Sleep Flashcards
what percent of ppl will exp some kinds of sleep DO in their life?
40%
What is the most common sleep DO, but most underdx’ed?
sleep apnea
insomnia vs. hypersom; which do you have to be sure to ask about?
hypersomnia, most ppl won’t complain about it unless you ask
why are sleep do’s underdx’ed
rarely reported, most ppl just think they’re normal
What natural rhythm regulates sleep patterns?
light dark cycle
How dies light-dark cycle impact sleep?
via retnia to hypothalamus which triggers release of certain hormones
What hormone is released, why does this make sense?
cortisol, increases arousal
What else decreases as we ready for sleep and increases as we wake and throughout the day?
body temp
what environ factors impact light dark cycle?
location of bed(room)
seasonal change
northern lights (russia alaska)
travel across time zones
what can ppl take to help regulate sleep when traveling?
melatonin
how many hours of sleep to most ppl need?
8
If ppl say they need more, what might you suspect?
poor quality throughout the night
developmental consideration to amount of sleep needed?
teenagers tend to sleep more, this may be normative
what are the stages of sleep?
falling asleep
NREM
REM
How long do most ppl need to fall asleep?
10 mins
How can we differentiate between the sleep stages?
each characterized by its own: neural structure neurochemical properties neurophysio characteristics electrographic patterns
Do most ppl remember falling asleep?
no
once we fall asleep, what phases do we cycle between?
NREM REM
on average how many cycles per night? (between NREM and REM
4-5
How long after falling asleep does it typically take to get to first REM cycle?
about 90 mins, then we cycle quicker
How many stages does NREM have in of itself?
4
Dreams, NREM vs REM?
NREM - tend to be fragmented
REM - tend be longer, more involved, elaborate
NREM vs REM, which one varies with age, which remain constant?
NREM varies
REM stable
how does NREM vary with age?
with age spend less time in stage 3 and 4
how does REM change throughout the night?
REM cycles get longer and have more eye movements per cycle
assessment of sleep is comprised of (3 things)
physio assessment
self-report measures
semi-strctured interview
different kinds of physio assessments?
Electroencephalography (EEG)
Measures of blood pressure and body temperature
Actigraphy monitor measures rest/activity cycles
name three self-report measures you can use
Pittsburgh Sleep Quality Index (PSQI)
Iowa Sleep Disturbance Inventory (ISDI)
Sleep Hygiene Index (Mastin, Bryson & Corwyn, 2006)
semi-strcut interview for sleep all consist of (there’s a long list)
History of sleep problems (when began, frequency, any changes)
Sleep environment (comfort, noise, kids in bed, pets)
Pre-sleep behaviors (exercise, eating, smoking, caffeine, sleeping pills, TV, reading, relaxation)
Patterns of sleep (time go to bed, when wake up, frequency of waking up at night, worry at night, naps, what do when wake up, stay in bed when awake)
Consequences (feel restored/tired when wake up, sleepy during day, fall asleep when inappropriate, difficulty concentrating, impact on daily functioning, naps during day
Questions to RULE OUT RARE conditions (periodic limb movements, sleep walking/talking, snoring)
of the things you assess in the interview, what are things that are good starting points for intervention?
pre sleep bx’s
precipitants of night wakening (e.g. bad dreams)
Sleep apnea is the…
most common sleep do
how long does a person have to stop breathing to qualify for SA?
more than 10 secs
What else characrertizes sleep apnea?
very very loud snoring
GASPING (key)
risk factors for SA?
Obesity Facial/skeletal abnormalities Short thick neck Septal deviation causing an obstruction Enlarged tonsils Mucosal edema Large tongue/soft palate Small pharynx
what should you notice about these risk factors?
obesity is the only one amenable to psychological intervention
the rest require medical/surgical intervention - therefore, it’s professionally responsible to refer out for sleep study/sleep doc
3 types of SA?
