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Sleep disorders
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- 2. INTRODUCION TO SLEEPDISORDERS (KUSHIDA, 2009) Sleep disorders can affect the quality and quantity of sleep or can cause difficulty maintaining normal wakefulness Both of which can cause impaired daytime functioning and a host of medical, psychiatric and psychosocial problems. There are more than 80 different types of sleep disorders that afflict about 70 million Americans.
- 3. FUNCTIONS OF SLEEP(MORIN & ESPIE, 2012) What is Microsleep? (3-15 sec) Sleep restores our body tissues and facilitates body growth Sleep increases our immunity to disease Sleep keeps our mind alert Sleep helps us to process memories Sleep enhances our mood
- 4. HOW MUCH SLEEPDO WE NEED? Age Baby (16-18 hours) Preschoolers (10-12) Teenagers & young adults (8-10) 33-45 years (6-8) 50-70 years (4-6) Life style Genetics
- 5. CIRCADIAN RHYTHUM(CHOKROVERTY, 2010) Circadian Rhythum: Changes in bodily processes that occur repeatedly on approximately a 25-hour cycle Suprachiasmatic nucleus SCN : A group of brain cells in hypothalamus that signal other brain areas when to be aroused and when to shut down. Melatonin: hormone in the body that facilitate the sleep
- 6. CONTI…. Our biologicalclock that is genetically programmed to regulate physiological responses within a 24 – 25 hour period. They operate without normal night and day cues The circadian rhythm does not control our sleep cycle; the environment and the 24 hour period does. (i.e.. Jet lag)
- 7. STAGES OF SLEEP(AMBROGETTI HENSLEY & OLSON, 2006) About every 90 or 100 minutes we pass through 5 stages of sleep. Throughout the five stages, our brain waves continually fluctuate, thus defining each distinctive stage.
- 9. LIGHT SLEEP- STAGE1(WALKER & STICKGOLD, 2005) Body movement decreases Spontaneous Waking may occur (when you feel like you are falling out of bed)
- 10. INTERMEDIATE SLEPP-STAGE 2 Officially asleep Your brain waves slow down with some bursts of brain activity called ‘Sleep Spindles’ half of your sleep in this stage. Helps refresh body
- 11. DEEP SLEEP-3 &4 STAGE Deep sleep sets in – hard to wake up brain waves become large and slow Your breathing becomes rhythmic, and your muscles remain relaxed. Most Restorative stage (reparative hormones released) 30-40 min first and shorter later Towards the end of stage 4, children may wet beds, adults may sleep walk, etc… Interestingly, even though you are in deep sleep, your brain will still process the meaning of certain stimuli!!
- 12. RAPID EYE MOVEMENT(REM) Nearly an hour after you fall asleep, you begin to descend back through the stages of sleep. During sleep you go stages 1,2,3,4,3,2 then… You then enter what is known as REM Sleep! REM –This stage only lasts about 10 minutes. (20 – 30 minutes later in night) Heart rate rises Breathing becomes rapid Every 30 seconds or so, your eyes rapidly move around
- 13. REM (CONT…) Motorcortex is still active, but your brainstem blocks any messages. This leaves your muscles so relaxed that you are essentially paralyzed. Thus, you are not easily awakened. The cycle repeats itself every 90 minutes or so. As the night progresses, we spend less and less time in stage 4 and more in REM. By the time we wake-up, we have spent 20 – 25% of the night in REM Sleep.
- 15. SLEEP DISORDERS Dyssomnia (problems with amount,quality and timing of sleep) Parasomnia (abnormal behaviors that are associated with sleep) Primary Sleep disorders Sleep disorder related to another mental disorder Sleep disorder related to general medical condition Substance induced sleep disorder Secondary Sleep Disorders
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- 17. INSOMNIA (ESPIE, 2002) Difficulty falling asleep at night or getting back to sleep after waking during the night Waking up frequently during the night Your sleep feels light, fragmented, or exhausting You need to take something (sleeping pills, nightcap, supplements) in order to get to sleep Sleepiness and low energy during the day 30-40% population suffered from it Mostly in old age More prevalent in females
- 18. INSOMNIA (EXPLANATION) Excessivelevel of neurological activity Reticular activity system carrying too much activity from the brain stem to cortex
- 19. INSOMNIA (TREATMENT) Physiologicalapproach/drug therapy Hypnotics (Greek word means to “put to sleep”) (benzodiazepines): these increase the activity of inhibitory neurons, reduces the general arousal and thus facilitate sleep Commonly used hypnotics include 1. Halcion (trizolam) 2. Dalamine (flurazepam) 3. Restoril (temazepam)
- 20. TREATMENT FOR INSOMNIA Sleephygiene Sleep education Stimulus control Relaxation CBT Exercise and utilizing energy in daily chores Pharmaceutical
- 21. DRUG THERAPY Insome cases antidepressants are also used such as Elavil (amitriptyline) Antipsychotics are also used such as Haldol (haloperidol)
- 22. COGNITIVE BEHAVIORAL THERAPY Sleep education Cognitive control and psychotherapy Sleep restriction therapy (SRT) Stimulus control (SC) Sleep hygiene Progressive muscle relaxation (PMR) Deep breathing Bio-feed back Sleep diary
- 23. HYPERSOMNIA (CHOKROVERTY, 2009) Excessive sleepiness which leads to 1. Long periods of sleep at night 2. Need for nap during day time 3. But these naps not relieve sleepiness 4. Individual drag himself throughout the day 5. Become grouchy and ineffective Even dangerous when it continuous in different activities like driving etc.
