w3- sleep disorders Flashcards
“understanding “normal sleep”
What is normal sleep? What varies between people?
reversible state of unconscious mobile, vary in hrs, falling asleep easily, no frequent wakenings, refreshed
“understanding “normal sleep”
Which region of the brain contains wake promoting neurons?
ventrolateral nucleus (VLN)
Do young adults have more or less NREM and wakenings?
more NREM, less awakenings
Do elderly adults have more or less NREM and wakenings?
less NREM, more awakenings, lightening in sleep
Does REM sleep inc/dec in lifespan as age progresses?
What increases?
hint: REM is deep sleep- do babies have more or adults?
REM decreases
NREM 1-2 increases (lighter sleep)
sleep disorder #1 insomnia
What are the 3 main classifcation manuals for sleep disorders?
- ICD-11 (disease)
- ICD-SD (7 main/59 sleeping disorders)
- DSM-5
sleep disorder #1 insomnia
What are the 7 main sleep disorders in the ICD-SD?
hint: 3 “soms”, eyes, nose, hands, others
insomnia, parasomnia, hypersomnolence
sleep-wake circadian,
breathing related, movement related
others
sleep disorder #1 insomnia
What’s the difference bewteen primary vs secondary insomnia?
primary = unassociated with psych/med disorder
secondary= comorbid to psych/physical state, other disorders
sleep disorder #1 insomnia
6+1 criteria for insomnia
min 1/3 symptoms include:
1) complaining dissatisfaction in sleep quantitiy/quality
2) symptoms - early awakenings, hard to intitate, hard to maintain sleep
3) occur despite adequate sleep
4) duration = min 3 months
5) freq = min 3 times weekly
6) causing sig distress
7) unexplained by med/substance
before 2015 –> post 2015 had some changes in insomnia criteria
What is insomnia now interpreted as?
co-exists with other conditions, but still address disorder individually accounting for other related factors
sleep disorder #1 insomnia
prevalence of insomnia more in ? gender? age?
women, older
sleep disorder #1 insomnia
predisposing factors?
precipitating factors?
perpetuating factors?
genetics, women, hgiher anxiety
trauma, work stress, sleep env, new medication
stress, worrying, staying in bed/daytime naps
sleep disorder #1 insomnia
How to diagnosis insomnia?
hint: s____ i_______
sleep interview
includes problems, narrative of bedtime, triggers, perception, other factors
sleep disorder #1 insomnias
Negative outcomes of insomnia?
dec mental wellbeing, energy, workplace productivity, general function, accident risk
sleep disorder #1 insomnias
Is medication or therapy more preferred for insomnia treatment?
CBT-I cognitive restructuring inaccurate sleep thoughts –> changing behaviors–> arousal/stimulus/relaxation techniques
psychoeducation
sleep disorder #1 insomnias
3 limitations of CBT-I
high cost
low usage
low trained sleep psychs
sleep disorder #2 parasomnias
parasomnia “para” means ?
in which stages (2 types)
2 movement ex?
2 cognitive emotional ex?
3 sensory ex?
abnormal behaivors/experiences
in NREM (wake/transitions)
or REM (during slee)
movement = walking, paralysis
cognitive= nightmares, terrors
sensory = hallucinations, confusion, exploding head syndrome
sleep disorder #2 parasomnias
prevalence of parasomnias more common in ? gender? age?
males, age ranges from child to adult
sleep disorder #2 parasomnias
the first type of parasomnias occur in?
2 main disorders include?
hint: NREM - SWS TW
NREM 3/ short wave sleep SWS
sleep terrors
sleep walking
type 1: NREM wake associations parasomnias
which period of sleep? first/mid/end?
dream imagery recalled?
amnesia?
first third of the night
SWS, NREM 3
cannot recall dream (hint: NREM no dreams, mostly recall in REM)
amnesia present
sig distress
unexpalined by other med/MD/substance
type 1: NREM wake associations parasomnias
children and adults common older/younger age?
sleep terrors occur in first or end of night? symptoms?
awakening or recall present?
treatment?
children 4-12, adults 20-30 - younger age
occur first third of the night
abrupt terror, crying, sweat, autonomic nervous system aroused
not awakened, no recall
advised not to wake them up
treatment - avoid daytime sleepiness, over hyping, calming self
type 1: NREM wake associations parasomnias
sleep walking occur in first or end of night?
is consciousness present?
walking responsibvely or hard to wake?
awakening or recall present?
treatment?
common in children 8-12 yrs
first third of night SWS, impaired consciousness, hard to wake, unresponsive, no awakening/amnesia recall absent
manage safe env
type 2: REM wake associations parasomnias
nighmare disorder occur in which part of the night? wake or continues sleeping? recall present?
causes?
treatment?
second half of night REM< wake up, can recall dream, aroused/story like anxious
more distress
cause- stress, PTSD, medication
parental bedside behavior, CBT, reduce SNS meds, anti anxiety, SSRI
type 2: REM wake associations parasomnias
REM sleep behavior disorder (RBD) occurs in which part of the night? episodes of A____ with complex ______ _______ ? that resembles scary _____
wake or continue sleeping?
neg outcomes?
diagnosis?
treatment?
REM, second half of night
episodes arousal with of VOCALIZATION, complex motor behaviors resembles dream enactment
violent behaviors from dream
will wake up
injuries, crimes, violent attack self/others
PSG, min 3 months
anti anxiety drugs
type 2: REM wake associations parasomnias
sleep paralysis is what type of muscle movement?
occurs in ?
ventilation/breathing affected?
reasons for occuring?
treatment?
involuntary INHIBITED muscle movement
occurs in naps/sleep onset
ventilation unaffected
jetlag, shift work, lacking sleep, disturbed
anxiety management, sleep env
disorder #3 circadian rhythm sleep wake disorder
X is misalligned with Y?
2 main symptoms?
circadian clokc misalligned with sleepp-wake pattern and env demands
insomnia and excessive sleepiness both
disorder #3 circadian rhythm sleep wake disorder
What is delayed sleep wake phase? Is it more common in young/old people?
hint: sleep too ____, difficulty _____
1) sleep too late
2) difficulty waking
more in young adolescents
disorder #3 circadian rhythm sleep wake disorder
What is advanced wake phase? Is it more common in young/old people?
hint: wake up too ____, difficulty _____
1) wake too early
2) difficult to maintain awake in daytime (want to nap)
more in elderly
disorder #3 circadian rhythm sleep wake disorder
What are 3 examples of people who have disrupted circadian rhythm sleep wake disorder?
blind people, jetlag, shiftworkers
disorder #4 sleep related movement disorders
What are 2 main examples of sleep related movement disorders?
Which is more common in day/night?
PLM - periodic limb movement (more in daytime sleepiness, cramps, movements DURING SLEEP)
RLS - restless leg syndrome (more at night), irrestible urge to move legs painful repetitively
REM sleep behavior disorder (RBD) is liked to what age? what type of neurobiological/degenerative disorders? common in which gender?
older age, men
lewy bodies, PD, dementia
