Sleep disorders - Articles Flashcards
What are the two main phases of sleep? (Carskadon & Dement, 2005)
- NREM (Non-Rapid Eye Movement) Sleep: A relatively inactive brain in a mobile body, divided into 4 stages based on EEG patterns.
- REM (Rapid Eye Movement) Sleep: An activated brain in a paralyzed body, associated with dreaming.
What are the key characteristics of NREM sleep? (Carskadon & Dement, 2005)
- Divided into 4 stages (Stages 1-4).
- EEG pattern is synchronous, featuring sleep spindles, K-complexes, and high-voltage waves.
- Arousal thresholds increase from Stage 1 to Stage 4.
- Associated with minimal or patchy mental activity.
What are the key characteristics of REM sleep? (Carskadon & Dement, 2005)
- Defined by EEG activation, muscle atonia, and episodic bursts of rapid eye movements.
- Mental activity during REM is linked to dreaming.
- Alternates with NREM in a 90-minute cycle.
What are the three polysomnographic measures used to track sleep onset? (Carskadon & Dement, 2005)
- Electromyogram (EMG): Shows a gradual reduction in muscle tone before sleep.
- Electroculogram (EOG): Detects slow eye movements (SEMs) as sleep begins.
- Electroencephalogram (EEG): Tracks changes in brain waves, marking the transition from wakefulness to sleep.
How do sensory responses change during sleep onset? (Carskadon & Dement, 2005)
- Visual response: No response to light flashes in Stage 1 & 2.
- Auditory response: Slower reaction time and no response in deeper sleep stages.
- Smell response: Strong odors (peppermint, pyridine) may be detected in Stage 1 but not in Stages 2-4.
- Response to meaningful stimuli: The brain processes significant stimuli (e.g., one’s name) even in sleep.
What is hypnic myoclonia? (Carskadon & Dement, 2005)
A muscle twitch or jerk at sleep onset, often accompanied by vivid visual imagery.
How does memory function near sleep onset? (Carskadon & Dement, 2005)
- Memory deteriorates as sleep begins.
- Sleep blocks the transfer of short-term memories to long-term storage.
- If awakened 10 minutes into sleep, individuals recall only the last 4-10 minutes before sleep.
What is the progression of sleep during the night? (Carskadon & Dement, 2005)
- Sleep begins with NREM sleep.
- REM sleep follows after ~80 minutes.
- NREM and REM alternate in a 90-minute cycle throughout the night.
What are the four stages of NREM sleep and their approximate percentages in a sleep cycle? (Carskadon & Dement, 2005)
- Stage 1: Lightest sleep, 2-5% of total sleep.
- Stage 2: Sleep spindles/K-complexes, 45-55% of total sleep.
- Stage 3: Transition to deep sleep, 3-8% of total sleep.
- Stage 4: Deep sleep (slow-wave sleep), 10-15% of total sleep.
What happens in REM sleep and how much of sleep does it account for? (Carskadon & Dement, 2005)
- First REM episode lasts 1-5 minutes.
- Occurs 4-6 times per night.
- Becomes longer in later cycles.
- Accounts for 20-25% of total sleep.
How do NREM and REM sleep cycles change across the night? (Carskadon & Dement, 2005)
- Stage 3 & 4 decrease in later cycles.
- Stage 2 expands as sleep progresses.
- REM sleep duration increases in later cycles.
What factors modify sleep stage distribution? (Carskadon & Dement, 2005)
Age: Newborns enter sleep via REM; deep sleep (Stage 3 & 4) declines with age.
Prior sleep history: Sleep deprivation leads to SWS rebound.
Circadian rhythms: Sleep occurs when body temperature drops.
Temperature: Extreme heat or cold disrupts sleep, particularly REM sleep.
Drugs:
* Benzodiazepines suppress slow-wave sleep (SWS).
* SSRIs & TCAs suppress REM sleep.
* Alcohol initially increases deep sleep but later disrupts REM.
How do sleep disorders affect sleep structure? (Carskadon & Dement, 2005)
- Narcolepsy: Abnormal sleep-onset REM periods (SOREMPs).
- Sleep apnea: Suppresses SWS & REM sleep.
- Sleep fragmentation: Leads to frequent arousals throughout the night.
What are key clinical notes on sleep? (Carskadon & Dement, 2005)
- Older men experience less deep sleep.
- Memory deterioration near sleep onset leads to poor recall of nighttime events.
- Mismatched sleep schedules cause sleep disruptions.
