phase (80% ppl w adhd), 3-6h later than expected of society
- advanced phase (3h earlier)
- free running (no 24h rhythm, very rare)
- irregular (3 or more sleep periods per 24h)
- shift work disorder
- jet lag
what is treatment for circadian rhythm disorders? (4)
- light therapy
- melatonin
- chronotherapy
- shift work (other job, artifical light, melatnonin etc)
what are characteristics of pavor nocturnus aka night terror (5)
- more in children
- no memory
- no images
- intense sense of panic / threat
- wak up, slow orientation, no memory
what is the treatment for night terror? (5)
- little known about treatment
- sometimes helps to wake up children an hour before it usually happens
- dont wake up during, reassure them & lead back to bed
- relaation during the day
- possibly examination in sleep clinic
what are characteristics of sleepwalking? (3)
- more in children
- nocturanl movements
- usually no memory
what is treatment of sleepwalking? (3)
- waking up unnecessary unless danger
- ensure safe environment
- quietly lead to bed, reassur
what is REM sleep behaviour disorder? (5)
- not very common
- recurrent episodes of arousal during sleep accompanied by vocalization and/or motor behaviour
- during rem sleep
- fully alert upon awakening
- can be early manifestation neurodegenerative disorder
what is the treatment for rem sleep behaviour disorder? (2)
- referral sleep centres
- medication that relaes muscles
what is restless legs? (5)
- irristible urge to move legs
- urge becomes more intense during inactivity
- moving eases the urge
- evening or night worse than daytime
- makes it hard to get to sleep
what is treatment for restless legs? (2)
- iron supplement
- sleep facility
what are characteristics of nightmare disorder? (5)
- recurring nightmares
- cause sig distress / impairment
- w/o being attributable to substances/other disorder
in general pop: 2-5%
in psych pop: 30%
when do nightmares usually occur? (1)
during REM sleep
for who are nightmares more common? (3)
- women
- ppl w ptsd
- ppl w anxiety disorders
how is hyperarousal associated w nightmare disorder? (1, 1->2)
key factor in their dev.
ppl w nightmare disorder exhibit higher levels of arousal during sleep -> fragmented REM sleep & reinforcing negative fear memories
what are 2 key mechanisms in nightmare disorder?
- hyperaoursal
- impaired fear extinction
which 2 factors can worsen nightmare disorder?
- traumatic experiences & childhood adversity
- thought suppression
what are differential diagnostics for nightmare disorder (1->3, 1->1)
if during deep sleep phase
- pavor nocturnus aka night terror
- sleep walking
- rem sleep waking disorder
if during rem/waking state
- sleep paralysis
what is sleep paralysis? (2, 1)
- hypnogogic (upon falling asleep- or hypnopompic (upon awakening) hallucinations
- unable to move upon awakening from REM sleep
what is impact of nightmares? (2)
- negative impact on sleep, well being, and daily cognitive and emotional funcitoning
- relation to psychopathology: anxiety disorders, PTSD, psychosis, personality pathology
what are the 2 main treatment options for (PTSD) nightmares?
- imagery rehearsal therapy IRT
- prazosin (blocks stress response)
what are the 5 main treatment approaches for nightmare disorder?
- psychodynamic therapy (focus on meaning of nightmares & underlying conflicts they may represent)
- desensitization & exposure therapy: heps patients face their nightmares directly to reduce fear responses
- imagery rehearsal therapy (IRT)
- lucid dreaming therapy
how do you do imagery rehearsal / rescripting therapy? (6)
- modify storyline of the nightmare with a alternative better ending
- imagine this new nightmare during the day (in treatment & at home)
- psych education on sleep & nightmares
- start nightmare diary
- recognize different nightmares
- relaxation exercises/practice w safe place imagination
what are some tips for imagery rehearsal/rescripting therapy for nightmares? (8)
- keep going until completely right to you
- 2 phases: safety and comfort
- dont adjust dream too soon
- activating emotion is key
- no exposure exercise but exposure to pleasant images
- same techniques as for exposure to allow person to experience as much as posible (sight, hearing, feeligns etc
- adjust if necessary
- dont discuss, imagine right away
what are the 2 main stages of sleep?
- Non rapid eye movement sleep (subtypes 1-4, where N3 and 4 are slow wave sleep)
- REM
what is REM associated w? (3)
- dreaming
- brain activation
- muscle atonia
what is a sleep cycle? (3)
- last about 90min
- consist of period of NREM followed by REM
- first cycle of the night contains more NREM (mostly slow wave aka deep sleep, so stages 3-4), while REM sleep episodes lenghten in duration as night progresses
what are some age related changes in sleep? (5)
- infants enter sleep through REM rather than NREM
- newborns sleep cycl is only 50min
- as we age, sleep pattern begins to resemeble adult sleep w longer sleep cycles
- slow wave aka deep seleep decreases w age especially during adolescence & continuing into old age, especially in men
- REM sleep remains relativelyl consistent (25% of total sleep), except in dementia or other brain disorders
what factosr can affect sleep? (4)
- circadian rhythm
- previous sleep history
- ambient temperature
- use of meds/drugs (alcohol)
what are the physiological & behavioural aspects of sleep? (4)
- perceptual disengaments & unresponsiveness
- postural quiescence
- changes in brain activity (EEG), muscle tone (EMG), and eye movements (EOG)
- sleep onset marked by gradual dissapearance of slow eye movements
what EEG pattern is associated w memomry consolidation (perceptual & motor learning) (1)
sleep spindles
