Sleep-Wake Disorders & Breathing-Related Sleep Disorders Flashcards
What are the Sleep-Wake Disorders?
Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
What are the Breathing-Related Sleep Disorders?
Obstructive Sleep Apnea Hypopnea
Central Sleep Apnea
Sleep-Related Hypoventilation
Circadian Rhythm Sleep-Wake Disorders
What are the Parasomnias?
Non-Rapid Eye Movement Sleep Arousal Disorders
Nightmare Disorder
Rapid Eye Movement Sleep Behavior Disorder
Restless Leg Syndrome
What do Sleep-Wake Disorders/Breathing-Related Sleep Disorders commonly co-occur with?
Frequently co-occur with medical conditions
What is the diagnostic criteria for Insomnia Disorder?
- Dissatisfaction with quality or amount of sleep
- Difficulty falling asleep
- Difficulty maintaining sleep (frequent waking)
- Early morning waking
- At least three nights a week
- For at least three months
- In spite of adequate opportunities for sleep
- Distress or dysfunction
What is the differential diagnosis for Insomnia Disorder?
medical conditions
What are the comorbidities for Insomnia Disorder?
Anxiety disorders
Depression
Trauma-related disorders
What is the etiology for Insomnia Disorder?
Some genetic factors: strong heritability of insomnia in first degree relatives
Socioeconomical & Environmental risk factors (e.g. shift work)
Medical and psychiatric co-morbidities
What is the prognosis for Insomnia Disorder?
Self-limiting when situational issues are resolved
Treatment can be highly effective
What is the diagnostic criteria for Hypersomnolence Disorder?
Excessive daytime sleepiness in spite of at least seven hours sleep per night, including:
- Lapses into sleep during the day
- Nine or more hours of sleep that is not refreshing
- Difficulty being completely awake after abrupt waking
At least three times a week for at least three months
Distress or dysfunction
What is the etiology of Hypersomnolence Disorder?
mostly sleep apnea or medical conditions
What is the diagnostic criteria for Narcolepsy?
Repeated intense need to sleep, falling asleep, or napping within the same day.
At least three times per week for at least three months
At least one of:
- Cataplexy at least a few times per month:
- Brief episodes of sudden loss of muscle tone triggered by sudden, strong emotions- laughing/ joking, fear, anger or excitement while remaining conscious
- Spontaneous grimaces or global hypotonia
Hypocretin deficiency- regulate sleep and energy
Rapid eye movement (REM) sleep less than 15 minutes
What is cataplexy?
sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control
often triggered by sudden, strong emotions such as laughter, fear, anger, stress, or excitement
What is hypocretin?
neurotransmitters produced in hypothalamus
deficiency in narcolepsy due to toxin exposure, gene mutation, immure system attacking the cells, high stress
What is the differential diagnosis for Narcolepsy?
Other medical conditions
What is the etiology for Narcolepsy?
Major loss of orexin/hypocretin hypocretin neurons of the hypothalamus (neurons that prevent sleep), perhaps through some autoimmune mechanism
Environmental factors (e.g. flu a year prior, toxin)
Psychological stressors, esp. prior to puberty
What is the prognosis for Narcolepsy?
Early diagnosis plays a significant role in outcome
Better outcomes in younger individuals
What is the diagnostic criteria for Obstructive Sleep Apnea Hypopnea?
One of the following:
- Polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep with: Nighttime breathing disturbances like snoring or breathing pauses during sleep/ Daytime sleepiness or fatigue in spite of adequate opportunities for sleep
- Or 15 or more episodes of apnea or hypopneas per hour of sleep without other symptoms
What is the etiology for Obstructive Sleep Apnea Hypopnea?
Facial structure (shape of jaw, nasal septum) & amount of upper airway soft tissues
Overweight or obesity
What is the prognosis for Obstructive Sleep Apnea Hypopnea?
Treatment effective (continuous positive airway pressure [CPAP] most common) but often abandoned because of discomfort or cumbersome
What is the diagnostic criteria for Central Sleep Apnea?
- Polysomnographic evidence of 5 or more central apneas per hour of sleep
- (no facial related obstruction)
- brain doesn’t send proper signals to the muscles that control your breathing
What is the etiology of Central Sleep Apnea?
