Lecture 7: Sleep and Sexual Disorders Flashcards
Sleep Cycles (4)
- Proceed through stages of brain activity measured by EEG
- REM
- NREM
- average sleep cycle is approximately 90 minutes
REM overview (2)
- brain activity increased
2. physical paralysis
NREM overview (1)
“Non-REM”
- “deeper” stages of sleep characterized by
- increasing amounts of delta wave activity
Average time of sleep cycle
90 mintes
Sleep and Sexuality in psychosocial medicine
not indicators of disorder, but are very frequently symptoms that patients deal with
Hypnogram
Shows one sleep cycle, graph
REM Sleep (3)
- Rapid Eye Movement
- Lighter stage of sleep with dreams, partial or complete physical paralysis
- contributes less to feeling of restful sleep
Non- REM Sleep (3)
- Characterized by increasing delta wave frequency
- Assoc. with increased feeling of restfulness
- Divided into 3 increasingly “deep” stages
How Other Creatures Sleep (4)
- length of sleep cycles vary among species
- roughly correlated with metabolic rate - faster metabolism=shorter sleep cycles
- Most animals have REM and NREM cycles
- Some only sleep one hemisphere at a time- while the other hemisphere remains alert
Sleep Disorders (4)
- insomnia/hypersomnia
- narcolepsy
- breathing-related sleep disorders
- parasomnias
Insomnia (4)
- dissatisfaction with quantity or quality of sleep
- may be initial, middle, or late in sleep cycle
- Non-restorative sleep- complaint that the person does not feel rested upon awakening
- May be assoc. with physical or other psychiatric disorders
Insomnia Disorder
symptoms? (3)
How long?
- Dissatisfaction with quantity or quality of sleep that may beA. Difficulty initiating sleep
B. Frequent awakening or problems returning to sleep
C. Early awakening with problem returning to sleep - At least 3 nights a week for three months
- causes clinically significant distress or impairment
- Not fully explained by a coexisting mental disorder
Differentials to consider with sleep (3)
- Normal variations:
- age-related changes, situation variables - Circadian disturbances-late shift work, day-night reversals
- Medications, drugs or beverages
Hypersomnolence Disorder (4)
- Excessive sleepiness despite adequate sleep (7 hours)
- Recurrent sleep periods during the day or slow awakening
- Three times per week for three months
- Not related to another sleep disorder to substance use
Narcoplepsy
3 indicators
- Sudden and recurrent episodes of an irrepressible need to sleep during the day accompanied by 2 of the following:
A. Cataplexy- sudden loss of muscles tone with full consciousness, frequently precipitated by laughter
B. Hypocretin deficiency in CSF
C. Brief latency on EEG
Cataplexy
- indicator for narcolepsy
Def. sudden loss of muscle tone with full consciousness, frequently precipitated with laughter
Assoc. Features of Narcolepsy (5)
- Hazy-feel like automaton
- Vivid hypnogogic (falling asleep) or hypnopompic (awakening) hallucination
- Vivid dreams or nightmares
- Appears sleepy most of the time
- During episodes of cataplexy, reflexes abolished
***NOT due to lack of sleep, due to neurological disorder
Hypnogogic Hallucination
falling asleep
Hypnopompic Hallucination
Awakening
Obstructive Sleep Apnea (2)
- on polysomnography: at least 15 episodes of apneas or hypopnea accompanied by snoring, gasping, or breathing pauses
- excessive daytime sleepiness, fatigue, or unrefreshing sleep
Circadian Rhythm Disorders (4)
- Sleep disruptions due to misalignment between endogenous circadian rhythm and the person’s sleep-wake cycle
- frequently results from physical environment or social/ work schedules
- Leads to excessive sleepiness or insomnia
- Causes clinically significant impairment
Parasomnias (2)
- Abnormal behavioral, experiential, or physiological events associated with sleep
- Associated with both REM or NREM sleep
NREM Arousal Disorders (2)
- Assoc. with incomplete awakening, usually during the first 1/3 of sleep cycleA. Sleepwalking: rising from bed, walking around, staring gaze, minimally responsive, difficult to awakenB. Sleep terrors: abrupt awakening in terror, usually crying out, signs of intense fear, minimally responsive
- minimal recollection for dreams or events during episode
REM Sleep Disorder
- Repeated episodes or arousal during sleep with vocalizations or complex motor behaviors
- Usually occur in last part of sleep cycle, 90 minutes or so after sleep onset
- Upon awakening, person becomes completely alert and not confused or disoriented
- Polysomnography revelas REM sleep without atonia
- May occur in parkinson’s disease or other motor system diseases
Restless Leg Syndrome (2)
How often/how long?
- Urge to move the legs accompanied by uncomfortable and unpleasant sensations that:A. Begins or worsens during rest or activity
B. Primarily or completely relieved by movement
C. Worse in, or exclusive to, evening or night
- At least 3x a week for 3 months
Alcohol and sleep (3)
- induces somnolence quickly followed by wakefulness, vivid dreams, and restless sleep
- Reduced NREM sleep, and increased REM sleep
- Light, fragmented sleep may persist long after sobriety is established in chronic users
Sexual Disorders (3)
- Functional Disorders
- Gender Dysphoria
- Paraphilias
Functional Sexual Disorders (5)
- Delayed/premature ejaculation (male)
- Female Orgasmic Disorder
- Erectile Disorder
- Genito-Pelvic Pain/Penetration Disorder
- Hypoactive Sexual Desire Disorder
Gender Dysphoria (3)
4 sx
- Marked distress assoc. with incongruence between assigned gender and experienced or expressed gender
A. Strong desire to be rid of assigned gender
B. Strong desire for primary or secondary sex characteristics of experienced gender
C. Strong desire to be of experienced gender and treated as such
D. strong conviction that one has typical feelings and reactions of experienced gender
- Significant emotional distress and functional impairment
Paraphilic Disorders (8)
- Voyeuristic d/o
- Exhibitionist d/o
- Frotteuristic d/o
- Sexual masochism d/o
- Sexual sadism d/o
- Pedophilia
- Fetishistic d/o
- Transvestic
Voyeuristic Disorder
Paraphilic Sexual Disorder
arousal from observing an unsuspecting person naked or engaging ins sex
Exhibitionist Disorder
Paraphilic Sexual Disorder
arousal from exposing one’s genitals to an unsuspecting person
Frotteuristic Disorder
Paraphilic Sexual Disorder
arousal from touching or rubbing against a non-consenting person
Sexual Masochism Disorder
Paraphilic Sexual Disorder
arousal from being humiliated or being made to suffer
Sexual Sadism Disorder
Paraphilic Sexual Disorder
Arousal from inflicting physical or psychological suffering on another person
Pedophilia
Paraphilic sexual disorder
arousal from fantasies or actions involving prepubescent children
Fetishistic Disorder
Paraphilic Sexual Disorder
arousal from use or focus on nonliving objects or non-genital body parts
Transvestic Didorder
Paraphilic Sexual Disorder
arousal from cross-dressing
Fantasies and Arousal (3)
- Paraphilias involve both fantasies and actions
- involvement in these activities causes distress, interpersonal difficulties, and legal problems
- Sexual fantasies tend to increase in complexity over time, with arousal or climax more difficult to reach without elaboration of fantasies
Sexual Fantasy Issues
increase in complexity over time, makes arousal and climax more difficult to reach without elaboration of fantasies