- Properly timed sleep restriction improves insomnia treatment.
What percentage of children experience sleep problems, and how many receive a formal sleep disorder diagnosis? (Carter et al., 2014)
- Up to 50% of children experience sleep problems.
- About 4% have a formal sleep disorder diagnosis.
What are the main functions of sleep in children? (Carter et al., 2014)
- Conserves energy.
- Restores normal physiological processes.
- Promotes physical growth.
- Supports mental development.
How does sleep change during childhood? (Carter et al., 2014)
- Sleep periods gradually lengthen.
- Total sleep time decreases as the child ages.
What is obstructive sleep apnea (OSA) in children? (Carter et al., 2014)
A condition where upper airway obstruction disrupts normal sleep and ventilation despite respiratory effort.
At what age does OSA typically develop, and what is its prevalence? (Carter et al., 2014)
- Onset usually occurs between 2 and 8 years old.
- Prevalence is 1% to 5%.
What are the common symptoms of OSA in children? (Carter et al., 2014)
- Snoring and witnessed apneas.
- Unusual sleeping positions.
- Paradoxical breathing.
- Nighttime sweating or bedwetting (enuresis).
- Morning headaches and daytime sleepiness.
What are the possible consequences of untreated OSA? (Carter et al., 2014)
- Neurobehavioral issues (decreased attention, emotional dysregulation).
- Lower academic performance.
- Nighttime enuresis.
- Impaired growth.
- Rare cases: hypertension, pulmonary hypertension, cor pulmonale.
What is the primary treatment for OSA in children? (Carter et al., 2014)
- Adenotonsillectomy (removal of tonsils and adenoids).
- Weight loss interventions for overweight/obese children.
What are parasomnias? (Carter et al., 2014)
Undesirable events occurring during sleep-wake transitions, often involving complex but meaningless movements.
What are common parasomnias in children? (Carter et al., 2014)
- Sleepwalking (somnambulism).
- Sleep talking (somniloquy).
- Confusional arousals.
- Sleep terrors.
- Nightmares.
How do nightmares differ from other parasomnias? (Carter et al., 2014)
- Sleepwalking, sleep talking, and sleep terrors occur in NREM sleep (first half of the night).
- Nightmares occur in REM sleep (last half of the night) and are remembered by the child.
What are some triggers for parasomnias? (Carter et al., 2014)
- Sleep deprivation.
- Obstructive sleep apnea (OSA).
- Periodic limb movement disorder.
- Gastroesophageal reflux.
- Forced awakenings or certain medications.
How are parasomnias treated? (Carter et al., 2014)
- Reassurance (most resolve by adolescence).
- Eliminating precipitating factors.
- Increasing total sleep time.
What is behavioural insomnia of childhood, and how common is it? (Carter et al., 2014)
A learned inability to fall and/or stay asleep, affecting 10-30% of children.
What are the two subtypes of behavioural insomnia of childhood? (Carter et al., 2014)
- Sleep-onset association type: Child cannot fall asleep without specific conditions (e.g., rocking, nursing).
- Limit-setting type: Parents fail to enforce boundaries, leading to bedtime resistance.
How is behavioural insomnia of childhood treated? (Carter et al., 2014)
- Parental education on sleep hygiene and routines.
- Extinction techniques (e.g., controlled ignoring, gradual checking).
- Setting firm sleep boundaries.
What is delayed sleep phase disorder (DSPD)? (Carter et al., 2014)
A disorder where habitual sleep-wake times are delayed by at least two hours compared to socially acceptable times.
What is the prevalence of DSPD in adolescents?(Carter et al., 2014)
Between 7% and 16%.
How is DSPD treated? (Carter et al., 2014)
- Avoid bright light before bedtime.
- Remove light-emitting devices from the bedroom.
- Melatonin supplementation (timing and dosage not well established).
What is restless legs syndrome (RLS)? (Carter et al., 2014)
A disorder characterized by unpleasant sensations in the legs, with an urge to move them, which worsens in the evening and improves with movement.
What are the symptoms of restless legs syndrome in children? (Carter et al., 2014)
- Difficulty falling asleep.
- Bedtime resistance.
- “Growing pains”.
- ADHD-like symptoms.
What are the risk factors for RLS in children? (Carter et al., 2014)
- Dopamine dysfunction.
- Genetics.
- Iron deficiency.
How is RLS diagnosed in children? (Carter et al., 2014)
A diagnosis is made if history is consistent with the condition and at least two of the following are present:
* Sleep disturbances.
* Family history of RLS.
