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Sleep Disorders

                        Types & Treatments




Monday, May 21, 12                           1
Sleep Disorders
                                                                   ivation toll
  •Primary Sleep Disorders:
     -Dyssomnias                                          p depr eatest
                                                  • Slee it’s gr
                                                       akes              ilities.
       - Insomnia                                    t
                                                           cogni tive ab
                                                     on
         - Narcolepsy                                                   shown
         - Breathing-Related Sleeping Disorders                s have ugh sleep
                                                       Studie h eno
                                                         hat wit ion the
                                                   •
                                                       t
                                                           privat ill become
         - Circadian Rhythm Sleep Disorders
                                                        de
    -Parasomnias                                        anim    als w ntually
                                                                   d eve
       - Nightmares                                      sick an
         - Night Terrors                                  die.
         - Sleepwalking
         - Sleep Paralysis


Monday, May 21, 12                                                                  2
Insomnia
   •Difficulty falling asleep &
    staying asleep.
   •Not due to direct effects
    of substance use or
    general medical
    condition.
   •About 60 million
    Americans have chronic
    insomnia.
   •Affects 40% of women
    and 30 % of men.
   •Acute or Chronic
   •Treatment: medication or
    behavior modification.
Monday, May 21, 12               3
Monday, May 21, 12   4
Chronic Causes of Insomnia




Monday, May 21, 12                   5
Chronic Causes of Insomnia
        • Medications




Monday, May 21, 12                   5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use




Monday, May 21, 12                   5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use

        • Psychiatric disorders (e.g.,
            depression, anxiety)




Monday, May 21, 12                       5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use

        • Psychiatric disorders (e.g.,
            depression, anxiety)
        • Medical disorders




Monday, May 21, 12                       5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use

        • Psychiatric disorders (e.g.,
            depression, anxiety)
        • Medical disorders

        • Sleep apnea




Monday, May 21, 12                       5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use

        • Psychiatric disorders (e.g.,
            depression, anxiety)
        • Medical disorders

        • Sleep apnea

        • Restless leg syndrome



Monday, May 21, 12                       5
Chronic Causes of Insomnia
        • Medications

        • Drug or alcohol use

        • Psychiatric disorders (e.g.,
            depression, anxiety)
        • Medical disorders

        • Sleep apnea

        • Restless leg syndrome

        • Poor sleep hygiene
Monday, May 21, 12                       5
Insomnia Treatment




Monday, May 21, 12                        6
Insomnia Treatment
   Lifestyle changes often can help relieve acute (short-term) insomnia. These
   changes might make it easier to fall asleep and stay asleep.


   A type of counseling called cognitive-behavioral therapy (CBT) can help
   relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong
   insomnia.


   Several medicines also can help relieve insomnia and re-establish a regular sleep
   schedule.

Monday, May 21, 12                                                                      6
Sleep Apnea
  Repeated stoppage in breathing
  during sleep
  Caused by lack of breathing
  drive (central) or by blockage
  (obstructive)

  Signs/Symptoms:
    Snoring, headaches, fatigue,
    poor sleep, chronic
    congestion, irritability,      Treatment: Continual Positive Airway Pressure
    obesity, sexual dysfunction    (CPAP), Lifestyle Changes, and Surgery.


Monday, May 21, 12                                                                 7
Medications
   • Albuterol                              • Corticosteroids
   • Attention Deficit Disorder Meds (e.g.   • SSRIs (antidepressants)
     Ritalin)
   • Decongestants (Pseudoephedrine,        • Phenytoin (seizure medication)
     Phenylephrine)
                                            • Chemotherapy (cancer
   • Caffeine                                 medications)

   • “Diet pills"                           • Beta-blockers (high blood
   • Nicotine                                 pressure meds)

   • Thyroid medications
Monday, May 21, 12                                                             8
Circadian Rhythm Sleep
         Disorder

   •Persistent pattern of sleep disruption
    leading to excessive sleepiness or
    insomnia due to mismatch between sleep-
    wake schedule.

   •Obvious distress/impairment in social
    and occupational settings.

   Delayed Sleep Phase Type
     An unnatural sleeping pattern created by
     falling asleep late and waking up late
     which eventually establishes an inability
     to fall asleep and awaken at a desired
     earlier time.
Monday, May 21, 12                               9
Narcolepsy
 •Narcolepsy (NAR-ko-lep-se) is a
      disorder that causes periods of extreme
      daytime sleepiness due to trouble sleeping at
      night and is sometimes accompanied by
      paralysis and hallucinations

 • Hallucinations: Vivid, life-like dreams
       that occur while falling asleep or waking up.

