Sleep DisordersSleep Disorders

BYARUN.MKVM COLLEGE

SleepSleep

--SleepSleep is is unconsciousnessunconsciousness from which the from which the person can be person can be arousedaroused by sensory or other by sensory or other stimulistimuli

--ComaComa is unconsciousness from which the person is unconsciousness from which the person cannot be arousedcannot be aroused

SleepSleep

11. . Slow-wave sleepSlow-wave sleep (non REM sleep (non REM sleep((

22. . Rapid eye movement sleepRapid eye movement sleep (REM sleep (REM sleep( (

Slow-wave deep (non-REMSlow-wave deep (non-REM((

--Most sleep during night (75%Most sleep during night (75%(.(.

--Exceedingly restfulExceedingly restful..

--Dec. peripheral vascular toneDec. peripheral vascular tone..

--10-30%10-30% dec. in blood pressure, resp. rate and dec. in blood pressure, resp. rate and basal metabolic ratebasal metabolic rate..

--dreams are usually not remembereddreams are usually not remembered..

Rapid Eye Movement (REMRapid Eye Movement (REM((

--Occurs in normal night sleepsOccurs in normal night sleeps..

--Last for 5-30 min. and occur every 90 minLast for 5-30 min. and occur every 90 min..

--Rapid movement of the eyesRapid movement of the eyes..

--Usually ass. With active dreaming and active Usually ass. With active dreaming and active bodily muscle movementbodily muscle movement..

--The heart rate and resp. rate become irregular The heart rate and resp. rate become irregular (dream(dream(.(.

--The brain is highly activeThe brain is highly active..

Theories of sleepTheories of sleep

passive theory of slepassive theory of sleep: ep: excitatory areas of (RAS) in excitatory areas of (RAS) in the upper brain stem fatigued and became inactivethe upper brain stem fatigued and became inactive..

active inhibitory processactive inhibitory process::Stimulation of center located below the Stimulation of center located below the midpontile midpontile levellevel of the brain stem inhibiting excitatory areas of of the brain stem inhibiting excitatory areas of (RAS) in the upper brain stem leading to sleep(RAS) in the upper brain stem leading to sleep..

Sleep DisordersSleep Disorders

--1/31/3 of U.S. people suffer from sleep disordersof U.S. people suffer from sleep disorders..

--It is classified intoIt is classified into::

11. . PrimaryPrimary ( (DyssomniasDyssomnias and and ParasomniasParasomnias((

22. . SecondarySecondary

Causes of 2ry sleep disordersCauses of 2ry sleep disorders

--Medical conditions (pain, met dis, endo disMedical conditions (pain, met dis, endo dis((

--Physical conditions (obesityPhysical conditions (obesity((

--Sedative withdrawalSedative withdrawal

--Use of stimulantsUse of stimulants

--Major depressionMajor depression

--Mania or anxietyMania or anxiety

--Neurotransmitter abnormalities ( dopamine or Neurotransmitter abnormalities ( dopamine or norepinephrine, ACH, serotoninnorepinephrine, ACH, serotonin(.(.

Dyssomnias (1ry sleep dis.)Dyssomnias (1ry sleep dis.)

It is disturbance in the It is disturbance in the amountamount, , qualityquality or or timingtiming of sleep. It is subdivided intoof sleep. It is subdivided into::

11..Primary InsomniaPrimary Insomnia22..Primary hypersomniaPrimary hypersomnia

33..NarcolepsyNarcolepsy44..Breathing-Related DisorderBreathing-Related Disorder

55..Circadian Rhythm Sleep DisorderCircadian Rhythm Sleep Disorder

11. . Primary InsomniaPrimary Insomnia

--Difficulty in initiating or maintaining sleepDifficulty in initiating or maintaining sleep . .

--Occurs 3x or more per week for at least 1 monthOccurs 3x or more per week for at least 1 month..

--Affects 30% of the populationAffects 30% of the population..

--Often exacerbated by anxiety and preoccupation Often exacerbated by anxiety and preoccupation with getting enough sleepwith getting enough sleep..

Primary Insomnia (contPrimary Insomnia (cont.(.(

TreatmentTreatment::

11. . Sleep hygiene measures (1Sleep hygiene measures (1stst line line((

22. . Pharmacotherapy (for short term usePharmacotherapy (for short term use(:(:

--BenadrylBenadryl

--Ambien (zolpidemAmbien (zolpidem((

--Sonata (zaleplonSonata (zaleplon((

--Desyrel (trazodoneDesyrel (trazodone((

22. . Primary HypersomniaPrimary Hypersomnia

--At least At least 1 month1 month of excessive of excessive daytime sleepinessdaytime sleepiness not not due to any medical or other conditiondue to any medical or other condition..

--TreatmentTreatment::

11. . Stimulant drugs as amphetamine (1Stimulant drugs as amphetamine (1 stst line line((

22. . SSRI may be useful in some patientsSSRI may be useful in some patients..

