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sleep disorders Flashcards

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1
Q

Two main processes the regulate the timing and structure of sleep

A

1) Homeostatic process- the drive to sleep that is influenced by the duration of wakefulness –> with each hour you are awake the drive for sleep increases (linear function)
2) The circadian process transmits stimulatory signals to arousal networks to promote wakefulness in opposition to the homeostatic drive to sleep
- melatonin is produced, circadian system switches off and sleep period happens during this night time hours

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2
Q

normal sleep characterised by

A
  • 4-5 sleep cycles
  • start with more slow wave sleep and at the end more REM sleep
  • Older people; reduction of slow wave sleep and increase fragmentation in sleep
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3
Q

Insomnia Disorder (Primary) DSM 5 Criteria

A

A) complaint of: Initiation/Maintenance/Early morning awakening
B) Clinically significant distress/impairment in social/cognitive/occupational functioning
C) occurs at least 3 times/week
D) Sleep difficulty present for at least 3 months
E) Sleep difficulty occurs despite adequate opportunity for sleep
F) Disturbance is not due to another sleep disorder
G) Disturbance is not due to a mental disorder, substance, and/or general medical condition

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4
Q

causes of insomnia

A
  • signal in the body is not at the right time
  • Sleep should be ALIGNED with the biological signal for sleep
  • different circadian timing to the norm
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5
Q

Psychophysiological insomnia

A

o high arousal -have problem falling asleep and becomes a learnt response
o worry about the sleep they don’t have
o present for at least 1 month and is

characterised by a heightened level of arousal with learned sleep-preventing associations. There is an overconcern with the inability to sleep.

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6
Q

Sleep State Misperception (paradoxical insomnia)

A

o report terrible sleep but sleep well in a lab (their recordings show they are doing fine) objectively they aren’t having poor sleep

o Paradoxical insomnia (sleep state misperception: a complaint of severe insomnia that occurs without evidence of objective sleep disturbance and without daytime impairment to the extent that would be suggested by the amount of sleep disturbance reported.

o The patient often reports little or no sleep on most nights. It is thought to occur in up to 5% of insomniac patients.

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7
Q

Idiopathic Insomnia

A
  • no real cause
  • appears in childhood (long lasting)
  • long-standing form of insomnia –>date from childhood and has an insidious onset.
  • no factors associated with the onset of the insomnia, which is persistent and without periods of remission
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8
Q

Inadequate Sleep Hygiene

A
  • doing the wrong things and forming bad habits that do not promote the right sleep

-behaviours you are doing that ruin your sleep (going on phone)
- drink caffeine late in the night
- common daily activities that are inconsistent with good-quality sleep and full daytime alertness.
o include irregular sleep onset and wake times
o stimulating and alerting activities before bedtime and substances (e.g., alcohol, caffeine, cigarette smoke) ingested around sleep time

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9
Q

Adjustment sleep disorder

A

insomnia that is associated with a specific stressor.

The stressor can be psychological, physiologic, environmental, or physical. This disorder exists for a short period, usually days to weeks, and usually resolves when the stressor is no longer present.

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10
Q

Behavioural insomnia of childhood

A
  • child has learnt all the wrong things when they go to sleep
  • good practise by parents to teach the right sleep cues
  • Limit-setting sleep disorder: stalling or a refusing to go to sleep that is eliminated once a caretaker enforces limits on sleep times and other sleep-related behaviours.

Sleep onset association disorder: reliance on inappropriate sleep associations, such as rocking, watching television, holding a bottle or other object, or requiring environmental conditions such as a lighted room or an alternative place to sleep

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11
Q

Insomnia: The Spielman et al (1987) Model

A

Pre-disposing factors: individual differences (psychological or biological characteristics that increase your ability to having insomnia
o Being a woman
o Being anxious having hyperarousal

Precipitating factors; certain life events that trigger this insomnia (medical, psychological or environmental) trauma, death, bereavement, work, noise

Perpetuating; maintenance or exacerbation factors, drink coffee, take big naps that take us into this problem

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12
Q

2015 vision onwards

A
  • insomnia can coexist with many conditions, and regardless of which came first we need to address the sleep problems in their own right
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13
Q

treatment for insomnia

A

o sleep restriction
o Stimulus control (phones tv and alarm clocks out of bedroom
o Relaxation techniques
o Cognitive therapy: challenge persons beliefs about sleep
o Sleep hygiene (regular sleep timing, control of light,  CBTI

