Sleep disorders (PPT 83 kB)

SLEEP DISORDERS

Andrzej Kokoszka

II Klinika Psychiatryczna AM w Warszawie

Dyssomnias – problems with the timing, quality or amount of sleep

Parasomnias - abnormalities in physiology or in behavior associated with sleep

General information

Sleep disorders

Insomnia - difficulty falling asleep or staying asleep

that - occurs three times per week for at least 1

month and leads to sleepiness during the day- or causes problems fulfilling social or

occupational obligations.

- is present in at least 30% of the population.

General information

Dyssomnias

Causes of insomnia: Major depressive disorder

- normal sleep onset

- repeated nighttime awakenings

- waking too early

General information

Dyssomnias

Causes of insomnia: Mania or hypomania - trouble falling

asleep and sleep fewer hours. Anxious patients trouble falling asleep

General information

Dyssomnias

Causes of insomnia: Use of CNS stimulants (e.g., caffeine) -

the most common cause of insomnia. Withdrawal of agents with sedating action

(e.g., alcohol, benzodiazepines, and opiates).

Medical conditions causing pain and endocrine and metabolic disorders.

General information

Dyssomnias

• Avoidance of caffeine, especially before bedtime

• Development of a series of behaviors associated with bedtime (i.e., "a sleep ritual" or "sleep hygiene")

• Maintaining a fixed sleeping and waking schedule

• Daily exercise (but not just before sleep)

General information

Dyssomnias – treatment of insomnia

• Relaxation techniques

• Psychoactive agents (i.e., limited use of sleep agents to establish an effective sleep pattern and antidepressants or antipsychotics if appropriate)

General information

Dyssomnias – treatment of insomnia

stop of breathing for brief intervals. low oxygen or high carbon dioxide level in

the blood awakens the patient repeatedly during the night, resulting in daytime sleepiness.

General information

Dyssomnias: breathing-related sleep disorder (sleep apnea)

central sleep apnea (more common in the elderly), little or no respiratory effort occurs, resulting in less air reaching the lungs.

obstructive sleep apnea, respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs.

General information

Dyssomnias: breathing-related sleep disorder (sleep apnea)

obstructive sleep apnea occurs most often in people 40-60 years of age, and is more common in men (8x) and in the obese. Patients often snore.

Sleep apnea occurs in 1%-10% of the population and is related to depression, headaches, and pulmonary hypertension. It also may result in sudden death during sleep in the elderly and in infants.General information

Dyssomnias: breathing-related sleep disorder (sleep apnea)

Treatment:

• Weight loss (if overweight)

• Continuous positive airway pressure (CPAP), a device applied to the face at night to gently move air into the lungs

• Surgery to enlarge the airway, e.g.,

• Tracheostomy (as a last resort)

General information

Dyssomnias: breathing-related sleep disorder (sleep apnea)

sleep attacks (i.e., fall asleep suddenly during the day) despite having a normal amount of sleep at night.

-hypnagogic or hypnopompic hallucinations. These are strange perceptual experiences that occur just as the patient falls asleep or wakes up, respectively, and occur in 20- 40% of patients.

General information

Dyssomnias: narcolepsy

sleep paralysis - the inability to move the body for a few seconds after waking.

is uncommon decreased sleep latency, very short REM

latency (<10 minutes), less total REM, and interrupted REM (sleep fragmentation).

General information

Dyssomnias: narcolepsy

cataplexy - a sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus (e.g., laughter, fear) and occurs in 30-70% of patients.

occurs most frequently in adolescents and young adults.

may have a genetic component.

General information

Dyssomnias: narcolepsy

Treatment: Stimulant agents (e.g., methylphenidate

[Ritalin], modafinil [Provigil] if cata plexy is present, antidepressants may be added)

Scheduled daytime naps

General information

Dyssomnias: narcolepsy

Circadian rhythm sleep disorder Inability to sleep at appropriate times Delayed sleep phase type involves falling

asleep and waking later than wanted Jet lag type last 2-7 days after a change in

time zones Shift work type (e.g., in physician training)

can result in physician errorGeneral information

Dyssomnias

Nocturnal myoclonus Repetitive, abrupt muscular contractions in

the legs from toes to hips Causes nighttime awakenings More common in the elderly

General information

Dyssomnias

Restless leg syndrome Uncomfortable sensation in the legs

necessitating frequent motion Repetitive limb jerking during sleep Causes difficulty falling asleep and

nighttime awakenings More common with aging, pregnancy, and

kidney disease

General information

Dyssomnias

Primary hypersomnias [Kleine-Levin syndrome and menstrual-associated syndrome (symptoms only in the premenstrum)]

Recurrent periods of excessive sleepiness occurring almost daily for at least 1 mont

Sleepiness is not relieved by daytime na Often accompanied by hyperphagia

(overeating) Kleine-Levin syndrome is more common in

adolescent malesGeneral information

Dyssomnias

Sleep drunkenness Difficulty awakening fully after adequate

sleep Rare, must be differentiated from

substance abuse or other sleep disorder Associated with genetic factors

General information

Dyssomnias

Bruxism Tooth grinding during sleep (stage 2) Can lead to tooth damage and jaw pain Treated with dental appliance worn at

night or corrective orthodontia

General information

Parasomnias

Sleepwalking disorder Repetitive walking around during sleep No memory of the episode on awakening Begins in childhood (usually 4-8 years of

age) Occurs during delta sleep

General information

Parasomnias

Sleep terror disorder Repetitive experiences of fright in which a person

(usually a child) screams in fear during sleep The person cannot be awakened The person has no memory of having a dream Occurs during delta sleep Onset in adolescence may indicate temporal lobe

epilepsy

General information

Parasomnias

Nightmare disorder Repetitive, frightening dreams that cause

nighttime awakenings The person usually can recall the

nightmare Occurs during REM sleep

General information

Parasomnias

REM sleep behavior disorder REM sleep without skeletal muscle

paralysis Patients can injure themselves or their

sleeping partners

General information

Parasomnias