 • Sleep paralysis: This condition prevents
       you from moving or speaking while waking up
       and sometimes while falling asleep. Last from
       a few seconds to a few minutes.
Monday, May 21, 12                                     10
Narcolepsy Causes
  Hypocretin (hi-po-KREET-in), a chemical in                                                    sy?
                                                                                    Na  rcolep
  the brain that helps promote wakefulness. Most             Wh o Is A
                                                                        tR  isk for
                                                                         sy af f
                                                                                 ects men
                                                                                            and
                                                                                            lly be
                                                                                                   gin
                                                             Narco
                                                                    lep                usua
                                                                               ptoms
  people who have narcolepsy have low levels of this          wome
                                                                    n . Sym
                                                                       t he
                                                                                     r yo ung a
                                                                             teen o also can
                                                                                                dult

                                                              during e disorder                 childr
                                                                                                      en ,
  chemical. What causes these low levels is unknown.                    Th
                                                               years. later in life
                                                                                          or in
                                                                                               5.
                                                                develop         befo  re age
                                                                but it' s rare



Possible factors include:
•Heredity. Some people may inherit a gene that affects hypocretin. Up to 10% of people who
have narcolepsy report having a relative with the same symptoms.
•Infections
•Brain injuries caused by brain tumors, strokes, or trauma.
•Autoimmune disorders
•Low levels of histamine, a substance in the blood that promotes wakefulness.
Monday, May 21, 12                                                                                           11
Narcoleptic
      Cataplexy
      Cataplexy (KAT-ah-
      plek-se) This condition
      causes a sudden loss of muscle
      tone while you're awake.
      Muscle weakness can affect
      certain parts of your body or
      your whole body. For example,
      if cataplexy affects your hand,
      you may drop what you're
      holding. It may last seconds or
      minutes.
Monday, May 21, 12                      12
Sleepwalking
                                (somnambulism)
  Sleepwalking is a disorder that
  occurs when people walk or do                 Symptoms of sleepwalking
  another activity while they are               include:
  still asleep.
                                                •Confusion/disorientation when woken up.
  •Sleepwalking most often occurs during
  deep, non-REM sleep, early in the night.      •A blank look on their face.
                                                •Opening their eyes while still asleep.
  •Sleepwalking happens most often in           •No memory of the episode.
  children ages 5 - 12.
                                                •Performing a detailed activity of any type
  •The episode can last from a few seconds to   while still asleep.
  over 30 minutes.
Monday, May 21, 12                                                                            13
Sleep Paralysis
                              •In the early stages of sleep.

                              •A person suddenly wakes
                               up and is aware of their
                               surroundings, but cannot
                               move.

                              •Treated with
                               antidepressants and SSRI’s


Monday, May 21, 12                                             14
Night Terrors
    Night terrors (sleep terrors)
    are a sleep disorder in which a
    person quickly wakes from
    sleep in a terrified state.             •Most common in children ages 3 - 7
                                           between midnight and 2 a.m.
    •The cause is unknown, but night       •A person may remember the details of
      terrors may be triggered by:         the dream and will not be disoriented after
          •Fever                           the episode.
          •Lack of sleep
          •Periods of emotional tension,
                                           •Treatment: Reducing stress may reduce
                                           night terrors.
             stress, or conflict.
          •Frightening movies or
              TV shows.
Monday, May 21, 12                                                                       15
Nightmares
                                              Prevalence by Age Group

• Extremely frightening dreams that
  occur in REM sleep.                              Young Adults
                                                       3%

• Less intense then sleep terrors.                                3-5 Year Olds
                                          Adults
                                           47%                        50%

• Person rapidly becomes aware and
  alert almost immediately after waking
  up.

Monday, May 21, 12                                                                16
Restless Leg Syndrome
 Neurological disorder that is characterized by unpleasant
 sensations of legs and an urge to move them when at the
 rest.
 •The unpleasant feelings are described as creeping, crawling, pulling, itching,
   tingling, burning, aching, or electric shocks.

 •The urges to move happen when the body is at rest and inactive. Thus, being worse
  in the evening which can cause chronic sleep disturbances and sleep deprivation.

 •Causes: Mostly unknown (idiopathic)

 •Treatment: underlying cause, some meds, and exercise.
Monday, May 21, 12                                                                    17
Sleep Hygiene




Monday, May 21, 12                   18
Sleep Hygiene
                     ✓   Try to limit caffeine intake.




Monday, May 21, 12                                       18
Sleep Hygiene
                     ✓   Try to limit caffeine intake.
                     ✓   Have a light snack before bedtime. (no big meals
                         before bedtime)




Monday, May 21, 12                                                          18
Sleep Hygiene
                     ✓   Try to limit caffeine intake.
                     ✓   Have a light snack before bedtime. (no big meals
                         before bedtime)
                     ✓   Set your bedroom for a comfortable temperature.