33. . NarcolepsyNarcolepsy

--Repeated, sudden attacks of sleep during the day Repeated, sudden attacks of sleep during the day for at least for at least 3 months3 months, ass. With, ass. With::

11. . Cataplexy (collapse due to sudden loss of Cataplexy (collapse due to sudden loss of muscle tonemuscle tone(.(.

22. . Short REM latencyShort REM latency..33. . Sleep paralysis ( brief paralysis upon Sleep paralysis ( brief paralysis upon

awakeningawakening(.(.44. . Hypnagogic, hypnopompic hallucinationsHypnagogic, hypnopompic hallucinations..

Narcolepsy (contNarcolepsy (cont.(.(

--Occur in 0.02-0.16% of populationOccur in 0.02-0.16% of population..

--EqualEqual incidence in males and females incidence in males and females..

--Onset most commonly in Onset most commonly in childhoodchildhood and and adolescenceadolescence..

--May have genetic componentMay have genetic component..

--Patients usually have poor nighttime sleepPatients usually have poor nighttime sleep..

Narcolepsy (contNarcolepsy (cont.(.(

--TreatmentTreatment::

11. . Timed daily napsTimed daily naps..

22. . Stimulant drugs (amphetamines and Stimulant drugs (amphetamines and methylphenidatemethylphenidate(.(.

33. . SSRI or oxalate for patients with SSRI or oxalate for patients with cataplexycataplexy..

44. . Breathing-Related disBreathing-Related dis..

--Sleep disruption and excessive daytime sleepiness Sleep disruption and excessive daytime sleepiness caused by abnormal sleep ventilation from caused by abnormal sleep ventilation from eithereither::

11. . Obstructive Sleep ApneaObstructive Sleep Apnea [OSA] which is [OSA] which is correlated to correlated to snoringsnoring or or

22. . Central Sleep ApneaCentral Sleep Apnea [SPA] which is correlated [SPA] which is correlated to to heart failureheart failure..

OSA risk factorsOSA risk factors::

-Male gender.-Male gender.

-Obesity-Obesity

-male shirt collar size >17-male shirt collar size >17

-Previous upper airway surgeries.-Previous upper airway surgeries.

-Deviated nasal septum.-Deviated nasal septum.

- retrognathia- retrognathia

Large uvulaLarge uvula

Breathing-Related dis. (contBreathing-Related dis. (cont.(.(

--TreatmentTreatment::

11. . OSAOSA::

Nasal continuous positive airway pressure Nasal continuous positive airway pressure (nCPAP), weight loss, nasal surgery or (nCPAP), weight loss, nasal surgery or uvulopalatoplastyuvulopalatoplasty..

22. . CSACSA::

Mechanical ventillation with a backup rateMechanical ventillation with a backup rate..

ParasomniasParasomnias

--Abnormal events in Abnormal events in behaviorbehavior or or physiologyphysiology during sleep. It is subdivided intoduring sleep. It is subdivided into::

11. . Nightmare disorderNightmare disorder..

22. . Night Terror disorderNight Terror disorder..

33. . Sleep Walking disorder (somnambulismSleep Walking disorder (somnambulism(.(.

11. . Nightmare disNightmare dis..

--Repeated Repeated awakeningsawakenings with recall of extremely with recall of extremely frightening dreamsfrightening dreams..

--Occurs during Occurs during REMREM sleep sleep..

--Onset most often starts at Onset most often starts at childhoodchildhood..

--Occur more frequently during time of stressOccur more frequently during time of stress..

--NO NO SPECIFIC SPECIFIC TREATMENTTREATMENT but but tricyclicstricyclics could be usedcould be used..

22. . Night Terror disorderNight Terror disorder

--Repeated episodes of fearfulness during sleepRepeated episodes of fearfulness during sleep..

--Episodes usually occur during the Episodes usually occur during the slow-wave slow-wave deep stage of sleepdeep stage of sleep..

--Patients usually donPatients usually don’’t remember the episodest remember the episodes..

--It usually begins with a scream and ass. With It usually begins with a scream and ass. With intense anxietyintense anxiety..

Night Terror dis. (contNight Terror dis. (cont.(.(

--Usually occur in Usually occur in childrenchildren..

--More common in More common in boysboys..

--Tend to run in familiesTend to run in families..

--High ass. With High ass. With comorbid sleepwalking discomorbid sleepwalking dis..

--NoNo specific specific treatmenttreatment but giving but giving diazepamdiazepam before before bedtime might be effectivebedtime might be effective..

33. . Sleepwalking dis. (SomnambulismSleepwalking dis. (Somnambulism((

--Repeated episodes of getting out of bed and Repeated episodes of getting out of bed and walkingwalking..

--Ass. With Ass. With blank stareblank stare and and difficulty in being difficulty in being awakenedawakened..

--Onset bet. Age 4-8 yrsOnset bet. Age 4-8 yrs..

run in family run in family toto tendstends boyboy - More common in- More common in

--The best treatment is to prevent injury in The best treatment is to prevent injury in surrounding environmentsurrounding environment..

Thank youThank you