Week 3 - Sleep Disorders Flashcards
What are the characteristics of normal sleep?
- Reversible state of immobility
- cyclical
- ritualistic
- active (
- essential for mental and physical health
What are the 3 ways to classify/ examine sleep disorders?
- 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
What brain region is implicated in wakefulness?
- Brain stem
- Forebrain/ cortex
What brain region is implicated in sleep?
- 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)
Why do sleep disorders have their own classification system?
- 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
Define Insomnia (Primary)
Predominant complaint of: initiation, maintenance or early morning awakening
What is the DSM-5 criteria for insomnia (primary)?
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
Describe the characteristics of insomnia (primary)
Difficulties with sleep:
- initiation
- consolidation
- quality
- daytime impairment
Describe the causes of insomnia
- Circadian timing
- Sleep should be aligned with biological signal for sleep
Describe the prevalence of insomnia
- 10-30%
- 3rd cause of seeing physician
- Highly co-morbid with depression(60% in world) (1/2 patients)
How is insomnia diagnosed?
Sleep interview
- Narrative of bedtime
- Sleep perceptions
- Triggers
What are the types of primary sleep disorders according to the ICSD-3?
- 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)
What is Spielman’s (1987) Model of insomnia?
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]
Outline the global changes in cognitive and mental health that occur as a consequence of insomnia
increased pain, emotional effects & mental health effects compared to heart failure
In terms of occupational risk ____ % more likely to have accident as a consequence of insomnia
2.5-4.5%
Describe the pre-2015 view of insomnia
Primary
- Insomnia only not associated with physical or psychological disorder
Secondary
- as a consequence of a co-morbidity with other conditions
What are the treatments for insomnia?
- 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)
What are the treatments for insomnia?
- 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
What are the treatments for insomnia?
- 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
Define Narcolepsy
Characterised by the irrepressible urge to sleep or lapses into sleep
What is the DSM-5 criteria for Narcolepsy?
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
What is the prevalence of narcolepsy?
1 in 2000
can take 5-10 years to get diagnostic
What are the three defining symptoms of narcolepsy ?
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
What are the causes of narcolepsy?
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
Which peptide that is involved in narcolepsy is also involved in addiction/ reward, feeding and wake
orexin
Modafinil promotes ___ and is used for the disorder___
promotes wakefulness and is used for the treatment of narcolepsy.
A form of Provigil and Nuvigil
Define Parasomnia
Abnormal behavioural, experiential or physiological events occurring in association with sleep, specific sleep stages or sleep-wake transitions
What is the prevalence of Parasomnia?
4%
Greater in males
True or false, parasomnia can occur at any stage of sleep
True - this impacts the presentation of experiences e.g. night terrors possible in NREM sleep because muscles sedation hasn’t occurred yet
True or false, parasomnia can occur at any stage of sleep
True - this impacts the presentation of experiences e.g. night terrors possible in NREM sleep because muscles inhibition hasn’t occurred yet
What is the DSM-5 criteria for disorders from arousal/ NREM parasomnia?
A. Recurrent episodes of incomplete awakening from sleep usually occurring in the first third of the sleep episode
What is the DSM-5 criteria for disorders from arousal/ NREM parasomnia?
A. Recurrent episodes of incomplete awakening from sleep usually occurring in the first third of the sleep episode accompanied by:
- NIGHT TERRORS
- 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
What is the Diagnostic Criteria (DSM-IV-TR) for Night Terrors.
(how are night terrors different to nightmare disorder?)
- 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
What is the prevalence of night terrors and typical age of onset
Prevalence
Children - 1-6%
Adults - <1%
Age of onset
Children - 4-12y
Adults 20-30y
What are the treatments for night terrors?
- avoid day-time sleepiness
- don’t wake someone during a night terror
- scheduled awaking e.g. wake before terror occurs using sleep scheduling
What is the Diagnostic Criteria for Sleep Walking?
- 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
What is the treatment for sleep walking?
- environment modification to make it safer
- scheduled awakening (before onset of sleep walking)
- medications
What is the prevalence of sleep walking? Prevalence peaks
1-5% population
10-30% in children