* Five or more periodic limb movements per hour during polysomnography.
What is the treatment for RLS in children? (Carter et al., 2014)
- Avoid exacerbating factors.
- Measure ferritin levels (iron deficiency is common).
- No approved medications; refer for further evaluation if symptoms persist.
How does sleep change as we age? (Crowley, 2011)
- More interruptions in sleep.
- Earlier awakenings.
- Less deep sleep (less slow-wave sleep, SWS).
What are two major causes of sleep problems in older adults? (Crowley, 2011)
- Specific disorders (e.g., OSA, PLMS, RLS).
- Health issues, medications, mental health conditions, or lifestyle factors.
How does ageing affect sleep structure? (Crowley, 2011)
- More light sleep (NREM stages 1 & 2).
- Less deep sleep (slow-wave sleep, SWS).
- Shorter total sleep duration.
- More nighttime awakenings (longer and more frequent).
What is slow-wave sleep (SWS), and how does ageing affect it? (Crowley, 2011)
- SWS is deep sleep associated with recovery and cognitive function.
- Ageing reduces SWS and weakens delta wave activity.
What are K-complexes, and how do they change with age? (Crowley, 2011)
- K-complexes are brain waveforms in NREM sleep that promote deeper sleep.
- In ageing, there are fewer and weaker K-complexes.
What are sleep spindles, and how do they change with ageing? (Crowley, 2011)
- Sleep spindles are bursts of rhythmic brain activity that help protect sleep.
- With ageing, spindle density, amplitude, and duration decrease.
How does ageing affect circadian rhythms? (Crowley, 2011)
- Lower amplitude in circadian markers (e.g., body temperature, melatonin, cortisol).
- Older adults tend to fall asleep and wake up earlier.
What is primary insomnia, and how does it differ from secondary insomnia? (Crowley, 2011)
- Primary insomnia: No underlying cause for sleep difficulties.
- Secondary insomnia: Sleep problems caused by medical conditions, medications, or lifestyle factors.
What is the relationship between ageing and insomnia? (Crowley, 2011)
- Age is the biggest risk factor for insomnia.
- More prevalent in women.
- Medications and increased sensitivity to caffeine and alcohol worsen sleep disturbances.
What is sleep-disordered breathing (SDB)? (Crowley, 2011)
Disruptions in breathing during sleep, ranging from snoring to obstructive sleep apnea (OSA).
* Complete airflow loss = Apnea.
* Partial airflow loss = Hypopnea.
What are risk factors for sleep-disordered breathing (SDB)? (Crowley, 2011)
- Older age.
- Obesity.
- Neurological impairment.
- Abnormal nocturnal respiratory reflexes.
What are the consequences of sleep-disordered breathing (SDB) in older adults? (Crowley, 2011)
- Cognitive impairment (memory loss, attention issues).
- Increased risk of stroke, coronary artery disease, and heart failure.
What is REM sleep behavior disorder (RBD)? (Crowley, 2011)
- Lack of muscle paralysis during REM sleep.
- Leads to shouting, kicking, or punching during sleep.
- More common in older men.
What is restless legs syndrome (RLS), and how does it change with age? (Crowley, 2011)
- Uncomfortable leg sensations (e.g., tingling, cramping, pain).
- Relieved only by movement.
- Becomes more common with age, especially in women.
What is periodic limb movement during sleep (PLMS)? (Crowley, 2011)
- Involuntary leg movements during sleep.
- More common than sleep-disordered breathing (SDB).
- May be linked to age-related dopamine declines.
What are the main sleep disturbances in dementia? (Crowley, 2011)
- Insomnia.
- Circadian rhythm disruptions.
- Excessive nighttime movement and agitation.
- Abnormal nighttime behaviors.
How does Alzheimer’s disease (AD) affect sleep? (Crowley, 2011)
- More frequent awakenings.
- Reduced sleep efficiency.
- Fewer sleep spindles and K-complexes.
- Worse circadian rhythm disturbances with disease progression.
How does Parkinson’s disease (PD) affect sleep? (Crowley, 2011)
- Frequent nighttime awakenings.
- Severe sleep fragmentation.
- Nocturnal immobility, rest tremors, and eye blinking.
- 90% experience sleep maintenance insomnia.
How is sleep connected to having a stroke? (Crowley, 2011)
- Poor sleep linked to heart disease, memory problems, and increased stroke risk.
- Snoring and low oxygen levels worsen stroke prognosis.