Clinical situations that cause hypocapnia (reduced CO2 in the blood) and respiratory instability (e.g. heart failure, stroke, neurological diseases
Stays at high altitudes
What is the prognosis for Central Sleep Apnea?
Depends on the cause; good if underlying cause treated
What is the diagnostic criteria for Circadian Rhythm Sleep-Wake Disorders?
Sleep disruption due to alteration of circadian system or a mismatch between the person’s rhythm and the requirements of the social or work environment
Excessive sleepiness or insomnia or both
Distress or dysfunction
What is the etiology for Circadian Rhythm Sleep-Wake Disorders?
- Degeneration or decreased neuronal activity of suprachiasmatic nucleus neurons (melatonin)
- Decreased responsiveness of the body’s internal clock to signals such as light and activity
- Decreased exposure to bright light and structured social and physical activity during the day (Zee & Vitiello, 2009)
- These may occur as a result of shift work or jet lag
What is the prognosis for Circadian Rhythm Sleep-Wake Disorders?
Often improves over time
Sleep medication may be indicated for short-term use
How many stages are in the sleep cycle?
4
What is the type of sleep and duration of sleep stage 1?
type: NREM-Entering sleep, light
length: 1-7 minutes
What is the type of sleep and duration of sleep stage 2?
type: NREM- Light sleep, heartbeat and breathing start to slow down, muscles start to relax
length: 10-60 mins
What is the type of sleep and duration of sleep stage 3?
type: NREM- Deep sleep, more slow and relaxed
length: 20-40 mins
What is the type of sleep and duration of sleep stage 4?
type: REM- Increase brain activity, increase heartrate & BP, dreams, muscles paralyzed
length: 10-60 mins
What is the diagnostic criteria for Parasomnias?
- Nightmare Disorder
- Non-rapid eye movement sleep arousal Disorder
- Rapid Eye Movement Sleep Behavior Disorder
- Restless Leg Syndrome
What is nightmare disorder?
frequent troubling dreams that are well-remembered
What is Non-rapid eye movement sleep arousal Disorder?
sleep walking, sleep terrors
What is Rapid Eye Movement Sleep Behavior Disorder?
repeated periods of arousal during sleep with vocalization and/or complex motor behaviors, occurring during REM sleep
What is Restless Leg Syndrome?
Frequent urge to move the legs, with uncomfortable or unpleasant sensations during sleep, frequently in REM
What are the implications for function for Sleep Disorders?
- Performance affected in work, leisure, play, education, social participation due to daytime fatigue or excessive sleepiness
- Skills affected include cognition (executive function, concentration, attention span), emotional regulation
- Self esteem and confidence
What treatments are used for Sleep Disorders?
- Behavioral strategies with focus on sleep hygiene
- Short or long term medication use
- Continuous Positive Airway Pressure (CPAP) machine
- Surgical options for obstructive sleep apnea
- Treat medical conditions
What are the implications for OT for Sleep Disorders that revolve around sleep hygiene?
- Focus on habits/patterns
- Establishing a calm bedtime routine
- Using the bed only for sleep and sex
- Avoiding naps if possible, or one nap not more than 30 mins
- Avoiding vigorous exercise too close to bedtime
- Minimize or avoid screen time 1 hour before bedtime
- Making sure the bedroom is dark and a comfortable temperature for sleep
- Minimize liquid in evening; urinate before bedtime
- Daily exercise (safety!)
What are the implications for OT for Sleep Disorders?
- Focus on sleep hygiene
- Strategies to improve circadian rhythm: Sunlight exposure in morning, Going to sleep and getting up at the same time each day
- Mindfulness meditation if related to stress, worries & anxiety
- Body positioning for comfort- Restless legs, Parkinson’s
- Managing and routinely using CPAP
- Work simplification/energy conservation to address fatigue until sleep improves
- Childhood narcolepsy- parent education
- Family education for safety- Sleep walking, act out dreams
What are the cultural considerations for Sleep Disorders?
Cultures vary in sleep patterns and expectations
Important to understand cultural values in framing intervention
What are the lifespan considerations for Sleep Disorders?
- Some disorders (e.g. narcolepsy) may emerge in childhood
- Early intervention can minimize duration and impact
- In older adults, insomnia is very common
- Need to use caution with medications in older adults due to risk of falls/injury