Central
Obstructive
Complex
which is the most common type? least common?
obstructive most (85%) central least (.4%)
which is the most dangerous?
obstruct
Dx requires…
Overnight polysomnography, which includes assessment of:
Respiratory effort Air flow Stages of sleep Oxygen saturation Electrocardiogram Body position
bx and affective consequences
Daytime sleepiness Mood changes (irritability) Memory impairment Difficulty concentrating Fatigue Work productivity Reaction times Greater accidents Relationships
health/medical conseqeunces
Hypertension– more prominent issue even when control for age, sex, and obesity Cardiac arrhythmias Coronary artery disease Stroke mortality
What combo might present o you as the psychologist that would make you think sleep apnea?
mood sx’s + other ax’s + daytime sleepiness + reporting “enough” sleep
tx for SA?
behavioral (weight loss, position tx, reduce drinking and smoking)
medications (tricyclics, but not very effective)
CPAP
surgical (fix strcut/anatom abnorms)
What’s a CPAP
a machine that forces air through mouth and nasal passage while you sleep
How effective is it?
95%
What are th adherence rates?
45-70%
are adherence rates so low?
they have to use it of the ret of their ives
its heavy, it has a tube, its loud, etc
ppl say they wake up more with the machine
ppl with CPAP, do they really wake up more?
no, they just feel that way, research shows they acutely wake up less than they would without the machine
narcolepsy, prev rate?
1 in 2000
narcolepsy, gender differences?
no
narco, characterized by?
excessive daytime sleepiness
dysregulation of REM sleep (awake more)
urge for sudden brief sleep during day (seconds, minutes)
narco, recommended to drive?
no
narco, ancillary features?
Cataplexy (Sudden motor paralysis during wakefulness; loss of tone) Hynogogic hallucinations (Dream like images during as fall asleep/waking up) Sleep paralysis (Mind waking up while body still asleep)
narco, how to dx
Polysomnography
Sleep latency tests
Sleep diary (amount prior to test)
narco, eval/dx?
Sleep onset quicker than usual
Spend more time in REM during brief naps (this is a good Ddx)
Disrupted sleep pattern without other symptoms
what does quicker than usual mean in terms of falling asleep
less than 10 minutes
Narco, tx
Stimulant medications most effective
if you’re gonna rx stimulants, what do you need
a cardio workup
What is a parasomia
an acture, episodi, physical phenom that occurs only during sleep
Parasomnias usually occur
in the first third of the night
aout 2-3 hours after falling asleep
how long do they usually last?
10 mins to an hour
parasomnias, associated with psychopathology? if so , what kind?
yes, depression psychosis and anxiety
more common in adults or children?
children, dissipates by adolescence
name some different types of parasomnias
sleep walking sleep talking bruxism sleep terrors extreme confusion while seeming awake RBD
what % of kids sleep walk?
5-30
what % of adult sleep walk?
2-5
What % of kids have sleep terrors? Adults?
1-6.5; unknown
bruxism and sleep talking, rates?
we don’t know
What does “extreme confusion while seeming awake look like?”
dissorientation (i.e. to person, place, and time)
inappropriate bx
reduced cogntive responsiveness
What’s RBD
REM sleep behavioral disorder
Decreased skeletal muscle tone during REM sleep
Movement of limbs in purposeful ways (e.g. looks like trying to act something out, getting into a physical altercation with someone)
One way RBD is different that other sleep disorders?
actually more common in older adult than in children
parasomnias, tx?
Combination of behavioral and medical
Most are outgrown by adolescence/young adulthood
If persist into adulthood, medications be necessary
parasomnias, what classes of meds are rx’ed
Benzodiazepines (Klonopin)
Tricyclics
anticonvulsants
define insomnia
Chronic inability to obtain sufficient sleep for optimal functioning and well-being
insom, what % dx? % that repot occasional? % that report chronic?
6-30% diagnosed
up to 50% report occasional insomnia
19% report chronic insomnia
Clinical manifestations of insomnia?
Can look different
Wake up frequently at night
Waking up too early
Feeling “not rested” when wake up
