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SLEEP DISODERS

SLEEP DISODERS. Americans. 62% have sleep problems once wkly or more 40% sleepy enough during the day to interfere with activities 62% drive while drowsy 27% have fallen asleep while driving 60% children feel parents are tired during the day 15% children admit falling asleep at school.

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SLEEP DISODERS

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  1. SLEEP DISODERS

  2. Americans • 62% have sleep problems once wkly or more • 40% sleepy enough during the day to interfere with activities • 62% drive while drowsy • 27% have fallen asleep while driving • 60% children feel parents are tired during the day • 15% children admit falling asleep at school

  3. Women Males • 79% report sleep disturbance during pregnancy • 36% peri-menopausal women have disturbed sleep • 25% suffer from significant daytime sleepiness • 30% disturbed sleep interferes with daily activity, 27% job performance is impaired • 24% say sleep gets in the way of caring for family 1/3 of men get less than 6 hours sleep (during week)

  4. COMORBIDITIES • 40-45% of those with insomnia & hypersomnia have another Axis I disorder • Mood Disorders – 4x higher • Anxiety Disorders • Schizophrenia • Substance abuse

  5. Normal Sleep • Normal Sleep patterns (cycles) • Non REM • REM • Circadian rhythm • Drugs influence on sleep • Genetics of sleep

  6. Sleep Disorder Physiology of sleep • Sleep Stages • NREM Sleep • REM Sleep • Sleep-Regulating Processes • Circadian Rhythm • Endogenous vs. exogenous factor • Homeostasis • Balance o f sleep and awake

  7. Influences on Sleep • Developmental Changes • Newborns and Infants • Children • Adolescents • Young and Middle Adults • Older Adults – myth • Amount of sleep=F (genetics, preferences, lifestyle, environment)

  8. Influences on Sleep (Cont’d) • Medical Disorders and Treatments i.e.. Asthma, hyperthyroidism, COPD • Drugs and Chemical Substances i.e. alcohol, lithium, cocaine-> CNS was affected • Jet lag

  9. Sleep Disorders • Etiology • Signs and Symptoms/Diagnostic Criteria • Dyssomnias: abnormalities in the amount, quality, or timing of sleep • Narcolepsy • breathing-related sleep disorders • periodic limb movement disorder • insomnia • Parasomnias: abnormal behavioral or physiological events associated with sleep • sleepwalking • tooth grinding

  10. DYSSOMNIAS

  11. PRIMARY INSOMNIA • difficulty initiating and maintaining sleep • awakenings that occur much earlier than desired • sleep that is non-restorative and of poor quality • result in impairment in daytime function.

  12. Prevalence rates are higher in women and increase with age. • Associated with reduced quality of life, mood disorders and increased health services usage • Represents a significant economic burden in the US, with estimated direct costs of $13.9 billion annually.

  13. Change in sleep environments • Jet lag • Changes in work shift • Excessive noise • Unpleasant room temperature • Stressful life events • Medical condition • Medications • Poor sleep hygiene Causes of Insomnia

  14. Behavioral Model of Insomnia • Insomnia occurs acutely in relation to both predisposing and precipitating factors • The chronic form of the disorder is maintained by maladaptive coping behaviors. • A state of “conditioned arousal” may develop in which situations associated with sleep become alerting rather than relaxing- further impairing sleep.

  15. Insomnia Cycle

  16. Cognitive Behavioral Therapy for Insomnia • change poor sleep habits and faulty beliefs about sleep • promote good sleep hygiene THROUGH……. • sleep restriction, stimulus control, relaxation techniques, education and good sleep practices.

  17. CBT is as successful as medications in the acute treatment (4-8 weeks) of insomnia. • It is more effective than medications in the long term. • Average of 50-60% improvement • Long term studies reveal a sustained improvement in sleep quality and duration. • Patients continued to experience improvement over follow-up periods of >1year.

  18. Other Treatments • Pharmacologic therapy • Benzodiazepines / related hypnotics • Antidepressants • Antihistamines • Melatonin • Light

  19. BREATHING-RELATED SLEEP DISORDER • Unlike people with insomnia, this is a structural/ anatomical problem with physiological consequences • Treatment with oral appliance or surgery is needed • Sleep maintenance, sleep walking, or other consequences are generally relieved after treatment but….. • Co-occurring sleep disorders may need psychological treatment.

  20. Sleep Apnea • Obstructive sleep apnea • Clinical manifestations • Central sleep apnea • Restrictive lung disease • Neuromuscular disease • Cardiac • Neurological

  21. Other sleep disorders Narcolepsy • Genetic Aspects of narcolepsy • Irresistible attacks of refreshing sleep daily for 3 months • Diagnosis • Cataplexy- brief periods of loss of muscle tone • REM disordered transitions- can report hallucinations, sleep paralysis at transitions between wakefulness and sleep • Treatment of narcolepsy • Stimulants, REM suppressants • Behavioral adjustments

  22. Circadian Rhythm Sleep Disorder • Causes insomnia because of a lack of synchronization between an individual’s internal clock and the external schedule • Treatment is best accomplished with chronotherapy and/ or phototherapy

  23. Specifiers • Delayed Sleep Type- late sleep onset & late awakening • Shift Work Type • Unspecified Type • Jet Lag Type……

  24. … Jet Lag Type • Use activities (eating, exercise, sightseeing) and exposure to light to try to synchronize body rhythms with those of the new environment • Melatonin 3 mg about 30 minutes before bedtime on the day of travel and for up to four days after arrival is appropriate • A dose of 0.5 mg has less effect on sleep, but otherwise helps adaptation similarly • Adult travelers crossing five or more time zones are likely to benefit from melatonin

  25. DYSSOMNIA NOS • Environmental Issues • “Restless Legs Syndrome” • Periodic Limb Movements

  26. PARASOMNIAS

  27. Parasomnias • Sleep disorders characterized by abnormal behavioral or physiological events which occur during sleep or during sleep-wake transitions. • Parasomnias typically do not cause insomnia or excessive sleepiness

  28. Sleep Terror- awakening with fear, dream amnesia and unresponsiveness VS. • Nightmare- awakening with detailed threatening dream recall with rapid alertness • Sleepwalking- activities without responsiveness and difficulty awakening • NOS

  29. GMC and Sleep • Parkinsonism • Neuromuscular disease • Respiratory disease • Dementia • Epileptic seizures • Cardiovascular disease

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