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PSY3032 - Abnormal Psychology > Week 3 - Sleep Disorders > Flashcards

Week 3 - Sleep Disorders Flashcards

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1
Q

What are the characteristics of normal sleep?

A
  • Reversible state of immobility
  • cyclical
  • ritualistic
  • active (
  • essential for mental and physical health
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2
Q

What are the 3 ways to classify/ examine sleep disorders?

A
  • International Classification of Diseases (ICD-11) (medical model)
  • International Classification of Sleep Disorders (ICSD-3)
  • The Diagnostic and Statistical Manual (DSM-5)
  • -> Sleep-Wake Disorders
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3
Q

What brain region is implicated in wakefulness?

A
  • Brain stem

- Forebrain/ cortex

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4
Q

What brain region is implicated in sleep?

A
  • ventrolateral preoptic nucleus sends inhibitory signals to arousal centres promoting sleep state
  • problems with these regions cause disorders. with wakefulness/sleep or on the cusp (Parasomnia)
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5
Q

Why do sleep disorders have their own classification system?

A
  • There are 85+ sleep disorders according to the ICSD-3
  • Sleep is critical for health (third pilar)
  • Costs 66.3 Billion: healthcare costs & loss of productivity
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6
Q

Define Insomnia (Primary)

A

Predominant complaint of: initiation, maintenance or early morning awakening

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7
Q

What is the DSM-5 criteria for insomnia (primary)?

A

A) Predominant complaint of: initiation, maintenance or early morning awakening

B) clinically significant distress/ impairment

C) 3 times per week

D) Sleep difficulty presents for at least 3 months

E) Sleep difficulty occurs despite adequate opportunity for sleep

F) Disturbance not caused by another sleep disorder

G) Disorder not due to another mental/ substance or general medical disorder

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8
Q

Describe the characteristics of insomnia (primary)

A

Difficulties with sleep:

  • initiation
  • consolidation
  • quality
  • daytime impairment
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9
Q

Describe the causes of insomnia

A
  • Circadian timing

- Sleep should be aligned with biological signal for sleep

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10
Q

Describe the prevalence of insomnia

A
  • 10-30%
  • 3rd cause of seeing physician
  • Highly co-morbid with depression(60% in world) (1/2 patients)
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11
Q

How is insomnia diagnosed?

A

Sleep interview

  • Narrative of bedtime
  • Sleep perceptions
  • Triggers
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12
Q

What are the types of primary sleep disorders according to the ICSD-3?

A
  • Psychophysiological - heightened sense of arousal
  • Sleep state misconception (paradoxical insomnia)– no evidence of objective disorder
  • Idiopathic insomnia (childhood onset insomnia)
  • Inadequate sleep hygiene (e.g. caffeine too late )
  • Adjustment sleep disorder (triggered by stressor e.g. pain, anxiety, noise)
  • Behavioural insomnia of childhood (refusal to go to bed, reliance of sleep onset cues)
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13
Q

What is Spielman’s (1987) Model of insomnia?

A

Predisposing - e.g. being female & anxiety makes one more vulnerable to insomnia [premorbid]

Precipitating - trigger symptoms e.g. divorce, noise, stress [acute]

Perpetuating - e.g. day time napping, excessive worry about sleep. exacerbate symptoms [chronic insomnia]

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14
Q

Outline the global changes in cognitive and mental health that occur as a consequence of insomnia

A

increased pain, emotional effects & mental health effects compared to heart failure

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15
Q

In terms of occupational risk ____ % more likely to have accident as a consequence of insomnia

A

2.5-4.5%

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16
Q

Describe the pre-2015 view of insomnia

A

Primary
- Insomnia only not associated with physical or psychological disorder

Secondary
- as a consequence of a co-morbidity with other conditions

17
Q

What are the treatments for insomnia?

A
  • Benzodiazepines or Z-drugs for sleep
CBT for insomnia 
  - Sleep restriction (cutting 
   time in bed to increase 
    sleep drive)
  - Stimulus control (removing 
    clocks 
   - Relaxation. (progressive 
   muscle relaxation)
18
Q

What are the treatments for insomnia?

A
  • Benzodiazepines or Z-drugs for sleep
CBT for insomnia 
  - Sleep restriction (cutting 
   time in bed to increase 
    sleep drive)
  - Stimulus control (removing 
    clocks 
   - Relaxation. (progressive 
   muscle relaxation)
   - cognitive therapy - 
   challenging beliefs and 
   expectations
  - slee hygiene
19
Q

What are the treatments for insomnia?

