Sleep Disorders

Question 1

Sleep as an active process

Answer 1

Brain remains active while sleeping

Question 2

5 stages of sleep

Answer 2

Stage 1, stage 2, stage 3, stage 4, REM

Question 3

Stage 1 of sleep

Answer 3

Transition between sleep and awake
Person doesn’t know if he/she is awake or asleep
Hypnogogic hallucinations: dreams that happen while partially awake

Question 4

Stage 2 of sleep

Answer 4

Shallow sleep

Brain slows down

Question 5

Stage 3 of sleep

Answer 5

Transition between shallow sleep and deep sleep

Question 6

Stage 4 of sleep

Answer 6

Deep sleep
Makes person feel rested when he/she wakes up
Hard to arouse- if person is awakened, then is really groggy

Question 7

REM (rapid eye movement) sleep

Answer 7

Dreaming
Paradoxical: person is firmly asleep, but brain is active as if awake
Body is paralyzed to prevent acting out dream

Question 8

Way brain cycles through sleep stages

Answer 8

1 -> 2-> 3 -> 4 -> 3 -> 2 -> REM -> 2 -> …
Cycle between REM stages lasts about 90 minutes
5-8 cycles per night

Question 9

Objective methods of assessing sleep

Answer 9

Polysomnography (most common method): hook person up to several machines to measure brain waves, heartbeat, muscle movement, temperature, sounds produced, etc.
Actigraphy: measure movement during sleep

Question 10

Subjective method of assessing sleep

Answer 10

Ask person how he/she is sleeping

Doesn’t always line up with objective (may actually sleep just fine)

Question 11

Dyssomnias

Answer 11

Difficulties in amount, quality, or timing of sleep

Question 12

Parasomnias

Answer 12

Abnormal behavioral and physiological events during sleep

Question 13

Insomnia disorder

Answer 13

Difficulty initiating or maintaining sleep
Impairment during day
Unrelated to another condition

Question 14

Epidemiology of insomnia

Answer 14

A good subset of people experience insomnia (30-45%), but only a small number experience insomnia not due to anything else (1-10%)
Sex: twice as common in females
Age of onset: young adult to middle age

Question 15

Contributing factors to insomnia

Answer 15

Unrealistic expectations about sleep
Exaggerated belief about the negative impact of sleep difficulties
High levels of arousal
Poor sleep habits (staying up too late and sleeping in, drinking caffeine before bed)
Altered perception of sleep

Question 16

Medications used to treat insomnia

Answer 16

Benzo/non-benzo hypnotics (Ambien): help to fall asleep, but don’t give good sleep; addictive
Antihistamines (benadryl)
Melatonin (hormone that controls circadian rhythym)

Question 17

CBT treatments for insomnia

Answer 17

Reduce cognitive arousal prior to going to bed
Tell self to stay awake (makes person fall asleep)
Train person to associate bed with sleep (don’t do anything in bed other than sleep)
Fix sleep hygiene
Train person to spend as much time in bed as needed to sleep

Question 18

Hypersomnolence disorder

Answer 18

Excessive sleepiness despite having had adequate sleep
Unrelated to another condition
Treatment: give person stimulant to help him/her stay awake

Question 19

Narcolepsy

Answer 19

Falling asleep at inappropriate times
One of the following:
Cataplexy episodes (sudden loss of muscle tone while awake; often in response to strong emotions)
Hypocretin deficiency
Rapid transition to REM or falling asleep too rapidly

Question 20

Sleep paralysis

Answer 20

Symptom of narcolepsy

As person is waking up, paralysis system stays on: person can’t move

Question 21

Hypnopompic hallucinations

Answer 21

Symptom of narcolepsy

Like hypnogogic hallucinations (people with narcolepsy also have these), but happen as person is waking up

Question 22

Treatments for narcolepsy

Answer 22

Treating sleepiness: give stimulant

Treating cataplexy: give anti-depressant

Question 23

Sleep apneas

Answer 23

Stop breathing during middle of night
Gasping for air, increasingly louder snoring
2 types: obstructive (throat closes while sleeping), central (breathing stops for reason other than throat closure)

Question 24

Treatments for sleep apneas

Answer 24

Weight loss

Hook person up to mechanical device such as CPAP (pushes air down throat to keep it from closing)

Question 25

Circadian rhythm disorders

Answer 25

Disturbed sleep due to alteration/misalignment of circadian system with life’s demands
Can cause sleepiness or insomnia

Question 26

Types of circadian rhythm disorders

Answer 26

Delayed sleep phase syndrome (person’s body wants to be awake late)
Advanced sleep phase syndrome (person’s body wants to go to sleep early)
Shift work type (shift work for a long period of time can screw up circadian clock)

Question 27

Treatments for circadian rhythm disorders

Answer 27

Bright light to trick the brain into resetting system
Sleep medications (especially melatonin)

Question 28

Types of parasomnias

Answer 28

REM related: nightmare disorder, REM sleep behavior disorder

Non-REM related (occur during stage 4 sleep): sleep terrors, sleep walking

Question 29

Nightmare disorder

Answer 29

REM related disorder
Repeated nightmares that are well remembered
Oriented and alert upon waking

Question 30

REM sleep behavior disorder

Answer 30

REM related disorder
Paralysis system doesn’t work, so person acts out dream
Oriented upon waking
Treatment: protect person (ex- sleep in restrictive sleeping bag)

Question 31

Sleep terror

Answer 31

Non-REM related disorder
Episodes of abrupt terror arousals: person wakes up terrified, doesn’t remember why he/she is afraid, and can’t go back to sleep
Don’t remember dream: wake up from stage 4 sleep
Common among children and decreases into adulthood

Question 32

Sleepwalking

Answer 32

Non-REM related disorder
Episodes of rising from bed during sleep and walking around
Generally blank face, unresponsive, and hard to arouse
No dream imagery recalled