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PSYC 208 > Lecture 7 > Flashcards

Lecture 7 Flashcards

1
Q

How are sleep disorders assessed?

A
  • primary care physician, send to sleep clinic
    and/or
  • sleep lab, polysomnography w/ multiple physiological measurements
  • patient histories, diagnostic info
  • signs (observable) & symptoms (reported)
  • sleep amount, quality, timing & daytime
  • technicians, researchers, clinicians, psychologists & physician specialists
  • meet regularly, review & discuss patients: share knowledge & for treatment
  • case studies/“grand rounds”: multiple doctors visiting patient
  • International Classification of Sleep Disorders
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2
Q

What are the symptoms of sleep disorders? (UEDUSMM)

A

how persistent/frequent:

  • unrefreshed sleep
  • excessive daytime fatigue/sleepiness
  • difficulty staying/falling asleep
  • unusual/violent behaviour during sleep
  • snoring, breathing irregularities
  • motor restlessness in the evening/previous to sleep
  • mood changes/issues
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3
Q

What is insomnia?

A

cannot obtain enough time asleep, quality sleep despite adequate opportunity to do so

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4
Q

What is sleep onset insomnia?

A

difficulty initiating sleep

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5
Q

What is sleep maintenance insomnia?

A

difficulty maintaining sleep thruout the night

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6
Q

What is early awakening insomnia?

A

rapid sleep onset, good sleep continuity, but awakening much earlier than desired, inadequate total amount

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7
Q

What is sleep dissatisfaction?

A

not feeling refreshed after a night of seemingly sufficient sleep

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8
Q

What is idiopathic insomnia?

A

no found cause (15% of cases, childhood onset, life-long condition w/o treatment)

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9
Q

What is psychophysiological insomnia?

A

chronically hyper-aroused; greater arousal at night + day restless, overactive, nervous, apprehensive; intense and persistent physiological arousal

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10
Q

What is paradoxical insomnia?

A

“sleep state misperception”

  • no daytime impairment
  • normal sleep length & profile, but report no sleep
  • highly attentive, “thinking all night”
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11
Q

What are the causes of insomnia? (GCCD)

A
  • genetic component (7 genes contribute)
  • cause for initial sleep disruption should be found, but not as relevant as perpetuating circumstance
  • Co-morbid insomnia
  • decongestants, caffeine
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12
Q

What are the causes of insomnia? (ATTPU)

A
  • alcohol:
    • increase sleep time, less N3 & REM
    • alcoholism: permanent irreversible reduction of N3 & REM
  • time zone, schedule changes
  • temperature regulation
  • pregnancy, menopause
  • unique sleeping environments
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13
Q

What are the causes of insomnia? (MMGTW)

A
  • mild to severe psychological issues
  • marital, job stress
  • grief
  • trauma
  • war, PTSD
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14
Q

What is co-morbid insomnia?

A

insomnia caused by other disorders, medication, illicit drug use, pain/discomfort, environmental factors

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15
Q

What are the sleep specific cognitive issues for the causes of insomnia?

A
  • exaggerated concerns about “not enough sleep”
  • self-blame/guilt of lack of sleep
  • dread sleep time, pressure to sleep leading to hyper-vigilance about sleep
  • if try to self-treat, cannot sleep b/c monitoring sleep treatment to evaluate its effectiveness
  • mental listing/persistent problem solving
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16
Q

What is the impact of insomnia? (PIFBUP)

A
  • physical & psychological issues of sleep deprivation
  • impact on work performance, communication, relationships
  • family/sleep partner: sleep separate, need quiet, sleep envy/resentment
  • bargaining with partner/children
  • unpredictable in planning, choices of activities, lifestyle
  • purchasing/relying on “aids”
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17
Q

What are the physical and psychological issues of sleep deprivation? (CIJDIC)

A
  • concentration
  • irritability
  • jitters
  • diminished well being
  • inappropriate sleeping locations/episodes
  • clumsiness to severe accidents
18
Q

What are facts about insomnia? (36V1)

A
  • 30-50% of Western pop. report occasional/temporary insomnia
  • 6-10% report serious problem, persistent
  • v. rare in children 8-10 but 25-35% of retirees/post middle-aged
  • 1.5x more prevalent in women than men
19
Q

What are facts about insomnia? (MSSB)

A
  • more prevalent in those w/ depression, anxiety, substance abuse, disordered breathing & recurrent health issues
  • sleep onset insomnia: more common in younger adults
  • sleep maintenance insomnia: more common in older adults
  • BUT types can change w/ physical + psychological circumstances & aging
20
Q

What are treatments for insomnia? (S)

A

sleeping pills:

  • over-the-counter (OTC), non-prescription: ineffective/questionable effectiveness
    • antihistamine, acetaminophen
    • magnets, herbal treatments
21
Q

What are treatments for insomnia? (P)

A

prescription: effective temporarily
- hypnotics, benzodiazepines: work on GABA receptors to promote sleep, relax muscles & reduce anxiety
- “psychological dependency”
- amnesia, risk of falls, serious accidents
- people tend to overdose on non-prescription, thinking they are “safer” or combine w/ other substances which can be disastrous or lethal

22
Q

What is CBT for insomnia (CBT-i)? (CEFES)

A
  • change thoughts, emotions, beh., “relearn to sleep”
  • effective, long-lasting
  • few sessions to several weeks, practitioner, resources provided
  • examine: what contributing to issues, tracking/log
  • several components sequentially, individually introduced, monitor motivation/compliance & progress; enough in place, good sleep will result
23
Q

What are the components introduced in CBT-i?