What are the consequences of poor sleep in older adults? (Crowley, 2011)
- Higher illness and mortality rates.
- Lower quality of life.
- Increased risk of depression and anxiety.
- Memory deficits and cognitive decline.
- Difficulty with balance, walking, and vision.
What is insomnia? (Riemann et al., 2023)
- A sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early.
- Causes functional impairment during the day (fatigue, irritability, low mood, concentration problems).
- Must occur at least 3 times a week for 3 months for diagnosis.
What are the two main treatments for insomnia? (Riemann et al., 2023)
- Cognitive Behavioral Therapy for Insomnia (CBT-I):
- Addresses cognitive (mind racing) and behavioral (sleep patterns) factors.
- Pharmacological treatment:
- Recommended for short periods (≤4 weeks).
- Long-term use requires a risk-benefit evaluation.
What does the European Insomnia Guideline (2023) recommend? (Riemann et al., 2023)
- CBT-I should be the first-line treatment.
- Medication can be used, but only with patient agreement and short-term.
- Dose increases are generally not advised due to dependence risk.
How is insomnia diagnosed? (Riemann et al., 2023)
- Based on self-reports & clinical history of sleep difficulty.
- Must cause daytime impairment despite enough sleep opportunity.
- Diagnosis requires ≥3 episodes per week for 3 months.
- Sleep diaries should be kept for 7-14 days.
- Insomnia Severity Index (ISI) measures severity.
What are the polysomnographic (PSG) findings in insomnia? (Riemann et al., 2023)
- Reduced sleep efficiency.
- Shorter total sleep time.
- More nocturnal awakenings.
- Less slow-wave sleep (SWS) and REM sleep.
- PSG is not required for diagnosis but helps rule out other disorders.
What is actigraphy, and how does it compare to PSG? (Riemann et al., 2023)
- Actigraphy tracks sleep-wake patterns but doesn’t differentiate sleep stages.
- Less reliable than PSG but useful for detecting irregular sleep schedules.
Which medical conditions are associated with insomnia? (Riemann et al., 2023)
- Neurological disorders (stroke, Parkinson’s, epilepsy, migraines, traumatic brain injury).
- Cardiovascular disease & diabetes.
- Hypertension.
- Mental health conditions (depression, anxiety).
What role does alcohol play in insomnia? (Riemann et al., 2023)
- Frequently used as self-medication, but worsens sleep quality.
- Alcohol fragments sleep and reduces REM sleep.
- Alcohol and substance use should be assessed in insomnia patients.
Why do many people not seek treatment for insomnia? (Riemann et al., 2023)
- Only 30% seek help.
- Public awareness about treatment options should be increased.
What are the key components of CBT-I? (Riemann et al., 2023)
- Psychoeducation/sleep hygiene (information on sleep).
- Relaxation therapy (e.g., progressive muscle relaxation).
- Sleep restriction therapy (SRT) (limiting time in bed to improve sleep pressure).
- Stimulus control therapy (SCT) (associating bed with sleep, not wakefulness).
- Cognitive strategies (reducing worry, negative sleep beliefs).
How does sleep restriction therapy (SRT) work? (Riemann et al., 2023)
- Limits time in bed to increase sleep pressure.
- Gradually extends sleep time once sleep consolidates.
- Improves sleep continuity, depth, and daytime functioning.
What is stimulus control therapy (SCT)? (Riemann et al., 2023)
Breaks the association between bed and wakefulness.
Includes 7 key instructions, such as:
* Only use the bed for sleep and sex.
* Leave the bed if unable to sleep after 15-20 min.
What are the effects of CBT-I beyond sleep improvement? (Riemann et al., 2023)
- Reduces depressive symptoms, anxiety, and daytime sleepiness.
- Improves energy levels and quality of life.
- Effective in patients with comorbid conditions (chronic pain, cancer, sleep apnea, neurological disorders).
Can CBT-I be delivered digitally? (Riemann et al., 2023)
- Yes, digital CBT-I is effective.
- Personal support is preferred.
- Requires quality control to ensure effectiveness.
What are the side effects of CBT-I? (Riemann et al., 2023)
- Sleep restriction therapy (SRT) can cause daytime sleepiness in the first weeks.
- Not recommended for epilepsy or conditions worsened by sleep deprivation.
- Unlike medication, CBT-I has no risks of abuse or dependency.
How does CBT-I compare to pharmacotherapy? (Riemann et al., 2023)
- CBT-I has longer-lasting effects than medication.
- Combining CBT-I with zolpidem worked well initially, but CBT-I alone was better long-term.