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14
Q

Sleep restriction

A
  • reduce the sleep period (increase the association with being in bed and being sleep increase their drive for sleep)
    o shorten the amount of time spent in bed in order to consolidate sleep.
    o Plan to stay in bed for only the length of your calculated average sleep time
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15
Q

Narcolepsy

A

A. Recurrent periods of an irrepressible need to sleep or lapsing into sleep.

B. At least 3 times/week for 3 months.

C. The presence of one of the following:

a. Episodes of cataplexy (lose all muscle tone - like you would certain stages of sleep)
b. Hypocretin/orexin deficiency ( a neuropeptide)

C. REM sleep latency less than 15minutes, OR MSLT

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16
Q

diagnosing narcolepsy

A

1) EDS; excessive daytime sleepiness (multiple sleep latency test
- MSLT average time= 15 minutes —– someone with abnormal MSLT = 8 minutes)

2) Orexin deficiency (take a lung puncture – look in cerebrospinal fluid
a. Orexin is a neuropeptide that controls these wake systems –> also associated with feeding behaviour
b. Orexin deficiency involved in the inhibition of rem sleep  which all in turn impacts motor neurons and having that loss of muscle tone

3) Cataplexy; triggered by emotional reactions (laugh you may fall asleep instantly!)
4) hypnogogic hallucinations (sleep paralysis could be a symptom of narcolepsy)

17
Q

Causes of narcolepsy

A
  • Genetic?
  • Onset occurs in springs and late spring (probably a late response to winter)
  • (HLADQB1*06:02) gene environment interaction
  • specific brand of vaccination (people who had that vacc were 10 x more likely of having this disorder – happened to young people but those who had the gene)  young genetic immune response
18
Q

treating narcolepsy

A

Stimulants

  • Ritalin
  • Modafinil
  • Xyrem (Sodium Oxybate/Gamma-hydroxybutyric acid – GHB) keep them asleep for long
Sleep hygiene 
 Prophylactic short naps (scheduled naps throughout the day)
  Regular sleep hours 
 Management of  Sleep deprivation 
 Caffeine/alcohol 
 Exercise 
 Emotions
19
Q

Circadian rhythm sleep disorders

A
  • persistent or recurrent misalignment between the patient’s sleep pattern and the pattern that is desired or regarded as the societal norm
  • Maladaptive behaviours influence the presentation and severity of the circadian rhythm sleep disorders.
  • Only if the timing of sleep is the predominant cause of the sleep disturbance and is outside the societal norm would the diagnosis be a circadian rhythm sleep disorder.
20
Q

Delayed sleep phase type

A
  • more commonly seen in adolescents
  • delay in the phase of the major sleep period in relation to the desired sleep time and wake time,
  • advanced sleep phase type- more commonly seen in older adults, is characterised by an earlier time in phase of the major sleep period in relation to the desired sleep time and wake-up time.

causes

  • alterations to the homeostatic regulation of sleep may be responsible.
  • the delayed and advanced sleep phase types can have a predominant influence caused by the person’s choice to remain awake late into the night
21
Q

The irregular sleep-wake type disorder

A
  • a lack of a clearly defined circadian rhythm of sleep and wakefulness
  • most often seen in older adults and is associated with a lack of synchronizing agents such as light, activity, and social activities.
  • The free-running type or nonentrained type (formerly known as the non–24-hour sleep–wake syndrome) occurs because there is a lack of entrainment to the 24-hour period, and the sleep pattern often follows that of the underlying free-running pacemaker with a sequential shift in the daily sleep pattern.
22
Q

Limit-setting sleep disorder

A
  • also associated with an altered time of sleep within the 24-hour day.
  • If the setting of limits is a function of the caretaker, then the sleep disorder is more appropriately diagnosed as a limit-setting sleep disorder.
23
Q

parasomnias

A
  • undesirable physical or experiential events that accompany sleep
  • abnormal sleep-related movements, behaviours, emotions, perceptions, dreaming, and autonomic nervous system functioning.
  • disorders of arousal, partial arousal, and sleep-stage transition.
  • Many of the parasomnias are manifestations of central nervous system activation.
  • Autonomic nervous system changes and skeletal muscle activity are the predominant features.
  • occur in conjunction with other sleep disorders such as obstructive sleep apnea syndrome.
  • several parasomnias to occur in one patient.
  • Parasomnias can be associated with any stage of sleep
24
Q

NREM Sleep Arousal Disorders

A

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the sleep episode SLOW WAVE SLEEP
1. SLEEP WALKING
2. SLEEP TERROR
B. No or little dream imagery recalled
C. Amnesia for episodes
D. Episodes cause clinically significant distress or impairment in social, occupational or other important area of functioning
E. Not attributable to a substance
F. No Coexisting medical and/or mental health disorders to do explain the episodes.

