2. Occupies 1/3 of our Lives (3,000 hrs /year) Necessary for Physical and Mental Health $50 Billion / Year in Lost Productivity Occupies 1/3 of our Lives (3,000 hrs /year) Necessary for Physical and Mental Health $50 Billion / Year in Lost Productivity

3. n Amount Varies u By Persons u By Age n Problems are Common n Can Become Chronic n Amount Varies u By Persons u By Age n Problems are Common n Can Become Chronic

5.  Biological State  Two Major Periods u NREM Non-Rapid Eye Movement u REM Rapid Eye Movement  Two Major Periods u NREM Non-Rapid Eye Movement u REM Rapid Eye Movement

6.  Actigraph  Sleep efficiency  Polysomnographic (PSG) Evaluation  Actigraph  Sleep efficiency  Polysomnographic (PSG) Evaluation u Detailed history u Electrooculograph (EOG) u Electroencephalograph (EEG) u Electrocardiogram (EKG) u Electromyograph (EMG) u Detailed history u Electrooculograph (EOG) u Electroencephalograph (EEG) u Electrocardiogram (EKG) u Electromyograph (EMG)

7. Compensation & Rebound

8. n Dyssomnias u Difficulties Getting Enough Sleep u Amount, Quality, Timing n Parasomnias u Abnormal Behavior During Sleep n Dyssomnias u Difficulties Getting Enough Sleep u Amount, Quality, Timing n Parasomnias u Abnormal Behavior During Sleep  Two Major Categories

9. n I have difficulty falling asleep n Thoughts race through my mind and prevent me from getting to sleep n I anticipate a problem with sleep several times a week n I often wake up and have trouble going back to sleep

10. n I worry about things and have trouble relaxing n I wake up earlier in the morning than I would like to n I lie awake for a half an hour or more before I fall asleep n I often feel sad or depressed because I can’t sleep n I worry about things and have trouble relaxing n I wake up earlier in the morning than I would like to n I lie awake for a half an hour or more before I fall asleep n I often feel sad or depressed because I can’t sleep

11. n ADD ALL TRUES n SCORE > 3, you have symptoms of INSOMNIA n INSOMNIA is a persistent inability to fall asleep or stay asleep n ADD ALL TRUES n SCORE > 3, you have symptoms of INSOMNIA n INSOMNIA is a persistent inability to fall asleep or stay asleep

12. n Most Common Sleep Disorder u Trouble Initiating Sleep u Trouble Maintaining Sleep u Have Nonrestorative Sleep n Most Common Sleep Disorder u Trouble Initiating Sleep u Trouble Maintaining Sleep u Have Nonrestorative Sleep  “Primary” Insomnia

13.  Primary Insomnia n Facts and Statistics u Common (1/3 Population) u 17% Have it in Severe Form u Females Report Problem > Males u Common in Older Populations n Facts and Statistics u Common (1/3 Population) u 17% Have it in Severe Form u Females Report Problem > Males u Common in Older Populations

14.  Primary Insomnia n Causes u Higher Body Temperature u Drug Use and Poor Sleep Hygiene u Unrealistic Views About Sleep u Stress and Trying to Sleep u Use of Sleep Medications n Causes u Higher Body Temperature u Drug Use and Poor Sleep Hygiene u Unrealistic Views About Sleep u Stress and Trying to Sleep u Use of Sleep Medications

16.  Hypersomnolence Disorder n Problem of Sleeping Too Much u Excessive Sleepiness u Person Experiences it as a Problem u Appear to Have Enough Sleep u Little is Known About Causes u Appears to Run in Families n Problem of Sleeping Too Much u Excessive Sleepiness u Person Experiences it as a Problem u Appear to Have Enough Sleep u Little is Known About Causes u Appears to Run in Families

17.  Narcolepsy n The “Sleep Attack” u Excessive Sleepiness & Cataplexy – Triggered by Strong Emotion – Go Right Into REM u Sleep Paralysis u Hypnagogic Hallucinations n The “Sleep Attack” u Excessive Sleepiness & Cataplexy – Triggered by Strong Emotion – Go Right Into REM u Sleep Paralysis u Hypnagogic Hallucinations