Monday, May 21, 12                                                          18
Sleep Hygiene
                     ✓   Try to limit caffeine intake.
                     ✓   Have a light snack before bedtime. (no big meals
                         before bedtime)
                     ✓   Set your bedroom for a comfortable temperature.
                     ✓   Minimize light exposure.



Monday, May 21, 12                                                          18
Sleep Hygiene
                     ✓   Try to limit caffeine intake.
                     ✓   Have a light snack before bedtime. (no big meals
                         before bedtime)
                     ✓   Set your bedroom for a comfortable temperature.
                     ✓   Minimize light exposure.
                     ✓   Try to follow a regular and consistent sleep schedule.

Monday, May 21, 12                                                                18
Sources




Monday, May 21, 12             19

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Sleep Disorders

  • 1. Sleep Disorders Types & Treatments Monday, May 21, 12 1
  • 2. Sleep Disorders ivation toll •Primary Sleep Disorders: -Dyssomnias p depr eatest • Slee it’s gr akes ilities. - Insomnia t cogni tive ab on - Narcolepsy shown - Breathing-Related Sleeping Disorders s have ugh sleep Studie h eno hat wit ion the • t privat ill become - Circadian Rhythm Sleep Disorders de -Parasomnias anim als w ntually d eve - Nightmares sick an - Night Terrors die. - Sleepwalking - Sleep Paralysis Monday, May 21, 12 2
  • 3. Insomnia •Difficulty falling asleep & staying asleep. •Not due to direct effects of substance use or general medical condition. •About 60 million Americans have chronic insomnia. •Affects 40% of women and 30 % of men. •Acute or Chronic •Treatment: medication or behavior modification. Monday, May 21, 12 3
  • 5. Chronic Causes of Insomnia Monday, May 21, 12 5
  • 6. Chronic Causes of Insomnia • Medications Monday, May 21, 12 5
  • 7. Chronic Causes of Insomnia • Medications • Drug or alcohol use Monday, May 21, 12 5
  • 8. Chronic Causes of Insomnia • Medications • Drug or alcohol use • Psychiatric disorders (e.g., depression, anxiety) Monday, May 21, 12 5
  • 9. Chronic Causes of Insomnia • Medications • Drug or alcohol use • Psychiatric disorders (e.g., depression, anxiety) • Medical disorders Monday, May 21, 12 5
  • 10. Chronic Causes of Insomnia • Medications • Drug or alcohol use • Psychiatric disorders (e.g., depression, anxiety) • Medical disorders • Sleep apnea Monday, May 21, 12 5
  • 11. Chronic Causes of Insomnia • Medications • Drug or alcohol use • Psychiatric disorders (e.g., depression, anxiety) • Medical disorders • Sleep apnea • Restless leg syndrome Monday, May 21, 12 5
  • 12. Chronic Causes of Insomnia • Medications • Drug or alcohol use • Psychiatric disorders (e.g., depression, anxiety) • Medical disorders • Sleep apnea • Restless leg syndrome • Poor sleep hygiene Monday, May 21, 12 5
  • 14. Insomnia Treatment Lifestyle changes often can help relieve acute (short-term) insomnia. These changes might make it easier to fall asleep and stay asleep. A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia. Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. Monday, May 21, 12 6
  • 15. Sleep Apnea Repeated stoppage in breathing during sleep Caused by lack of breathing drive (central) or by blockage (obstructive) Signs/Symptoms: Snoring, headaches, fatigue, poor sleep, chronic congestion, irritability, Treatment: Continual Positive Airway Pressure obesity, sexual dysfunction (CPAP), Lifestyle Changes, and Surgery. Monday, May 21, 12 7
  • 16. Medications • Albuterol • Corticosteroids • Attention Deficit Disorder Meds (e.g. • SSRIs (antidepressants) Ritalin) • Decongestants (Pseudoephedrine, • Phenytoin (seizure medication) Phenylephrine) • Chemotherapy (cancer • Caffeine medications) • “Diet pills" • Beta-blockers (high blood • Nicotine pressure meds) • Thyroid medications Monday, May 21, 12 8
  • 17. Circadian Rhythm Sleep Disorder •Persistent pattern of sleep disruption leading to excessive sleepiness or insomnia due to mismatch between sleep- wake schedule. •Obvious distress/impairment in social and occupational settings. Delayed Sleep Phase Type An unnatural sleeping pattern created by falling asleep late and waking up late which eventually establishes an inability to fall asleep and awaken at a desired earlier time. Monday, May 21, 12 9
