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current topics 2 > L2: sleep problems > Flashcards

L2: sleep problems Flashcards

1
Q

why focus on sleep? (what happens when fatigued)(18)

A

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

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2
Q

why do we sleep? (5)

A
  • 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)
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3
Q

what mechanisms help your memory during sleep? (3)

A
  1. hippocampus receives new memory files and during deep sleep transfers them to cortex for long term memory
  2. replay memories of the day fast during sleep, which strengthens the memory
  3. integration & association: sleep interconnects memories together
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4
Q

when is sleep the most important? (1)

A

right after learning smoething new (including right after a therapist treatment)

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5
Q

what 3 factors determine (not) sleeping

A
  • 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
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6
Q

what is the biological clock aka circadian rhythm? (6)

A
  • 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
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7
Q

what is core vs residual sleep (3)

A
  • 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!
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8
Q

what is healthy sleep? (5)

A
  • 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
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9
Q

what are some false ideas about sleep? (3)

A

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

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10
Q

what are different sleep disorders? (8)

A
  • 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)
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11
Q

what is hypersomnolence disorder? (4)

A
  • 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
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12
Q

what is the treatment for hypersomnolence disorder? (3)

A
  • lifestyle interventions
  • structuring naps
  • activation
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13
Q

what is sleep apnoea? (3)

A
  • snoring, holding breath
  • brief awakenings, often no awarness of waking up
  • mostly surface sleep
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14
Q

what are the consequences of sleep apnoea? (8)

A
  • daytime sleepiness
  • decreased alertness/attention
  • worse memory
  • decreased driving ability
  • irritability
  • fatigue
  • depression
  • increased risk of high blood pressure/cardiovasc disease
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15
Q

what is the treatment of sleep apnoea? (4)

A
  • sleep study in sleep clinic
  • inventory of physical problems & med use
  • CPAP
  • surgery
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16
Q

what are common sleep disorders in ppl w PTSD? (4)

A
  • nightmares (50-70%)
  • apnoea (33-76%)
  • restless legs (60%?)
  • insomnia (40-50%)
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17
Q

what is narcolepsy? (4)

A
  • daytime sleepiness
  • sleep paralysis
  • hallucinations
  • cataplexy (suddenly falling asleep)
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18
Q

what is the treatment for narcolepsy (3)

A
  • go sleep center
  • lifestyle changes (regularity, fixed naps during day, possibly losing weight)
  • medication (mainly symptom management)
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19
Q

what are type of circadian rhythm disorders? (6)

A
  • 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
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20
Q

what is treatment for circadian rhythm disorders? (4)

A
  • light therapy
  • melatonin
  • chronotherapy
  • shift work (other job, artifical light, melatnonin etc)
21
Q

what are characteristics of pavor nocturnus aka night terror (5)

A
  • more in children
  • no memory
  • no images
  • intense sense of panic / threat
  • wak up, slow orientation, no memory
22
Q

what is the treatment for night terror? (5)

A
  • 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
23
Q

what are characteristics of sleepwalking? (3)

A
  • more in children
  • nocturanl movements
  • usually no memory
24
Q

what is treatment of sleepwalking? (3)

A
  • waking up unnecessary unless danger
  • ensure safe environment
  • quietly lead to bed, reassur
25
Q

what is REM sleep behaviour disorder? (5)

A
  • 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
26
Q

what is the treatment for rem sleep behaviour disorder? (2)

A
  • referral sleep centres
  • medication that relaes muscles
27
Q

what is restless legs? (5)

A
  • 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
28
Q

what is treatment for restless legs? (2)

A
  • iron supplement
  • sleep facility
29
Q

what are characteristics of nightmare disorder? (5)

A
  • recurring nightmares
  • cause sig distress / impairment
  • w/o being attributable to substances/other disorder
    in general pop: 2-5%
    in psych pop: 30%
30
Q

when do nightmares usually occur? (1)

A

during REM sleep

31
Q

for who are nightmares more common? (3)

A
  • women
  • ppl w ptsd
  • ppl w anxiety disorders
32
Q

how is hyperarousal associated w nightmare disorder? (1, 1->2)

A

key factor in their dev.
ppl w nightmare disorder exhibit higher levels of arousal during sleep -> fragmented REM sleep & reinforcing negative fear memories

33
Q

what are 2 key mechanisms in nightmare disorder?

A
  • hyperaoursal
  • impaired fear extinction
34
Q

which 2 factors can worsen nightmare disorder?

A
  • traumatic experiences & childhood adversity
  • thought suppression
35
Q

what are differential diagnostics for nightmare disorder (1->3, 1->1)

A

if during deep sleep phase
- pavor nocturnus aka night terror
- sleep walking
- rem sleep waking disorder
if during rem/waking state
- sleep paralysis

36
Q

what is sleep paralysis? (2, 1)

A
  • hypnogogic (upon falling asleep- or hypnopompic (upon awakening) hallucinations
  • unable to move upon awakening from REM sleep
37
Q

what is impact of nightmares? (2)

A
  • negative impact on sleep, well being, and daily cognitive and emotional funcitoning
  • relation to psychopathology: anxiety disorders, PTSD, psychosis, personality pathology
38
Q

what are the 2 main treatment options for (PTSD) nightmares?

A
  • imagery rehearsal therapy IRT
  • prazosin (blocks stress response)
39
Q

what are the 5 main treatment approaches for nightmare disorder?

A
  • 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
40
Q

how do you do imagery rehearsal / rescripting therapy? (6)

A
  • 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
41
Q

what are some tips for imagery rehearsal/rescripting therapy for nightmares? (8)

A
  • 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
42
Q

what are the 2 main stages of sleep?

A
  • Non rapid eye movement sleep (subtypes 1-4, where N3 and 4 are slow wave sleep)
  • REM
43
Q

what is REM associated w? (3)

A
  • dreaming
  • brain activation
  • muscle atonia
44
Q

what is a sleep cycle? (3)

A
  • 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
45
Q

what are some age related changes in sleep? (5)

A
  • 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
46
Q

what factosr can affect sleep? (4)

A
  • circadian rhythm
  • previous sleep history
  • ambient temperature
  • use of meds/drugs (alcohol)
47
Q

what are the physiological & behavioural aspects of sleep? (4)

A
  • 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
48
Q

what EEG pattern is associated w memomry consolidation (perceptual & motor learning) (1)

A

sleep spindles

current topics 2 (6 decks)

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