25
Q

SLEEP TERRORS

A
  • Sleep terrors also occur from slow-wave sleep and are associated with a cry or piercing scream accompanied by autonomic nervous system activation and behavioural manifestation of intense fear.
  • Patients may be difficult to arouse from the episode and when aroused can be confused and subsequently amnestic for the episode.
  • sleepwalking and sleep terrors, often coexist together, and sometimes one form blends into the other or is difficult to distinguish from the other.

Diagnostic Criteria (DSM-IV-TR)
o Abrupt “awakening” from sleep
o Episodes accompanied by intense fear and autonomic response
o Unresponsiveness to wake or comfort
o No recall of dream
o Sleep Stage: SWS (S3/S4 or N3) – first third of the night thus slow wave sleep
oOften co-exists with sleep walking

26
Q

Differences b/w sleep terrors and nightmare disorder

A
  • Sleep terrors occur in NREM sleep and nightmare ones occur in REM
  • Sleep terror in children (3-8 years) WHEREAS nightmare in all age groups people who have bad dreams more chronically and remember
  • Sleep terror no arousal and don’t wake up WHEREAS nightmare they can wake up and remember the dream and tell you about the dream
27
Q

Treatment for sleep terrors

A
  • help the parents through it because child will grow out of it
  • Avoid excessive sleepiness before bed
  • Don’t overheat the child
  • Don’t try to wake the child
  • Find the schedule time of these panics and prevent it
28
Q

SLEEP WALKING -

A
  • a series of complex behaviours that occur from sudden arousals from slow-wave sleep and result in walking behaviour during a state of altered consciousness.
  • Complex motor movement during (SWS) sleep
  • Reduced alertness and responsiveness
  • Limited recall of events if awaken
  • After the episode, regain full cognition and appropriate behaviour.
  • Prevalence: 1-5% (10-30% children sleepwalk)
    o Prevalence peaks – 8-12y

Prevention and Treatment

  • Minimise sleep deprivation
  • Make sure it’s a safe environment
29
Q

Nightmare disorder

A

A) Repeated occurrence of extended, extremely dysphoric, and well-remembered dreams, that generally occur in the second half of the night.
B) On awakening, the individual becomes rapidly awake and alert
C) The sleep disturbance causes clinically significant distress in social, occupational or other important areas of functioning
D) The nightmare symptoms are not due to any other medical, physical or mental health problem.

30
Q

Rapid eye movement sleep behaviour disorder

A
  • Complex, vigorous or violent behaviours sometimes associated with dreamlike thoughts/images, occurring in pathological REM sleep.
  • Muscle tone is abnormally preserved during some or all of REM sleep.
  • Patients usually middle-aged or elderly, with neurological disorder

A) Repeated episodes of arousal during sleep associated with vocalisation and/or complex motor behaviours
B) Behaviours arise in REM sleep and occur more than 90minutes after sleep onset, later in the sleep episode, and uncommon during naps.
C) Individual is awake and alert and is not confused or disoriented.
D) Either:
a. REM sleep without atonia on PSG
b. History suggestive of REM sleep BD and/or established disorders (i.e. PD)
E) Behavioural clinical distress and impairment
F) Not attributable to any other disorder
- Potensh a neurological disease (Parkinson’s onset)

Prevalence
- Injury – 79% injured themselves or bed partner
- Recall of dreams (up to 93% of cases)
- Defending attack from person (57%) 
- Defending attack from animal (30%) 
- Adventure sports/aggression (less common) 
- Multiple events per night – once/3months 
Diagnosis PSG
- Prognosis
- Treatment; benzodiazepine

31
Q

paralysis

A

Paralysis
- Discrete period of time during which voluntary muscle movement is inhibited, but ocular and respiratory movements are intact and one’s senses remain clear.
- Occurs at sleep onset or offset (hypnogogic and hypnopompic hallucinations)
- Supine/passive position
- Varied supernatural explanations
Linked with:
o Hypertension; narcolepsy; seizure; anxiety
- Sleep disturbance; insufficient sleep; jetlag; shift work (isolated SP)

Abnormal Psychology (9 decks)

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