Other Sleep Disorders Flashcards
Circadium Rhythm Disorders
Delayed sleep-wake phase disorder
Advanced sleep-wake phase disorder
Irregular sleep-wake rhythm disorder
Non 24-hr sleep-wake rhythm disorder
Shift work disorder
Jet lag disorder
Delayed sleep-wake phase disorder
- Delay in the major sleep episode
- > 3 months
- More common in young adults
- Melatonin rises later than regular (sleep ~12-2am, wake ~11-1pm)
- Poor functioning in morning
- Often end up deprived of sleep
- Sleep onset insomnia if they try to sleep earlier
Siverstan et al. (2015)
- depression, anxiety, OCD, ADHD risk
- less social support, family cohesion
- less attentive parents enhancing bio problem
- Reduced academic performance
Advanced sleep-wake phase disorder
Advance in the major sleep episode
> 3 months
More common in older individuals
Irregular sleep-wake rhythm disorder
- Irregular sleep-wake episodes across 24hr period
- Insomnia and daytime sleepiness
- > 3 months
- No major sleep period on 7-14 days of diary
- Often present in dementia, children with developmental disorders
- Usual bout of sleep ~4hrs
- Lack of regular zeitgebers
Non 24-hr sleep-wake rhythm disorder
AKA free-running
- Alternating symptomatic (insomnia/daytime sleepiness) and non-symptomatic episodes
- > 3 months
- > 14 days diary/actigraphy demonstrates delays each day and circadian period longer than 24hrs
In blind people: non-functioning retina-retinohypothalamic tract (RHT) & supreachiasmatic nuclei (SCN) pathway - no light zeitbeger
In sighted people: working pathways but they aren’t exposed to correct light/dark cycle –> becomes out of sync
- behaviourally induced
- more free-running than the blind bc blind still have non-light zeitgebers
Shift work disorder
- Insomnia/daytime sleepiness that overlaps with period of shift work
- > 3 months
- > 14 days actigraphy/diary demonstrates disturbed sleep-wake pattern
- Drake et al. (2004) - Night shift workers get less total sleep than day shift workers and rotating shift workers
- Drake et al. (2004) - Rotating shift workers with insomnia & excessive sleepiness miss more shifts, more family/social events than night workers or day workers
- Yoon et al. (2015) - Increased risk of suicide
Jet lag disorder
Associated with travel across at least 2 time zones
Insomnia/daytime sleepiness + shortened total sleep time
Associated daytime dysfunction
Treatments for circadian rhythm disorders
Chronotherapy
- gradual delay/advancement of schedule
Melatonin
- Malatonin pulls the sleep schedule
- endogenous melatonin
- exogenous melatonin –> lowered alertess & core body temo 3-4hrs later
- Taken 5-13hrs before core body temp at minimum –> phase advance
- Taken 1-2hrs after –> phase delay
Light treatment
- Light pushes the sleep schedule
- delays sleep when administered before body temp minimum
- advances when administered after body temp minimum
Melatonin and light phase-response curves are opposites of each other (Burgess et al., 2002)
CBT for delayed sleep phase disorder
Session 1
- sleep education, sleep hygiene & bright light
- light: sun or ~1000lux lamp at natural wake up time for 30+mins. 30 mins earlier each day until reaching 6am
- go to bed when sleepy, no napping
Session 2 and 3
- cognitive therapy – identifying and monitoring automatic thoughts associated with not sleeping
Session 4 and 5
- Developing alternative thoughts
Session 6
- recap and goal setting
School-based intervention for DSPD
Teenagers recommended 8-10hrs sleep each night but most don’t get it
Students using portable green light LED glasses experienced improved sleep onset latency
(Bonnar et al., 2014)
Management of shift work disorder
Smith & Eastman, 2012
- Bright light upon waking in darkness and intermittently during shift, sunglasses when on the way home in daylight
Behavioural therapy (Valleres et al., 2015)
- Night sleep
- Sleep restriction therapy
- When sleep efficiency for night sleep = 85%….
- Day sleep
- Sleep restriction therapy
- When sleep efficiency for day sleep = 85%….
- Napping
- Scheduled naps using SRT
- Adapt length & timing of naps to fit lifestyle without interfering with homeostasis process
Narcolepsy ICSD-3
- Irrepressible need to sleep or lapses into sleep > 3 months AND
- Cataplexy (sudden muscle weakness)
- & mean SOL (time taken to fall asleep) < 8 minutes
- & 2+ sleep onset REMs on a multiple sleep latency test (MSLT)
- & mean SOL (time taken to fall asleep) < 8 minutes
- OR Depleated hypocretin levels
- Cataplexy (sudden muscle weakness)
- Narcolepsy type 2 – cataplexy doesn’t have to be present, hypocretin levels normal or not measured
Ideopathic hypersomnia ICSD-3
- Irrepressible eed to sleep or lapses into sleep >3 months
- No cataplexy
- <2 sleep onset REMs
- Multiple sleep latency test
- Mean SoL (time it takes to fall asleep) of < 8 mins
- OR
- Total sleep time > 660 minutes
Behavioural management of hypersomnia disorders
Conroy et al., 2012
- scheduled naps
- exercise
- sleep hygiene
- dietary manipulations e.g. caffeine
- environmental manipultions e.g. temperature
Neikrug et al., 2017
- Greater perceived effectiveness of pharmacological and non-pharmacological intervensions for narcolepsy than for idiopathic hypersomnia
- People with hypersomnia disorders more interested in CBT, mindfulness and support group interventoins than not
Mental health symptoms associated with hypersomnia disorders
Neikrug et al., 2017
- sad mood
- lost interest
- irritability
- social isolation
- concentration
- guilt/worthlessness
- anxiety
- worry
