Sleep Disorders

1. Psychology Term 2 - 2013/2014 Sleep Disorders

2. Avoid caffeine, nicotine, and other stimulants before bed Don’t go to bed when you are full or hungry Develop a nightly ritual, particularly one that is relaxing Engage in regular aerobic exercise, but not late at night Take a warm bath 90 minutes before bed Avoid emotional stressors (e.g., balancing check book) right before bed Limit activities in your sleeping area Avoid alcohol Designate a regular bedtime and waking time Minimize light and noises Improving Your Sleep

3. Types of Sleep Disorders • Dyssomnias: are a broad classification of Sleeping disorders that make it difficult to get to sleep, or to remain sleeping. • Eg: • Insomnia • Sleep Apnea • Narcolepsy • Parasomnias: behavioral or physiological abnormalities during sleep; are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. • E.g.: • Sleepwalking & Sleep talking Disorder • Night terror & Nightmares Disorder • REM Behavior Disorder

4. Dyssomnias: are a broad classification of Sleeping disorders that make it difficult to get to sleep, or to remain sleeping. • There are over than 30 kinds of sleep disorders but the most common and serious sleep disorders known are: • Insomnia: is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. • Sleep apnea: is a potentially serious sleep disorder in which breathing repeatedly stops and starts • Narcolepsy: is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep Sleep Disorders

5. Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms: • Difficulty falling asleep • Waking up often during the night and having trouble going back to sleep • Waking up too early in the morning • Feeling tired upon waking Insomnia

6. Insomnia Types of Insomnia • There are two types of insomnia: primary insomnia and secondary insomnia. 2 classifications; • Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem. • Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol). Acute vs. Chronic Insomnia • Insomnia also varies in how long it lasts and how often it occurs. • It can be short-term (acute insomnia) or can last a long time (chronic insomnia). • It can also come and go, with periods of time when a person has no sleep problems. • Acute insomnia can last from one night to a few weeks. • Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

7. Causes of acute insomnia can include: Causes of chronic insomnia include: • Continue reading below... • Significant life stress (job loss or change, death of a loved one, divorce, moving) • Illness • Emotional or physical discomfort • Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep • Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep • Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example) • Depression and/or anxiety • Chronic stress • Pain or discomfort at night Causes of Insomnia

8. Insomnia Symptoms of Insomnia • Sleepiness during the day • General tiredness • Irritability • Problems with concentration or memory Diagnosing Insomnia by a healthcare provider: • An evaluation may include a physical examination, a medical history, and a sleep history. • Also as a method of monitoring improvement or deterioration, patient might be asked to keep a sleep diary. • There are also specialized sleep centers for diagnosing, monitoring and treating. Treatment for Insomnia: • Acute insomnia may not require treatment. • Mild insomnia often can be prevented or cured by practicing good sleep habits. • If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. N.B.: • Avoid using over-the-counter sleeping pills for insomnia, because they may have undesired side effects and tend to lose their effectiveness over time. • Rapid onset, short-acting drugs can help you avoid effects such as drowsiness the following day.

9. Compare between the two types of sleep disorders , with explanation of each type giving examples. Assignment

10. Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. Causes of Sleep Apnea: The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night. Further physiological explanation : It is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe Sleep apnea

11. Sleep Apnea Major symptoms : • Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. • During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. • WHY? because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening. Other symptoms of sleep apnea include: • Loud or frequent snoring • Choking or gasping while you sleep • Pauses in breathing • Morning headaches • Excessive daytime sleepiness • Insomnia due to difficulty staying asleep • Waking up with dry mouth or a sore throat • Frequent need to urinate during the night • Trouble concentrating • Memory or learning problems • Moodiness, irritability or depression

12. Diagnosis: In-lab overnight sleep study: You will sleep with sensors hooked up to various parts of your body. These record your brain waves, heartbeat, and breathing among other things. Home sleep test: The testing equipment differs in that it is less complicated than what is used in an overnight sleep study. A staff member will show you how to hook up the testing equipment yourself. Once you are finished, you can take the device back to the sleep center or send it by mail. Sleep Diary for recording your daily improvement or deterioration. Sleep Apnea

13. Excess weight – An adult with a BMI of 25 or higher is considered to be overweight. Your risk of sleep apnea increases with the amount of excess body weight. Large neck size (>17 inches for men, > 16 inches for women) – A large neck will have more fatty tissue that can block your airway. Older age (40+ for men, 50+ for women) –Sleep apnea occurs more often in older adults, especially people older than 60. Being male – Men have twice the risk having sleep apnea compared to women Smoker – Smokers have a higher risk of sleep apnea Hypertensive – High blood pressure is very common in people with sleep apnea Family history – Sleep apnea can appear more often among family members. This may be a result of either inherited traits or common lifestyles. Sleep Apnea Risk Factors

14. Very important info: The lack of oxygen your body receives can have negative long-term consequences for your health. This includes: High blood pressure Heart disease Stroke Pre-diabetes and diabetes Depression Sleep Apnea –ve impact http://www.sleepeducation.com/sleep-disorders/sleep-apnea/treatment

