1. Sleep Disorders

2. One in Three Individuals are Dissatisfied with Their Sleep
Disorders of Sleep
One in Three Individuals are Dissatisfied with Their Sleep
58% Adults Snore
36% Complain of Insomnia
15% note persistent Excessive Daytime Sleepiness
3% Unusual Nocturnal Behaviors
28% Workforce on night or rotating shifts

3. Age and Sleep Disorders

4. Traditional classification of sleep disorders
Dyssomnias: They are associated with difficulty initiating or maintaining the sleep or daytime sleepiness.
Parasomnias: Abnormal behavioral or physiological events occurring during sleep but don’t involve the sleep mechanisms.

5. 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 disease

6. 4 x Disorders to be examined:
Sleep Disorders
Currently, 107 distinct sleep disorders (82 recognized in ICSD2, 25 proposed)
4 x Disorders to be examined:
Sleep Apnea
Insomnia
Narcolepsy
Somnambulism (sleep walking)

7. Dyssomnias

8. Obstructive Sleep Apnea
Repetitive episodes of airway collapse associated with arousals and oxygen desaturation.
Patients have hundreds of events per night.

9. Sleep Apnea – the facts Z Z Z 9-24% Adults Males 3-9% Adult Females
Obstructive 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 Z

10. Problems with Sleep Apnea
Increases the manifestations of other medical and psychiatric disorders:
Heart failure,
Stroke,
Epilepsy,
Depression
Sudden infant death syndrome (SIDS) is sleep apnea

11. Treatments:
Sleeping pills are not perfect—most bind to GABA receptors throughout the brain.
Continued use of sleeping pills:
Makes them ineffective
Produces marked changes in sleep patterns that persist even when not taking the drug
Can lead to drowsiness and memory gaps

12. OSA Treatment Surgery Dental Device Weight Loss Medication
Avoidance of alcohol
Sleep on side

13. Continuous Positive Airway Pressure
Fat bloke
Machine pumping in air
Tube and mask for air supply

14. INSOMNIA
Total 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.

15. I. Insomnias – the facts Prevalence: 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%

16. 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 insomnia
84% pregnant women report insomnia for a few nights each week
Other factors;
Noise (39%)
Giving care to children (20%)
Pets (17%)

17. Other factors causing Insomnia?
Primary insomnia – caused by biological factors
Inadequate sleep hygiene (10%)
Insomnia due to mental disorder (30-40%)
Insomnia due to drug or substance

18. Treatment of Insomnia? Pharmacologic treatment
Treating the medical or psychiatric conditions
Nonpharmacologic:
behavioral treatments: normalizing the circadian rhythm
sleep hygiene
cognitive behavior therapy
sleep restriction therapy

19. Prescribed Anti-depressants 12%
Prescribed Sleep medication 3%

20. Pharmacologic treatment
Benzodiazepines
Selective GABA drugs
Melatonin receptor sensitising drugs

21. Problems with insomnia research?

22. 3. Circadian rhythm disorders – a circadian rhythm is a body rhythm which occurs once in a 24 hour period e.g. sleep- wake cycle
A normal sleep pattern would be 5 cycles of the of the sleep stages
If the sleep-wake cycle is affected then it disrupts our body clock
E.g. shift workers
But this disorder can occur when there is seemingly no reason
Use of bright lights at certain times can help to reset the body clock & thus the sleep-wake cycle is restored

23. Parasomnias

24. Narcolepsy
SYMPTOMS:
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.

25. 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.

26. 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.

27. SLEEP PARALYSIS
Sleep 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.

28. Qu. When do people get the most incidents of sleep paralysis?
Changing sleeping position reduces sleep paralysis

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

30. (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)

31. Critique of Sleep Studies?
Labor intensive
Require technologists to attend patient all night
Technologist must score and summarize the physiology for the recording