Sleep Disorders

A Primer on Sleep

Sleep is an active, recuperative process. It is critical to survival.

Sleep deprivation = decreased functioning, hallucinations at extreme

Chronic sleep deprivation may precipitate disorders (diathesis-stress)

A Primer on Sleep

Begin of 20th century avg. night sleep = 10 hours

Today adults sleep an avg. of 6.7 hours/night It is highly unlikely our need for sleep has

decreased 40% in less than a century Mammals have entire brain involvement

Dreaming as a survival mechanism? As practice?

Stages of Sleep

1. Stage 1 = between awake/asleep. Body relaxes

2. Stages 2 -4 = relaxing muscles, no eye movement. Increasing depth of sleep

3. REM = brain waves suggest light sleep, but wakening is difficult. Body is paralyzed, brain waves are complex & varied

• Move through several stages several times in one night

• Children/fetuses show higher rates of REM

Types of Sleep Disorders

1. Dyssomnias - difficulty initiating or maintaining sleep, excessive sleep. Affect sleep and functioning when awake

2. Parasomnias - abnormal behavior or physiology occurring during sleep or transitioning between stages of sleep

* Not in the context of another type of disorder (e.g., depression)

Dyssomnias

1. Primary Insomnia

2. Primary Hypersomnia

3. Narcolepsy

4. Breathing-related sleep disorders

5. Circadian rhythm sleep disorders

Assessing Sleep Problems

Polysomnographic evaluation Respiration, airflow Leg movements Brain waves Eye movements, muscle movements Heart activity

Actigraph Sleep efficiency - % of time asleep in bed

Primary Insomnia

Difficulty falling asleep or maintaining it Person does not feel rested the next morning 33-50% of adults complain of insomnia

DSM estimate only 1-10% qualify for diagnosis Common among elderly individuals

Causes of Insomnia

Other disorders Biological

clock/temperature Higher, with less

variation

Drug use Environmental factors Cognitions regarding

sleep

Primary Hypersomnia

Excessive sleep Sleeping for long periods of time Taking frequent naps during the day

Prevalence is unknown 0.5 - 5% of adults complain of sleepiness during

day Usually begins in late adolescence or early

adulthood

Narcolepsy

Repeated and irresistible attacks of sleep Often in response to strongly emotional

situations May involve cataplexy (immediate muscle

paralysis and REM) 1/3 experience hypnogogic hallucinations

Prevalence is low (0.03-0.16% population)

Narcolepsy

Equal among men & women

First signs = intense daytime sleepiness

Often interferes with daily functioning Driving Jobs Relationships

Breathing & Circadian Related Sleep Disorders

Disruptions in normal breathing can interrupt sleep (excessive sleepiness during day) E.g. sleep apneas

Circadian characterized by a “mismatch” between person’s natural sleep-wake cycle and environmental demands E.g. you are unable to sleep until 4am, but you

work at 7am Subtypes: Delayed sleep phase, Jet Lag, Shift

Work

Parasomnias

1. Nightmare Disorder

2. Sleep Terror Disorder

3. Sleepwalking Disorder

Nightmare Disorder

Frequent awakening due to frightening dreams Involves detailed recall of content

Cause distress & sleep problems Impair daytime functioning Not diagnosed if another diagnosis accounts

for the symptoms better (e.g, PTSD) 50% of children experience occasional

nightmares; 1 in 30 young adults

Sleep Terror Disorder

Abrupt awakening from sleep, often with screaming

Unlike a nightmare, no quick orientation to where they are & feelings continue for several minutes

Difficult to comfort/reassure Report no dream content & do not occur

during REM More common in children than adults

Sleepwalking Disorder

Complex motor behavior during sleep Must cause distress for diagnosis

This makes prevalence rates low 2% of children frequently sleepwalk 1 in 200 adults frequently

Usually returns to bed with no recollection later

If awakened, will be confused (this is not dangerous as many people believe)

What Causes Parasomnias?

Less is known about prevalence or causes Individuals often unaware of the experience

Other psychopathologies (PTSD) Genetic risk for sleepwalking Stress, mood/anxiety, sleep deprivation,

medical conditions, shift work can all = sleepwalking

Biological Treatments for Sleep Disorders

May include sleep medication (hypnotics) Ineffective for

chronic insomnia - lose effectiveness after few nights + rebound insomnia

Environmental Changes

Change circadian rhythm (Phase delays or advances)

Dental devices, surgery Continuous Positive Airway Pressure Light treatment

Psychological Treatments

Psychological Treatments Many problems due to poor sleep hygiene Stimulus control

E.g. getting out of bed if not asleep Sleep reduction - do not go to bed until

normal sleep time (e.g., 2am) Progressive muscle relaxation, meditation

Preventing Sleep Disorders/Problems

Address sleep hygiene

Sleep Hygiene

Avoid consuming caffeine during the evening Avoid smoking just before falling asleep or

when you wake up in the night; Nicotine is a stimulant

Do not use alcohol as a sleep aid. It may help you fall asleep, but it causes awakening during the night and decreases the restfulness of sleep

Sleep Hygiene

Sleep in a comfortable environment. Block noise with earplugs or a white noise machine. Maintain a cooler temperature & keep the room reasonably dark

Do not stay in bed if you are not tired! Trying to force yourself to sleep makes it less likely you will! Get up, read, watch TV and don’t go back to bed until you are tired

Sleep Hygiene

If you are having trouble sleeping, do not watch the clock, as it will increase anxiety. Turn it around so that you cannot see the time

Do not rely on sleep medications. They lose effectiveness if used over and over again. Only use them for occasional bouts of sleeplessness

Only use your bedroom for sleep & sex (e.g. do not do homework on your bed, you should not associate your bed with anything else)