18.  Narcolepsy n Facts and Statistics u Rare Condition: Prevalence =.03% to.16% u Affects Males and Females Equally u Often Begins in Adolescence u Seems to Improve Over Time u Behavior Also Seen in Dogs n Facts and Statistics u Rare Condition: Prevalence =.03% to.16% u Affects Males and Females Equally u Often Begins in Adolescence u Seems to Improve Over Time u Behavior Also Seen in Dogs

19.  Breathing-Related Sleep Disorders n Sleep Apnea u Breathing is Constrained or Ceases u Snoring and Night Sweats u Person Often Unaware of Problem u Several Types of Sleep Apnea n Sleep Apnea u Breathing is Constrained or Ceases u Snoring and Night Sweats u Person Often Unaware of Problem u Several Types of Sleep Apnea

20.  Breathing-Related Sleep Disorders n Types Sleep Apnea u Obstructive (OSA) – Airflow Stops; Related to Obesity u Central (CSA) – Cessation of Respiratory Activity u Sleep-related hypoventilation n Types Sleep Apnea u Obstructive (OSA) – Airflow Stops; Related to Obesity u Central (CSA) – Cessation of Respiratory Activity u Sleep-related hypoventilation

21.  Circadian Rhythm Sleep Disorders n Problem With Circadian Clock u Disturbed Sleep – Insomnia or Excessive Sleepiness u The Biological Clock – Suprachiasmatic Nucleus – Melatonin May Help Set the Clock u Jet Lag & Shift Work Types n Problem With Circadian Clock u Disturbed Sleep – Insomnia or Excessive Sleepiness u The Biological Clock – Suprachiasmatic Nucleus – Melatonin May Help Set the Clock u Jet Lag & Shift Work Types

22.  Statistics  Obstructive sleep apnea = 10-20%  Female < Male  Associated with  Obesity  Increasing age

23. n Medical Treatments n Prescription and Over-the-Counter – Poor Sleep: – Hypersomnia & Narcolepsy: Stimulants (e.g., Ritalin) u Breathing-Related Disorders – Medications and Devices n Medical Treatments n Prescription and Over-the-Counter – Poor Sleep: – Hypersomnia & Narcolepsy: Stimulants (e.g., Ritalin) u Breathing-Related Disorders – Medications and Devices

24. n Cognitive-Behavioral Treatments u Modifying Timing of Sleep – moving bedtime earlier or later u Improving Sleep Hygiene u Addressing Beliefs About Sleep u Stress and Relaxation Training n Cognitive-Behavioral Treatments u Modifying Timing of Sleep – moving bedtime earlier or later u Improving Sleep Hygiene u Addressing Beliefs About Sleep u Stress and Relaxation Training

25. n Sleep Hygiene u Exercise u Don’t F Sleep u Don’t Force Sleep u 15 Minute Limit Getting to Sleep u Avoid Naps u Optimal Sleep Conditions u No Snacking u Avoid Alcohol & Stimulants u Set Wake-Up Time u Relax Before Bed u Bed = Sleep n Sleep Hygiene u Exercise u Don’t F Sleep u Don’t Force Sleep u 15 Minute Limit Getting to Sleep u Avoid Naps u Optimal Sleep Conditions u No Snacking u Avoid Alcohol & Stimulants u Set Wake-Up Time u Relax Before Bed u Bed = Sleep

26. n During REM u Nightmares n During NREM u Sleep Terrors u Sleep Walking (somnambulism) n During REM u Nightmares n During NREM u Sleep Terrors u Sleep Walking (somnambulism)  Two Main Types

27.  REM sleep  Involves dreams:  Distressing & disturbing  Disrupt sleep, cause awakening  Interfere with functioning  More common in children  Treatment  Antidepressants  Relaxation training

28.  More common in children  Piercing scream  Signs of elevated arousal (e.g., sweating)  Person looks extremely upset  Difficult to awaken  Little memory of the event  Prevalence  Children 6%  Adults 2%  More boys than girls  Treatment  “Wait-and-see” posture  Scheduled awakenings

29.  Somnambulism  Non-REM sleep  Usually during first few hours of deep sleep  Person must leave the bed  More common in children 15-30%  Difficult (not dangerous) to wake  Related Conditions  Sexomnia  Nocturnal eating syndrome  Person eats while asleep