What are some alternative psychotherapies for insomnia? (Riemann et al., 2023)
- Mindfulness-based therapy: Some benefits, but more research needed.
- Acceptance & Commitment Therapy (ACT): Less effective than CBT-I.
- Hypnotherapy: Mixed results.
- Intensive sleep retraining: Needs more research.
What are the pharmacological treatment options for insomnia? (Riemann et al., 2023)
- Benzodiazepines (BZs) & Z-drugs (effective for ≤4 weeks, risk of dependence).
- Low-dose sedating antidepressants (limited evidence).
- Antipsychotics (used, but lack strong evidence).
- Dual Orexin Receptor Antagonists (DORAs) (approved for up to 1 year).
- Melatonin (approved for ages 55+, small effects).
- Herbal remedies (low-quality studies, not recommended).
Is long-term medication use recommended for insomnia? (Riemann et al., 2023)
- No, most studies focus on short-term treatment (<4 weeks).
- No strong evidence supports use beyond 12 weeks.
Should insomnia medication be used daily or as needed? (Riemann et al., 2023)
Why is quality sleep important for young individuals?
* Unclear if daily or as-needed use is superior.
* Most clinical trials recommend daily use.
* In practice, “as needed” use is common, but needs more research.
Why is quality sleep important for young individuals?
Essential for well-being, learning, and mental health.
Poor sleep is linked to obesity, depression, suicidal tendencies, and substance abuse.
What are the recommended sleep durations for adolescents and young adults?
- Adolescents (14-17 years): 8-10 hours per night.
- Young adults (18-24 years): 7-9 hours per night.
What has been observed about adolescent sleep duration in recent years?
Decline in sleep duration over the past decade.
Possibly due to increased digital media use (especially smartphones).
What are the main types of digital media affecting sleep?
- Interactive media (smartphones, social media, gaming).
- Passive media (TV, non-interactive content).
Smartphones & internet use have a greater impact than television.
How does digital media use impact bedtime?
- Delayed bedtime is linked to texting, social media, and gaming.
- Gaming duration and engagement (not just accessibility) cause later bedtimes.
How does digital media use affect sleep onset latency?
Mixed results: Some studies show longer sleep onset, others show no effect.
* Use of phones, computers, or TV before bed increases the chance of taking >60 minutes to fall asleep.
What is the relationship between digital media use and sleep disturbances?
- Restless sleep, nightmares, and awakenings linked to nighttime tablet use.
- Other devices show inconsistent results.
How does digital media use relate to short sleep duration?
- 23 studies show a strong association.
- Smartphones, computers (games), internet, and social media cause shorter sleep.
- Tablets, game consoles, and TV show inconsistent results.
Does digital media use contribute to earlier awakening?
Some studies link it to early wake-up times and weekday-weekend discrepancies.
What effect does digital media use have on daytime tiredness and functioning?
- 5 out of 6 studies link nighttime smartphone use to increased daytime tiredness.
- Mixed results on whether digital media use worsens or improves daytime function.
How does digital media use impact overall sleep quality?
28 studies associate digital media use with poor sleep quality.
Smartphone addiction and phone use at bedtime show the strongest link.
What are the three main hypotheses explaining how digital media affects sleep?
- Engagement-induced arousal – Interactive media (social media, texting) keeps the brain alert.
- Blue light exposure – Blue light disrupts melatonin, delaying sleep.
- Sleep displacement hypothesis – Digital media replaces sleep time.
How does smartphone use specifically impact sleep?
- Worst offender for sleep issues.
- Notifications and interactions at night disrupt sleep.
- Social media addiction and gaming linked to poorer sleep quality.
What is the difference in sleep impact between smartphones and TV?
- Smartphones & social media cause greater sleep disruption.
- TV has less effect because it is passive and does not engage as much.
What are the key takeaways from this study? - Digital media use and sleep
- Consistent evidence links digital media to later bedtime, shorter sleep, and poorer sleep quality.
- Digital media use before bedtime leads to increased daytime fatigue.
- The strongest evidence shows negative effects from smartphones, social media, gaming, and internet use.
How can young people reduce digital media’s negative sleep effects?
- Limit smartphone & social media use before bed.
- Turn off notifications at night.
- Use blue light filters or avoid screens before sleeping.
What role can families, schools, and public health campaigns play?
- Educate young people on sleep hygiene.
- Encourage healthier digital habits (e.g., no phone use 1 hour before bed).
- Implement school policies to support better sleep practices.
