Sleep Disorders (Somnipathy)

1. Sleep Disorders (Somnipathy)

2. Sleep Disorders 1 - Insomnia • BATs • A01 Outline the classification of sleep disorders • A01 Explain the differences between primary and secondary insomnia • A01Describe some of the explanations for insomnia and the role of personality • Synoptic points – • research complications, • real world application – attribution theory (cognitive approach)

3. Traditionally, sleep disorders have been divided into primary and secondary disorders. Primary Insomnia - result from an endogenous disturbance in the sleeping mechanism, often complicated by learned behaviours and bad sleep habits. Insomnia the only problem. Insomnia occurs with no cause for more than 1 month (DSM) Secondary Insomnia - are said to be the result of another disorder –e.g. depression, pregnancy, respiratory problems or gastroesophageal reflux disease, shift work, too much caffeine or alcohol INSOMNIA

4. In 2007 Dr Ancoli-Israel suggested that this is a false distinction and that all sleep disorders should be regarded as comorbid, and receive the same emphasis in treatment. BUT Ohayon and Roth 2003 – Studied 15,000 Europeans – found that insomnia preceded cases of mood disorders. Therefore treat the insomnia whether it is primary or secondary

5. Dyssomnias- a broad category including insomnia and hypersomnolence (too much sleep) Parasomnias – strange behaviours during sleep Medical or psychiatric conditions that can produce somnipathy Major Classifications of Somnipathy

6. Insomnia Narcolepsy Obstructive sleep apnea Restless legs syndrome Klein-Levin Syndrome Post-traumatic hypersomnia Dyssomnias- a broad category including insomnia and hypersomnolence

7. Night terrors Bruxism (tooth grinding) Sleepwalking (somnambulism) Sleeptalking (somniloquy) Exploding head syndrome! Parasomnias – strange behaviours during sleep

8. Exploding head syndrome • is a conditionthat causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, waves crashing against rocks, loud voices or screams, a ringing noise, or the sound of an electrical short circuit (buzzing). • This noise usually occurs within an hour or two of falling asleep, but is not necessarily the result of a dream and can happen while awake as well.[1] Perceived as extremely loud, the sound is usually not accompanied by pain. Attacks appear to change in number over time, with several attacks occurring in a space of days or weeks followed by months of remission. Sufferers often feel a sense of fear and anxiety after an attack, accompanied by elevated heart rate. Attacks are also often accompanied by perceived flashes of light (when perceived on their own, known as a "visual sleep start") or difficulty in breathing. The condition is also known as "auditory sleep starts." It is not thought to be dangerous,[1] although it is sometimes distressing to experience. • Reference to the condition was made in an episode of the BBC TV drama "Doc Martin", which was instrumental in many sufferers becoming aware that the problem was in fact a known medical condition, and not one to be concerned about.

9. Psychoses Anxiety Depression Panic Alcoholism Sleeping sickness Medical or psychiatric conditions that can produce somnipathy

10. Risk Factors Influencing Insomnia • Age and Gender – older people and women more likely – illnesses (arthritis, diabetes) and menopause (hormone fluctuations) • Parasomnias - increase likelihood of insomnia - • -Sleep Apnoea • -Sleep walking • - Teeth grinding • Personality – Kales et al 1976 – insomniacs more likely to internalise psychological disturbance than acting out problems or being aggressive

11. Research Complications • Synoptic point • Chronic insomnia highly complex • Lots of causes of insomnia – stress, depression, poor sleep hygiene, age, gender e.t.c • Unlikely to be explained by one factor • Therefore - Difficult to draw conclusions

12. Attribution Theory • Synoptic Point (cognitive approach) • One cause of Primary Insomnia is a person’s belief that they are going to have difficulty sleeping. • Self fulfilling – tense before sleep • Attribute sleep problems to ‘insomnia’ • Treatment – • Train them to be convinced the source of problem lies elsewhere • Storms and Nisbett 1970 – insomniacs given apill – half told it would stimulate them and the other half it would sedate them. • Those expecting arousal went to sleep faster because they attributed their arousal to the pill and actually relaxed!!

13. Have a go at sleep dash!! • http://www.bbc.co.uk/science/humanbody/sleep/sheep/ Now drink some caffeine!! Wait 15mins and try again!! What do you predict will happen?

14. Treatment of Insomnia • Read p 17 • Create a problem page to give advice on why they may be suffering from insomnia and how to help it.

15. Sleep Disorders 2 – Narcolepsy and Sleep Walking • BATs • A01 Describe symptoms of sleep disorders – sleep • apnoea, narcolepsy and sleepwalking • A02 Understand explanations for these sleep disorders • Synoptic points – • Real world application – sleep walking diagnosis used in cases of murder

16. Narcolepsy • http://www.youtube.com/watch?v=3MBCeKn0Oeo narcolepsy 3 mins • Cataplexy – loss of muscular control during the day • Feeling sleepy all the time • Triggered by anger, fear, amusement or stress • 1/2000 suffer, starts in adolescence

17. Sleep Walking • Most common in children – 20% children, 3% adults • Only occurs during NREM/SWS sleep • Related to Night Terrors • Sleep walker not conscious and later has no knowledge of events during sleep walking

18. Your mission, should you choose to accept it,

19. In groups, you will choose one category of disorder to research. You must produce a poster on the category, giving detailed examples, explanations and treatments. You must consider behavioural /psychotherapeutic treatments, management and drug treatments. AS WELL AS A POSTER, YOU MUST ALSO PREPARE AND PRESENT A 5 MINUTE POWERPOINT FOR THE REST OF THE GROUP ON THE CATEGORY YOU CHOSE

20. Homework • Finish presentation and/or • Question 6 p19 • 600 word essay – • ‘Outline and evaluate explanations of two or more sleep disorders’ • The narcolepsy powerpoint on the blog is particularly good for essay prep (not done by me. More’s the pity!)