  • 18. Narcolepsy •Narcolepsy (NAR-ko-lep-se) is a disorder that causes periods of extreme daytime sleepiness due to trouble sleeping at night and is sometimes accompanied by paralysis and hallucinations • Hallucinations: Vivid, life-like dreams that occur while falling asleep or waking up. • Sleep paralysis: This condition prevents you from moving or speaking while waking up and sometimes while falling asleep. Last from a few seconds to a few minutes. Monday, May 21, 12 10
  • 19. Narcolepsy Causes Hypocretin (hi-po-KREET-in), a chemical in sy? Na rcolep the brain that helps promote wakefulness. Most Wh o Is A tR isk for sy af f ects men and lly be gin Narco lep usua ptoms people who have narcolepsy have low levels of this wome n . Sym t he r yo ung a teen o also can dult during e disorder childr en , chemical. What causes these low levels is unknown. Th years. later in life or in 5. develop befo re age but it' s rare Possible factors include: •Heredity. Some people may inherit a gene that affects hypocretin. Up to 10% of people who have narcolepsy report having a relative with the same symptoms. •Infections •Brain injuries caused by brain tumors, strokes, or trauma. •Autoimmune disorders •Low levels of histamine, a substance in the blood that promotes wakefulness. Monday, May 21, 12 11
  • 20. Narcoleptic Cataplexy Cataplexy (KAT-ah- plek-se) This condition causes a sudden loss of muscle tone while you're awake. Muscle weakness can affect certain parts of your body or your whole body. For example, if cataplexy affects your hand, you may drop what you're holding. It may last seconds or minutes. Monday, May 21, 12 12
  • 21. Sleepwalking (somnambulism) Sleepwalking is a disorder that occurs when people walk or do Symptoms of sleepwalking another activity while they are include: still asleep. •Confusion/disorientation when woken up. •Sleepwalking most often occurs during deep, non-REM sleep, early in the night. •A blank look on their face. •Opening their eyes while still asleep. •Sleepwalking happens most often in •No memory of the episode. children ages 5 - 12. •Performing a detailed activity of any type •The episode can last from a few seconds to while still asleep. over 30 minutes. Monday, May 21, 12 13
  • 22. Sleep Paralysis •In the early stages of sleep. •A person suddenly wakes up and is aware of their surroundings, but cannot move. •Treated with antidepressants and SSRI’s Monday, May 21, 12 14
  • 23. Night Terrors Night terrors (sleep terrors) are a sleep disorder in which a person quickly wakes from sleep in a terrified state. •Most common in children ages 3 - 7 between midnight and 2 a.m. •The cause is unknown, but night •A person may remember the details of terrors may be triggered by: the dream and will not be disoriented after •Fever the episode. •Lack of sleep •Periods of emotional tension, •Treatment: Reducing stress may reduce night terrors. stress, or conflict. •Frightening movies or TV shows. Monday, May 21, 12 15
  • 24. Nightmares Prevalence by Age Group • Extremely frightening dreams that occur in REM sleep. Young Adults 3% • Less intense then sleep terrors. 3-5 Year Olds Adults 47% 50% • Person rapidly becomes aware and alert almost immediately after waking up. Monday, May 21, 12 16
  • 25. Restless Leg Syndrome Neurological disorder that is characterized by unpleasant sensations of legs and an urge to move them when at the rest. •The unpleasant feelings are described as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. •The urges to move happen when the body is at rest and inactive. Thus, being worse in the evening which can cause chronic sleep disturbances and sleep deprivation. •Causes: Mostly unknown (idiopathic) •Treatment: underlying cause, some meds, and exercise. Monday, May 21, 12 17
  • 27. Sleep Hygiene ✓ Try to limit caffeine intake. Monday, May 21, 12 18
  • 28. Sleep Hygiene ✓ Try to limit caffeine intake. ✓ Have a light snack before bedtime. (no big meals before bedtime) Monday, May 21, 12 18
  • 29. Sleep Hygiene ✓ Try to limit caffeine intake. ✓ Have a light snack before bedtime. (no big meals before bedtime) ✓ Set your bedroom for a comfortable temperature. Monday, May 21, 12 18
  • 30. Sleep Hygiene ✓ Try to limit caffeine intake. ✓ Have a light snack before bedtime. (no big meals before bedtime) ✓ Set your bedroom for a comfortable temperature. ✓ Minimize light exposure. Monday, May 21, 12 18
  • 31. Sleep Hygiene ✓ Try to limit caffeine intake. ✓ Have a light snack before bedtime. (no big meals before bedtime) ✓ Set your bedroom for a comfortable temperature. ✓ Minimize light exposure. ✓ Try to follow a regular and consistent sleep schedule. Monday, May 21, 12 18