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)

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 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 % 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)

Narcolepsy 1/3 experience hypnogogic hallucinations Prevalence is low ( % population)

Narcolepsy Equal among men & women First signs = intense daytime sleepiness Often interferes with daily functioning Driving Jobs Relationships

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

Nightmare Disorder 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

Sleep Terror Disorder 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

Sleepwalking Disorder 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

What Causes Parasomnias? All can precede sleepwalking: Stress Mood/anxiety Sleep deprivation Medical conditions Shift work

Biological Treatments for Sleep Disorders May include sleep medication Ineffective for chronic insomnia lose effectiveness after few nights rebound insomnia

Environmental Changes Change circadian rhythm Phase delays or advances Dental devices or surgery Continuous Positive Airway Pressure Light treatment

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 and 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

Sleep Hygiene 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

Sleep Hygiene 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 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)

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