15. CPAP (Continuous Positive Airway Pressure): a machine that uses a steady stream of air to gently keep your airway open throughout the night by a mask so you are able to breathe. Oral Appliance Therapy: It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep Surgery: reduce or eliminate the extra tissue in your throat that collapses and blocks your airway during sleep. More complex procedures can adjust your bone structures including the jaw, nose and facial bones. Weight loss surgery may also be an option Weight Management: weight loss can help improve or eliminate your sleep apnea symptoms if you are overweight or obese (not guaranteed to be effective but it helps). Positional Therapy: it would help by improving or eliminating your symptoms by changing your sleep position. Your airway may open if you sleep on your side instead of your back.  Lifestyle Changes: quitting smoking or not drinking alcohol may improve sleep apnea symptoms. Alcohol relaxes your throat muscles which can cause you to snore or for your airway to collapse. Sleep Apnea treatment

16. Narcolepsy is a sleep disorder that causes overwhelming and severe daytime sleepiness. Pathologic sleepiness is characterized by the fact that it occurs at inappropriate times and places. The daytime sleep attacks may occur with or without warning, and can occur repeatedly in a single day. Persons with narcolepsy often have fragmented nighttime sleep with frequent brief awakenings. Narcolepsy

17. Symptoms: Excessive daytime sleepiness (most common and obvious) Cataplexy (sudden and temporary loss of muscle tone often triggered by emotions such as laughter) (common) Hallucinations (vivid dreamlike experiences that occur while falling asleep or upon awakening) (less common) Sleep paralysis (paralysis that occurs most often upon falling asleep or waking up; the person is unable to move for a few minutes, least common symptom) Narcolepsy

18. Causes: Narcolepsy is believed to result from a genetic predisposition and abnormal neurotransmitter (hypocretin) functioning and sensitivity. Diagnosis: Questionnaires are used to measure excessive sleepiness. Sleep lab visits & monitoring. CSF (cerebrospinal fluid) hypocretin test Narcolepsy

19. Narcolepsy Treatment: • Self-Care at Home • Many people have an improvement in their symptoms if they maintain a regular sleep schedule, usually seven to eight hours of sleep per night. • Scheduled naps during the day also help. • Patient's with narcolepsy should also avoid heavy meals and alcohol (as it can interfere with sleep). • Driving  should be restricted when the patient feels sleepy. • Children should be encouraged to participate in after-school activities and sports. • Parents should request school personnel to excuse the child from activities if he or she appears drowsy. • Medical Treatment: The main focus of medical treatment is symptomatic relief of excessive daytime sleepiness and cataplexy with stimulants of the central nervous system and antidepressants.

20. Parasomnias: behavioral or physiological abnormalities during sleep; are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. • Most parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness and NREM sleep, or wakefulness and REM sleep: • Sleepwalking & Sleep talking Disorder • Night terror & Nightmares Disorder • REM Behavior Disorder Sleep Disorders

21. Sleepwalking is a sleep disorder that causes people to get up and walk while sleeping. • Episodes of sleepwalking typically occur when a person is in the deep stages of sleep. • The sleepwalker is unable to respond during the event and does not remember sleepwalking. • In some cases, sleepwalking is associated with incoherent talking. • Sleepwalking occurs most commonly in childhood, typically between the ages of 4 and 8, but can last into adulthood. • Sleepwalkers walk with their eyes opened with a glassy, staring appearance. Symptoms of Sleepwalking • Episodes of sleepwalking can range from quiet walking about the room to agitated running or attempts to "escape." Typically, the eyes are open with a glassy, staring appearance as the person quietly roams the house. On questioning, responses are slow or absent. If the person is returned to bed without awakening, they usually does not remember the event. • Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it was inappropriate). What Causes a Person to Sleepwalk? • Several different factors may be involved in the development of sleepwalking. These may include genetics (traits that run in families), environment, and medical conditions. • Sleepwalking is not associated with other sleep problems, sleeping alone in a room or with others, fear of the dark, or anger outbursts. Genetics • Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if a first-degree relative has a history of sleepwalking. Therefore, it is thought the condition can be inherited. Sleep walking Disorder

22. Environmental Factors • Certain factors may cause a person to sleepwalk, such as: • Sleep deprivation • Chaotic sleep schedules • Stress • Alcohol intoxication • Drugs such as sedative/hypnotics (drugs that promote relaxation or sleep), neuroleptics (drugs used to treat psychosis), stimulants (drugs that increase activity), and antihistamines (drugs used to treat symptoms of allergy) Medical conditions that have been linked to sleepwalking include: • Arrhythmias (abnormal heart rhythms) • Fever • Gastroesophageal reflux (food or liquid regurgitating from the stomach up into the food pipe) • Nighttime asthma • Nighttime seizures (convulsions) • Obstructive sleep apnea (condition in which breathing stops temporarily while sleeping) • Psychiatric disorders, for example, posttraumatic stress disorder, panic attacks, or dissociative states, such as multiple personality disorder Sleep walking Disorder http://www.webmd.com/sleep-disorders/guide/sleepwalking-causes