A
  • Benzodiazepines or Z-drugs for sleep
CBT for insomnia 
  - Sleep restriction (cutting 
   time in bed to increase 
    sleep drive)
  - Stimulus control (removing 
    clocks 
   - Relaxation techniques. (progressive 
   muscle relaxation)
   - cognitive therapy - 
   challenging beliefs and 
   expectations
  - sleep hygiene
20
Q

Define Narcolepsy

A

Characterised by the irrepressible urge to sleep or lapses into sleep

21
Q

What is the DSM-5 criteria for Narcolepsy?

A

A. Characterised by the irrepressible urge to sleep or lapses into sleep
A.a 3 times per week, 3 months

B. one of the following:
 a) Episodes of cataplexy
 b) deficiency 
 c) REM sleep latency 
    <15minutes, OR MSLT 
    <8 minutes + two 
      SOREMPs
22
Q

What is the prevalence of narcolepsy?

A

1 in 2000

can take 5-10 years to get diagnostic

23
Q

What are the three defining symptoms of narcolepsy ?

A

A. Excessive daytime sleepiness

B. Hypocretin/orexin deficiency - system is implicated in wake signalling

C. Cataplexy - loss of muscle tone due to initiation of REM sleep

24
Q

What are the causes of narcolepsy?

A

Genetic
- Human leukocyte antigen (HLA- DQB1)

Immune response

  • most prevalent in late spring
  • 2009/10 winter (Swine flue& vaccine ^ cases of narcolepsy)

Strong emotions
- can cause episode of cataplexy

25
Q

Which peptide that is involved in narcolepsy is also involved in addiction/ reward, feeding and wake

A

orexin

26
Q

Modafinil promotes ___ and is used for the disorder___

A

promotes wakefulness and is used for the treatment of narcolepsy.

A form of Provigil and Nuvigil

27
Q

Define Parasomnia

A

Abnormal behavioural, experiential or physiological events occurring in association with sleep, specific sleep stages or sleep-wake transitions

28
Q

What is the prevalence of Parasomnia?

A

4%

Greater in males

29
Q

True or false, parasomnia can occur at any stage of sleep

A

True - this impacts the presentation of experiences e.g. night terrors possible in NREM sleep because muscles sedation hasn’t occurred yet

30
Q

True or false, parasomnia can occur at any stage of sleep

A

True - this impacts the presentation of experiences e.g. night terrors possible in NREM sleep because muscles inhibition hasn’t occurred yet

31
Q

What is the DSM-5 criteria for disorders from arousal/ NREM parasomnia?

A

A. Recurrent episodes of incomplete awakening from sleep usually occurring in the first third of the sleep episode

32
Q

What is the DSM-5 criteria for disorders from arousal/ NREM parasomnia?

A

A. Recurrent episodes of incomplete awakening from sleep usually occurring in the first third of the sleep episode accompanied by:

  1. NIGHT TERRORS
  2. SLEEP WALKING

B. No/ 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. Not better explained by another mental or medical disorder

33
Q

What is the Diagnostic Criteria (DSM-IV-TR) for Night Terrors.

(how are night terrors different to nightmare disorder?)

A
  • abrupt “Awakening” from sleep (may scream, no recollection of this)
  • Episodes feature intense fear and autonomic response
  • Unresponsive to wake or comfort
  • No recall of dream
  • common in children
  • occurs in first 3rd of the night. co-occurs with sleep walking
34
Q

What is the prevalence of night terrors and typical age of onset

A

Prevalence
Children - 1-6%
Adults - <1%

Age of onset
Children - 4-12y
Adults 20-30y

35
Q

What are the treatments for night terrors?

A
  • avoid day-time sleepiness
  • don’t wake someone during a night terror
  • scheduled awaking e.g. wake before terror occurs using sleep scheduling
36
Q

What is the Diagnostic Criteria for Sleep Walking?

A
  • 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
37
Q

What is the treatment for sleep walking?

A
  • environment modification to make it safer
  • scheduled awakening (before onset of sleep walking)
  • medications
38
Q

What is the prevalence of sleep walking? Prevalence peaks

A

1-5% population

10-30% in children

PSY3032 - Abnormal Psychology (5 decks)

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