- 24. HYPERSOMNIA (EXPLANATION) Causedby insufficient neurological activity due to many factors including lesions in hypothalamus Treatment Treat with stimulants like caffeine which increase alertness Ritalin (methylphenidate) and various amphetamines are also used Sleep restriction
- 25. HABBITS THAT IMPAIRSLEEP Day time napping Too much rest No activities for day time Excessive caffeine Anxiety and anticipations regarding sleep Excessive exposure to media Environmental factors such as noisy room Too active bed patterns, loud music etc
- 26. NARCOLEPSY Irresistible sleepattacks Loss of muscle tone REM sleep at the start or end of sleep Temporary refreshing Insufficient neurological arousal Stimulants are used Small naps during day time can help NARCOLEPSY (EXPLANATION AND TREATMENT)
- 27. BREATHING RELATED SLEEPDISORDER Sleep frequently disrupted because of problems with breathing Sleep apneas fall into two categories
- 28. OBSTRUCTIVE APNEA Obstructionof airway to the lungs that the individual is briefly deprived of oxygen due to following three reasons 1. The muscle that keep the airway open cannot receive enough stimulation 2. Obesity can lead to narrowing of airway 3. Position of sleeping 4. Surgery to increase the airway size
- 29. TREATMENT FOR OBSTRUCTIVEAPNEA Behavioral treatment Avoidance from sedatives Wt. loss Sleeping on side or face down Drug therapy Antidepressants to suppress REM Use of mechanical device
- 30. CENTRALAPNEA It stemsfrom the problem in brain that causes a brief interruption in breathing It occurs more often in older individuals
- 31. CIRCADIAN RHYTHM SLEEPDISORDER Mismatch between the timing of an individual’s natural sleep-wake cycle and the demands made on the individual by the circumstances in which he or she lives. It can be treated with bright light
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- 37. Other Types ofSleep disturbances
- 41. DELAYED SLEEP PHASEDISORDER People with delayed sleep phase disorder are unable to get to sleep earlier than 2 to 6 a.m. no matter how hard they try. They struggle to go to sleep and get up at socially acceptable times. When allowed to keep their own hours (such as during a school break or holiday), they fall into a regular sleep schedule. Delayed sleep phase disorder is most common in teenagers, and many teens will eventually grow out of it. For those who continue to struggle with a biological clock that is out of sync, treatments such as light therapy and chronotherapy can help. To learn more, schedule an appointment with a sleep doctor or local sleep clinic.
- 42. JET LAG Jetlag is a temporary disruption in circadian rhythms that occurs when you travel across time zones. Symptoms include daytime sleepiness, fatigue, headache, stomach problems, and insomnia. The symptoms typically appear within a day or two after flying across two or more time zones. The longer the flight, the more pronounced the symptoms. The direction of flight also makes a difference. Flying east tends to cause worse jet lag than flying west.
- 43. JET LAG (CONT….) However, jet lag can be worse if individual: Lost sleep during travel Are under a lot of stress Drink too much alcohol or caffeine Didn’t move around enough during your flight
- 44. DSM V CRITERIA The most obvious concerns are fatigue and cognitive focus, but mood can be greatly affected too. Sleep disorder not only is a risk factor for subsequent development of certain mental conditions but a potential warning sign for serious mental or medical issues.
- 45. CONT….. Sleep disordersrange from insomnia disorder to narcolepsy and breathing-related disorders to restless legs syndrome. A prime goal of DSM-5 changes to sleep-wake disorders is to increase the clinical utility of definitions and diagnostic criteria, especially for general medical or mental health clinicians, and to clarify when referral is appropriate to a sleep specialist.
- 46. CHANGES FROM DSMIV TR TO DSM V Sleep-wake disorders instead of sleep disorders. The diagnosis of primary insomnia has been renamed insomnia disorder to avoid the differentiation of primary and secondary insomnia. DSM-5 also distinguishes narcolepsy, which is now known to be associated with hypocretin deficiency, from other forms of hypersomnolence.
- 47. IS IT ASLEEP DISORDER? Do you. . . Feel irritable or sleepy during the day? Have difficulty staying awake when sitting still, watching television or reading? Fall asleep or feel very tired while driving? Have difficulty concentrating? Often get told by others that you look tired? React slowly? Have trouble controlling your emotions? Feel like you have to take a nap almost every day? Require caffeinated beverages to keep yourself going?
- 48. CONCLUSION Bio psychosocial model Successful management in sleep in adults can improve quality of life and daily functioning
- 49. REFERENCES Ambrogetti, A.,Hensley, M. J., & Olson, L. G. (Eds.). (2006). Sleep disorders: A clinical textbook. Quay Books. Chokroverty, S. (2010). Overview of sleep & sleep disorders. Espie, C. A. (2002). Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53(1), 215-243. Kushida, C. A. (Ed.). (2009). Handbook of sleep disorders. Informa Healthcare. Morin, C. M., & Espie, C. A. (Eds.). (2012). The Oxford handbook of sleep and sleep disorders. Oxford University Press. Walker, M. P., & Stickgold, R. (2014). Sleep, memory and plasticity.Neuroscience and Psychoanalysis, 1, 93.