A
  • sleep restricted to bedroom
  • progressive muscle relaxation, bath/shower, reading
  • scheduled worry, thinking and resting time
  • write lists of tasks and worry targets
  • change expectations about sleep
24
Q

What is sleep compression, restriction?

A
  • no daytime napping
  • change sleep onset time: 5 hours at a certain time, increase in 10-15 min intervals
  • start sleep prep later, even if fatigued
  • sleep drive will increase, less time awake
25
Q

What is narcolepsy?

A
  • appears in teens, early 20’s can appear in adulthood, both genders
  • complain of excessive, perpetual sleepiness
  • intractable sleep attack, w/o warning, even in stimulating situations
  • can have narcolepsy w/o cataplexy
  • hallucinations paired with sleep paralysis: reported in half of sufferers
  • blackouts
26
Q

What are hallucinations paired with sleep paralysis like?

A
  • vivid, dream-like occurrence
  • visual, auditory, tactile or involve movement
  • hypnagogic: entry to sleep
  • hypnopompic: from sleep
27
Q

What are blackouts?

A

typical wakefulness behaviour w/ no memory of events, behaviours

28
Q

What is cataplexy?

A

weakness in limbs, face, speech muscles; mild to complete wilting collapse

  • triggered by emotions/stress response
  • blurred vision, irregular respiration, slurred speech
  • if minutes, consciousness remains, but over 2min, REM sleep triggered
  • less than 1x/week to several per day
29
Q

What are the causes for narcolepsy? (GCAAI)

A
  • genetic predisposition
  • catalyst: brain damage, infection/other medical conditions
  • autoimmune disorder: body attacking own tissue in lateral hypothalamus
  • abnormally low/absent hypocretin in cerebral spinal fluid
  • increased activity of acetylcholine & decreased activation of locus coeruleus
30
Q

What are the impacts of narcolepsy? (WSPAF)

A
  • work: fall asleep on the job (fired)
  • social: dating, outings, events
  • personal: safety driving
  • appear dull, emotionally flat, unmotivated, withdrawn, aggressive, lazy or bored
  • feel guarded, anxious, frustrated: depression can result
31
Q

What are treatments for narcolepsy?

A
  • no cure
  • behavioural + pharmacological treatments necessary
  • naps: can be refreshing, although inconvenient
  • good sleep hygiene
  • medication:
    • stimulant for daytime activities, side effects
    • noradrenergic reuptake blocking, SSRI or gamma-hydroxybutyrate for cataplexy
  • psychological support (learn to anticipate attacks, support groups)
  • family, peer education & therapy
32
Q

What are new possibilities of treatment for narcolepsy?

A
  • stem cell transplant to regenerate hypocretin producing cells
  • gene replacement therapy: use virus to insert hypocretin procurer genes in cells to encourage hypocretin production
33
Q

What is restless leg syndrome (RLS)? (UUWRPMD)

A
  • unpleasant sensation at legs, tingling to painful
  • urge to move legs
  • when stationary, seated or lying, or at rest esp. at night
  • relieved w/ continuous movement
  • physical exam, lab tests = no issues
  • misdiagnosed as cramps, vericose veins, “nerve problems”
  • daytime: report fatigue, sleepiness
34
Q

What are facts about RLS?

A
  • 5-15% of pop. report it; 2x often in females
  • onset at any age, can be misdiagnosed as growing pains/hyperactivity disorder
  • highest incident in middle-age to elderly
  • family history, genetic component
  • 1/3 of cases due to iron deficiency
  • 15-40% of people on dialysis complain of RLS
  • 20% of pregnant women (temporary)
35
Q

What are the causes of RLS? (CDDIBI)

A
  • caffeine, warm rooms & exposure to cold intensifies symptoms
  • disappears w/ fever
  • depletion of dopamine & blood loss worsens symptoms
  • iron: deficiency, transferrin malfunction
  • iron therapy may improve symptoms
36
Q

What are treatments for RLS? (IAIASM)

A
  • improved sleep hygiene
  • awareness of & control for worsening circumstances + substances
  • iron supplementation
  • aware of blood loss
  • stretching, relaxation massage
  • medication:
    • dopamine agonists; issues with impulse control behaviours, increased dosing causes worsening symptoms
    • oxicodon hydrocodone, issues with dependency
37
Q

What is periodic limb movement (PLM’s)?

A
  • jerking of arms/legs during sleep
  • short duration (0.5-10 secs) at regular intervals
  • clusters (every 5 secs-90 secs) lasting several minutes to hours
  • more likely during first half of night
  • no awareness of movements, aware of multiple awakenings
  • accompany OSA, narcolepsy, REM beh. disorder
  • treatment similar to RLS
38
Q

What is bruxism?

A
  • teeth clenching, grinding, crunching, scraping
  • damage to teeth, jaw, muscle injury
  • due to stress, pre-existing mandibular/maxillary condition
  • during N2 sleep & REM; accompanied by partial arousal but no awareness
  • higher HR/other body movements accompany
39
Q

What is the goal of CBT-i?

A
  • alleviate perceived, actual nighttime sleep issues
  • eliminate self-blame & analysis
  • relief from consequences of poor/lack of sleep
40
Q

What is treatment for bruxism?

A
  • dental exam & correction of anatomic abnormalities
  • soft/hard guard over teeth
  • check for sleep apnea
41
Q

What is periodic limb movement disorder (PLMD)?

A

periodic limb movement + insomnia/excessive daytime sleepiness

PSYC 208 (7 decks)

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