Sleep DisordersSleep Disorders

SleepSleep

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

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

SleepSleep

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

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

Slow-wave deep (non-REM)Slow-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. dec. in blood pressure, resp. rate and basal metabolic raterate and basal metabolic rate..

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

Rapid Eye Movement Rapid Eye Movement (REM)(REM)

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

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

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

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

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

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

Theories of sleepTheories of sleep

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

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

Sleep DisordersSleep Disorders

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

--It is classified intoIt is classified into::

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

22 . .SecondarySecondary

Causes of 2ry sleep Causes of 2ry sleep disordersdisorders

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

--Physical conditions (obesity)Physical conditions (obesity)

--Sedative withdrawalSedative withdrawal

--Use of stimulantsUse of stimulants

--Major depressionMajor depression

--Mania or anxietyMania or anxiety

--Neurotransmitter abnormalities Neurotransmitter abnormalities ( dopamine or norepinephrine, ACH, ( dopamine or norepinephrine, ACH, serotonin)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 of sleep. It is subdivided intosubdivided 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 Difficulty in initiating or maintaining sleepsleep. .

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

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

--Often exacerbated by anxiety and Often exacerbated by anxiety and preoccupation with getting enough preoccupation with getting enough sleepsleep..

Primary Insomnia (cont.)Primary Insomnia (cont.)

TreatmentTreatment::

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

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

--BenadrylBenadryl

--Ambien (zolpidem)Ambien (zolpidem)

--Sonata (zaleplon)Sonata (zaleplon)

--Desyrel (trazodone)Desyrel (trazodone)

22 . .Primary HypersomniaPrimary Hypersomnia

--At least At least 1 month1 month of excessive of excessive daytime daytime sleepinesssleepiness not due to any medical or not due to any medical or other conditionother condition..

--TreatmentTreatment::

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

22 . .SSRI may be useful in some SSRI may be useful in some patientspatients..

33 . .NarcolepsyNarcolepsy

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

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

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

awakening)awakening)..44 . .Hypnagogic, hypnopompic Hypnagogic, hypnopompic

hallucinationshallucinations..

Narcolepsy (cont.)Narcolepsy (cont.)

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

--EqualEqual incidence in males and incidence in males and femalesfemales..

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

--May have genetic componentMay have genetic component..

--Patients usually have poor nighttime Patients usually have poor nighttime sleepsleep..

Narcolepsy (cont.)Narcolepsy (cont.)

--TreatmentTreatment::

11 . .Timed daily napsTimed daily naps..

22 . .Stimulant drugs (amphetamines and Stimulant drugs (amphetamines and methylphenidate)methylphenidate)..

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

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

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

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

22 . .Central Sleep ApneaCentral Sleep Apnea [SPA] which [SPA] which is correlated to is correlated 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. Breathing-Related dis. (cont.)(cont.)

--TreatmentTreatment::

11 . .OSAOSA::

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

22 . .CSACSA::

Mechanical ventillation with a backup Mechanical ventillation with a backup raterate..

ParasomniasParasomnias

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

11 . .Nightmare disorderNightmare disorder..

22 . .Night Terror disorderNight Terror disorder..

33 . .Sleep Walking disorder Sleep Walking disorder (somnambulism)(somnambulism)..

11 . .Nightmare disNightmare dis..

--Repeated Repeated awakeningsawakenings with recall of with recall of extremely frightening dreamsextremely frightening 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 Occur more frequently during time of stressstress..

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

22 . .Night Terror disorderNight Terror disorder

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

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

--Patients usually donPatients usually don’’t remember the t remember the episodesepisodes..

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

Night Terror dis. (cont.)Night 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 comorbid sleepwalking dissleepwalking dis..

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

33 . .Sleepwalking dis. Sleepwalking dis. (Somnambulism)(Somnambulism)

--Repeated episodes of getting out of Repeated episodes of getting out of bed and walkingbed and walking..

--Ass. With Ass. With blank stareblank stare and and difficulty difficulty in being awakenedin being awakened..

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

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

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

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