23. What causes sleep talking? • Sleep talking usually occurs by itself and is most often harmless. However, in some cases, it might be a sign of a more serious sleep disorder or health condition. • REM sleep behavior disorder (RBD) and sleep terrors are two types of sleep disorders that cause some people to shout during sleep. Sleep terrors, also called night terrors, usually involve frightening screams, thrashing, and kicking. It's hard to wake someone having a sleep terror. Children with sleep terrors usually sleep talk and sleepwalk. • People with RBD yell, shout, grunt, and act out their dreams, often violently. • Sleep talking can also occur with sleepwalking and nocturnal sleep-related eating disorder (NS-RED), a condition in which a person eats while asleep. Other things that can cause sleep talking include: • Certain medications • Emotional stress • Fever • Mental health disorder • Substance abuse Sleep Talking Disorder http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/talking-in-your-sleep?page=2

24. What is sleep talking? • Sleep talking, or somniloquy, is the act of speaking during sleep. It's a type of parasomnia-- an abnormal behavior that takes place during sleep. It's a very common occurrence and is not usually considered a medical problem. • The nighttime chatter may be harmless, or it could be graphic, even R rated. Sometimes, listeners find the content offensive or vulgar. Sleep talkers normally speak for no more than 30 seconds per episode, but some people sleep talk many times during a night. • The late-night diatribes may be exceptionally eloquent, or the words may be mumbled and hard to decipher. Sleep talking may involve simple sounds or long, involved speeches. Sleep talkers usually seem to be talking to themselves. But sometimes, they appear to carry on conversations with others. They may whisper, or they might shout. If you share a bedroom with someone who talks in his or her sleep, you might not be getting enough shut-eye. Who talks in their sleep? • Many people talk in their sleep. Half of all kids between the ages of 3 and 10 years old carry on conversations while asleep, and a small number of adults -- about 5% -- keep chit-chatting after they go to bed. The utterances can take place occasionally or every night. Experts think that sleep talking may run in families. What are the symptoms of talking in your sleep? • Usually, people will tell you they've heard you shout out during the night or while you were napping. Or maybe someone might complain that your sleep talking is keeping him or her up all night. Sleep Talking disorder

25. Definition of Night terror & Nightmares Disorder : sleep disorders in which a person abruptly awakens from sleep in a frightened or panicked state. • The condition most often happens during the first third of the night and is sometimes accompanied by sleepwalking. • It usually run in families. • It happens to adults , but more common in children, that usually outgrow after adolescence. Causes: • The condition may be triggered by a variety of Psychological factors including: anxiety, stress, depression or conflict in the household, Fatigue, sleep deprivation • Also, some underlying medical conditions such as: sleep apnea, a head injury, or migraines. • Certain medications including: antihistamines, sedatives, or sleeping pills may trigger an episode as well. • Addiction or dependency: Adults with an alcohol or other drug dependency are at a greater risk for night terrors than others. Night terror & Nightmares Disorder

26. Symptoms: Sit up in bed Scream or shout Kick and thrash Sweat, breathe heavily and have a racing pulse Be hard to awaken Get out of bed and run around the house Engage in violent behavior (more common in adults) Stare wide-eyed Treatment: Comfort to child if he or she has night terrors. Adults with night terrors may benefit from stress reduction, coping strategies, or psychotherapy. Complications of night terrors are rare and medication is rarely used. Night terror & Nightmares Disorder

27. In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to "act out" his or her dreams. • RBD is characterized by the acting out of dreams that are vivid, intense, and violent. • Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing. • An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs. • RBD is usually seen in middle-aged to elderly people (more often in men). REM Behavior Disorder (RBD)

28. Causes: • 55% has unknown cause, while the rest (45%) are associated with: • Alcohol • Sedative-hypnotic withdrawal • Some antidepressants • RBD is highly associated with Parkinson’s Disease*, however not all RBD patients have Parkinson’s. REM Behavior Disorder (RBD) *Parkinson’s disease involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination.

29. Treatment & Management: • Treatment usually includes medication as Clonazepam(drug having anxiolytic, anticonvulsant, muscle relaxant, sedative, and hypnotic properties. • Management includes removal of harmful objects from the surrounding area of sleeping, locking patient and monitoring and sometimes tying patient to bed. REM Behavior Disorder (RBD)

30. Compare between the two types of sleep disorders , with explanation of each type giving examples. • Define: Insomnia, Sleep Apnea, Narcolepsy, Sleep walking, Sleep Talking, Night terrors & nightmares, RBD. • What are the different classifications of Insomnia explain each. • What are the causes of Insomnia? • What are the treatment or management ways of insomnia? • What is the dangers or risks of having sleep Apnea? • What are the major symptoms of a Narcolepsy? • What are the main causes of Night terrors & Nightmares? • What are the main steps for RBD Management? Assignment