Sleep Disorders Disorders of Sleep - PowerPoint Presentation

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Sleep DisordersSlide2

Disorders of Sleep58% Adults Snore

36% Complain of Insomnia15% note persistent Excessive Daytime Sleepiness3% Unusual Nocturnal Behaviors28% Workforce on night or rotating shifts

One in Three Individuals are Dissatisfied with Their SleepSlide3

Age and Sleep DisordersSlide4

Traditional classification of sleep disorders

Dyssomnias: They are associated with difficulty initiating or maintaining the sleep or daytime sleepiness.Parasomnias:

A

bnormal behavioral or physiological events occurring during sleep but don’t involve the sleep mechanisms

.Slide5

Primary and Secondary Disorders

Traditionally, sleep disorders have been divided into primary and secondary

disorders.

Primary sleep disorders

result from an endogenous disturbance in the sleeping mechanism, often complicated by learned behaviours.

Secondary sleep disorders

are said to be the result of another disorder –e.g. depression, pregnancy, respiratory problems or

gastroesophageal

reflux diseaseSlide6

Sleep DisordersCurrently, 107 distinct sleep disorders (82 recognized in ICSD2, 25 proposed)

4 x Disorders to be examined:Sleep ApneaInsomniaNarcolepsy

Somnambulism (sleep walking)Slide7

DyssomniasSlide8

Obstructive Sleep ApneaRepetitive episodes of airway collapse associated with arousals and oxygen desaturation.Patients have hundreds of events per night.Slide9

Sleep Apnea – the factsObstructive Sleep Apnea occurs in;

9-24% Adults Males 3-9% Adult Females

3-15% of Children

More likely with:

Obesity

Smoking,

Narrow airway,

Heart disease

Brain disease

Z

Z

ZSlide10

Problems with Sleep ApneaIncreases the manifestations of other medical and psychiatric disorders:

Heart failure, Stroke, Epilepsy, DepressionSudden infant death syndrome (SIDS) is sleep apnea Slide11

Treatments:Sleeping pills are not perfect—most bind to GABA receptors throughout the brain.

Continued use of sleeping pills:Makes them ineffectiveProduces marked changes in sleep patterns that persist even when not taking the drug

Can lead to drowsiness and memory gapsSlide12

OSA TreatmentSurgeryDental DeviceWeight Loss

MedicationAvoidance of alcoholSleep on sideSlide13

Continuous Positive Airway Pressure

Machine pumping in air

Tube and mask for air supply

Fat blokeSlide14

INSOMNIATotal sleep deprivation compromises the immune system and leads to death.

The disease fatal familial insomnia is inherited—in midlife people stop sleeping and die 7-24 months after onset of the insomnia.Slide15

I. Insomnias – the factsPrevalence: 33

-36%Accompanied with daytime consequences: 10%Last more than 1 year: 85% (persistent insomnia)

Male:female = 1:1.4

Increase with age: above 65 years: 50%Slide16

Qu. Why Are Women Not Getting the Sleep They Need?

Lifestyle impacts sleep;Working mothers (72%) and single working women (68%) are more likely to experience insomnia84% pregnant women report insomnia for a few nights each week

Other factors;

Noise (39%)

Giving care to children (20%)

Pets (17%)Slide17

Other factors causing Insomnia?Primary

insomnia – caused by biological factorsInadequate sleep hygiene (10%)Insomnia due to mental disorder (30-40%)Insomnia due to drug or substanceSlide18

Treatment of Insomnia?

Pharmacologic treatmentTreating the medical or psychiatric conditions Nonpharmacologic: behavioral treatments: normalizing the circadian rhythm

sleep hygiene

cognitive behavior therapy

sleep restriction therapySlide19

Prescribed Anti-depressants 12%

Prescribed Sleep medication 3%Slide20

Pharmacologic treatmentBenzodiazepines

Selective GABA drugsMelatonin receptor sensitising drugsSlide21

Problems with insomnia research?Slide22

3. Circadian rhythm disorders – a circadian rhythm is a body rhythm which occurs once in a 24 hour period e.g. sleep- wake cycleA normal sleep pattern would be 5 cycles of the of the sleep stagesIf the sleep-wake cycle is affected then it disrupts our body clock

E.g. shift workersBut this disorder can occur when there is seemingly no reasonUse of bright lights at certain times can help to reset the body clock & thus the sleep-wake cycle is restoredSlide23

ParasomniasSlide24

NarcolepsySYMPTOMS:Have frequent sleep attacks and excessive daytime sleepiness

Do not go through SWS before REM sleep May show cataplexy—a sudden loss of muscle tone, leading to collapse.Slide25

Causes of Narcolpsy?Narcoleptic dogs have a mutant gene for a hypocretin receptor. Hypocretin normally prevents the transition from wakefulness directly into REM sleep.

Interfering with hypocretin signaling leads to narcolepsy.Slide26

Treatments of narcolepsy?Good sleep hygiene Stimulant drugs to help keep you awake during the day.Sodium oxybate is a medicine that can improve cataplexy and help you sleep at night, which can also reduce daytime sleepiness. However, it is not yet funded by the NHS in many areas. Slide27

SLEEP PARALYSISSleep paralysis

is the brief inability to move just before falling asleep, or just after waking up.It can be broken by being touched by someone.It may be caused by the pontine center continuing to signal for muscle relaxation, even when awake.Slide28

Qu. When do people get the most incidents of sleep paralysis?

Changing sleeping position reduces sleep paralysisSlide29

SLEEP WALKINGSomnambulism

(sleepwalking) occurs during stages 3 and 4 SWS, and may persist into adulthood.25% children will sleep walk, but most adults lose ability.Slide30

(3) REM Sleep Disorder

I was a halfback playing football, and after the quarterback received from the centre, he passed it to me and I’m supposed to go around and then cut back in. As I cut back in there is this big 280-pound tackle waiting so I, according to the rules, shoulder barged him…..

When I came to I was standing in front of our dresser and I had gotten out of bed and run and knocked lamps, mirrors and everything off the dresser, hit my head against the wall and my knee against the dresser -

Schenck et al. (1986)

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Critique of Sleep Studies?Labor intensiveRequire technologists to attend patient all night

Technologist must score and summarize the physiology for the recording